AUSTIN — The group of 40 people gathered at a popular burger and fish taco restaurant in San Antonio listened eagerly to the latest news about the anti-vaccine fight taking place in the Texas legislature.
Some mothers in the group had stopped immunizing their young children because of doubts about vaccine safety. Heads nodded as the woman giving the statehouse update warned that vaccine advocates wanted to “chip away” at parents’ right to choose. But she also had encouraging news.
“We have 30 champions in that statehouse,” boasted Jackie Schlegel, executive director of Texans for Vaccine Choice. “Last session, we had two.”
Now they also have one in the White House.
President Trump’s embrace of discredited theories linking vaccines to autism has energized the anti-vaccine movement. Once fringe, the movement is becoming more popular, raising doubts about basic childhood health care among politically and geographically diverse groups.
Public health experts warn that this growing movement is threatening one of the most successful medical innovations of modern times. Globally, vaccines prevent the deaths of about 2.5 million children every year, but deadly diseases such as measles and whooping cough still circulate in populations where enough people are unvaccinated.
Here in San Antonio, 80 miles southwest of the state capital, Texans for Vaccine Choice convened a happy hour to encourage attendees to get more involved politically. The event was among dozens of outreach events the group has hosted across the state. The relatively new group has boosted its profile, aided by a savvy social-media strategy, and now leads a contentious fight over vaccines that is gearing up in the current legislative session.
The battle comes at a time when increasing numbers of Texas parents are choosing not to immunize their children because of “personal beliefs.” Measles was eliminated in the United States more than 15 years ago, but the highly contagious disease has made a return in recent years, including in Texas, in part because of parents refusing to vaccinate their children. A 2013 outbreak in Texasinfected 21 people, many of them unvaccinated children.
The modern anti-vaccine movement is based on a fraud. A study published almost 20 years ago purported to show a link between childhood vaccines and autism. The data was later found to be falsified, and the study was retracted.
Scores of large-scale, long-term studies from around the world since then have proved that there is no connection between vaccines and autism. But the suspicion lingers. Its strongest form is a stubborn conspiracy theory that doctors, scientists, federal health agencies, vaccine-makers and the worldwide public health community are hiding the truth and are knowingly harming children.
A leading conspiracy theorist is Andrew Wakefield, author of the 1998 study that needlessly triggered the first fears. (The medical journal BMJ, in a 2011 review of the debacle, described the paper as “fatally flawed both scientifically and ethically.”) Wakefield’s Twitter handle identifies him as a doctor, but his medical license has been revoked. The British native now lives in Austin, where he is active in the state and national anti-vaccine movement.
Trump has met with Wakefield, who attended an inaugural ball and told supporters afterward that he had received “tremendous support” for his efforts and hoped to have more meetings with the president.
Peter Hotez, director of the Texas Children’s Hospital Center for Vaccine Development, predicts that 2017 could be the year the anti-vaccination movement gains ascendancy in the United States. Texas could lead the way, he said, because some public schools are dangerously close to the threshold at which measles outbreaks can be expected. A third of students at some private schools are unvaccinated.
“We’re losing the battle,” Hotez said.
Although the anti-vaccine movement has been strong in other states, including California, Oregon, Washington and Colorado, experts say the effort in Texas is among the most organized and politically active.
“It’s a great example of an issue that has a targeted, small minority but an intense minority who are willing to mobilize and engage in direct action,” said Mark Jones, a political science professor at Rice University in Houston.
The vast majority of parents in Texas and across the country vaccinate their children. Most people have never had to think much about this basic preventive-medicine practice.
But now immunization advocates are realizing that they can’t let vaccine critics go unchallenged, saying they need voices other than scientists and experts to make the case. They are recruiting teachers and grass-roots groups to explain how immunization protects families and communities.
