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Walter Orenstein: Vaccine Fears Threaten Progress Against Disease

AAAS Fellow Walter Orenstein. Credit: Emory University

AAAS Fellow Walter Orenstein was in 2nd grade when the first polio vaccine became available in 1955.

“I was none too thrilled about getting a shot for something I knew nothing about,” Orenstein, now a former head of the CDC’s National Immunization Program, recalls. “But my mother said to me, ‘Better you should cry than I should cry.’ That’s how fearful polio was.”

So, he lined up with the other kids at his school to get the Salk vaccine, which was the beginning of the end to a disease that had been killing or paralyzing nearly 20,000 Americans a year.

Six decades later, Orenstein is advising a campaign that’s on the verge of eradicating polio in its last remote holdouts overseas. He’s also fighting a rising tide of anti-vaccine sentiment at home in the United States, warning that misinformation and mistrust of childhood immunizations risks rolling back life-saving advances.  

“A vaccine that remains in a vial is zero percent effective, no matter what the results of the clinical trial were,” said Orenstein.  

A pediatrician by training, Orenstein went to New York’s City College and got his medical degree at Albert Einstein College of Medicine. In 1974, he took a two-year post at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

The CDC assigned him to its immunization division. Because he “wanted to see the