Jinny Suh, 39, runs one such group, Immunize Texas , from her Austin home, where she lives with her husband and two young sons. Their house is about three miles from the Austin Waldorf School, a private school where 158 students — more than 40 percent of the school population — are unvaccinated, and tuition costs more than $14,000 a year.
Suh worries about the risk that the school’s unvaccinated children pose to her 4-month-old, who is too young to be immunized. “I’m sure there are people I go to the grocery store with and go to the park with” who have unimmunized children, she said. “This is a public hazard. You can’t see germs.”
Those who oppose vaccination are driven by fear, even though it is misguided, and that fear drives passion, she said. But parents who support vaccination “need to step up our passion and speak up for science — and for children,” she said.
States set their own day-care and school vaccination requirements. Students in Texas are required to receive seven vaccinations before they attend school, unless their families file an exemption.
In Texas, the number of school-age children who are not vaccinated has soared since 2003, when the state expanded its exemption criteria to include reasons of conscience. Personal-belief exemptions increased from 2,314 in the 2003-2004 school year to 44,716 in 2015-2016.
Overall statewide vaccination rates remain high — over 98 percent. But in some parts of Texas, vaccine coverage is slipping below the 90 to 95 percent level that experts say is needed to prevent an outbreak. Many private schools, including in the Austin area, have the highest rates of unvaccinated children, exceeding 20 percent.
Wakefield has stoked parents’ unfounded fears about vaccines, even though his study was withdrawn and Britain’s General Medical Council stripped him of his medical license in 2010. In a brief phone interview, Wakefield said he had not spoken to Trump since last summer. He declined to say how he was invited to an inaugural ball. “Better to say nothing at this stage,” he said. Wakefield said he was heading to Europe to promote “Vaxxed,” the movie he directed and co-wrote in which he defends the debunked link between the measles, mumps and rubella vaccine and autism. Texans for Vaccine Choice has sponsored showings of the film and promotes it on its Facebook page.
One part of the anti-vaccine movement’s message is that vaccine-preventable diseases aren’t dangerous if people get modern medical care. But that’s a myth, and the failure to vaccinate can be catastrophic.
Texas health data shows a steady uptick in diseases such as pertussis and mumps in recent years. A recent mumps outbreak in Johnson County, southwest of Dallas, sickened at least 167 people, mostly students. In 2013, Texas experienced the largest outbreak of whooping cough, or pertussis, since 1959: nearly 4,000 cases. Five newborns who were too young to be vaccinated died.
Although anti-vaccine groups are gaining momentum in Texas, other states have shown that they can be fought. In 2015, California passed one of the strictest vaccine requirement laws in the country, mandating that almost all schoolchildren be fully vaccinated to go school. Exemptions are allowed only for documented medical conditions. The law was sparked by a 2014-2015 measles outbreak that started at Disneyland in California, where a single unvaccinated child with measles led to the infections of 131 people.
A Texas lawmaker tried to pass a similar bill during the legislative session in 2015. (Texas’s legislature meets every other year.) “It was clear common sense,” recalled Republican Rep. Jason Villalba, a Dallas lawyer. Mumps was resurgent in the state, including in his district, and his youngest child wasn’t old enough to be immunized.
The bill never made it out of committee. But it sparked a huge reaction and was the reason Schlegel and about 20 other mothers formed Texans for Vaccine Choice. The group claimed “that I was a mad scientist, stripping liberties from parents,” Villalba recalled.
He says Texas lawmakers are not likely to pass any legislation that could be viewed as government intrusion into parents’ rights. He is not planning to take up the fight against nonmedical exemptions again — unless there is a measles outbreak.
In the current legislative session, no bills have been filed to eliminate the personal-belief exemptions. In fact, vaccine opponents have introduced a bill to simplify the exemption process.
But pro-vaccine advocates are expected to try to change the law and give parents the right to know the number of unimmunized children at individual schools, information that’s not readily available now.
One bill already introduced would require parents to complete an online education course before seeking a vaccine exemption. Another would make it easier for teenagers to get vaccinated against cancer-causing human papillomavirus (HPV).
The bills’ sponsor, Republican Rep. Sarah Davis, a Houston lawyer whose district is home to some of Texas’s most well-known hospitals, said the bills are common-sense legislation that would better protect children.
“The more active the anti-vaxxers have become, the more that other members start to question whether vaccines are controversial, and most legislators are not wanting to make waves,” she said.
People on both sides of the vaccine issue are lobbying lawmakers and their staffs, and activity is sure to intensify before the session, which began Jan. 10, ends in May.
Vaccines aren’t a standard conservative or liberal issue. In many parts of the country, pockets of unimmunized children tend to be in white, upper-middle-class neighborhoods, including in Austin, said Anna Dragsbaek, who heads the Immunization Partnership, a Houston-based immunization advocacy group.
One particularly strong strain of anti-vaccine rhetoric in Texas is libertarian and anti-government. Texans for Vaccine Choice receives help and expertise from “friendly” lawmakers and groups such as Empower Texans, said Jonathan Stickland, a tea party Republican representative from Tarrant County and a key supporter. Political experts consider Empower Texans the state’s most sophisticated and influential conservative organization.
“Our message resonates with people,” said Schlegel, 37, in a brief interview after a day of meetings at the Capitol. “Texans value parental rights,” she said. “We have a message of liberty. We have a message of choice.”
Schlegel has an assistant who helps coordinate her schedule. The group has a director of state policy. Its Facebook page posts regular updates on Schlegel’s meetings with lawmakers. The group hands out sophisticated, glossy materials — in red, white and blue — to lawmakers.
The packets, with business cards tucked inside, lay out the group’s positions, the bills it supports and the ones it opposes. One leaflet describes “the lack of safety testing” and “questionable ingredients” in vaccines. (To be clear, vaccines and their ingredients are some of the most carefully tested medical interventions in history.) Another calls the current recommended schedule of vaccines “one of the most aggressive and bloated of ANY other nation on the planet.”
When the group recently sought volunteers on Facebook for “engagement days” at the state Capitol this month and in March, one woman said she wanted to help but was concerned she didn’t know enough about vaccines. Don’t worry, she was told. “Very little talk about vaccines and a LOT of talk about parental rights and CHOICE.”
The American Academy of Pediatrics and 350 other medical, professional and advocacy groups recently wrote a letter to Trump expressing “unequivocal support” for vaccines’ safety and endorsing the recommended schedule. The letter has links to more than 40 major studies on safety and effectiveness.
But immunization advocates like Suh say it’s hard to counter the passion of her opponents. Most people consider vaccinations to be such a basic part of life, like clean drinking water, that it’s hard to motivate them to take time to show up at lawmakers’ offices.
“We’re completely outgunned,” said Suh, who says there are only about a dozen members whom she can call on to show up for events. Immunize Texas is part of the Immunization Project.
Suh often writes emails and posts to the group’s Facebook account from her cellphone while caring for her two sons. She juggles her immunization advocacy, a mostly volunteer gig, with other businesses she runs from home.
To present herself and other mothers as the face of vaccine advocates, she and Jessica Cleary-Kemp, seven months pregnant and mother of a 13-year-old and a 2-year-old, met recently with several lawmakers. One was J.D. Sheffield, a Republican state representative who sought during the last session to require individual schools to provide immunization exemption data.
Suh jiggled her son on her lap while Cleary’s son played a game on an iPad. It’s not yet clear whether Sheffield or another lawmaker will introduce the bill this session. But they all agreed it will be a controversial issue.
To help get their social-media message out, Suh may need to redo the logo for the group’s website. Buttons and T-shirts are another idea. But first, she needs to be better prepared for the next face-to-face meetings.
“People kept asking for business cards,” she said. “So we need to get some.”
Alice Crites contributed to this report from Washington, and Eva Ruth Moravec contributed from San Antonio.
Disclosure: Rice University has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.
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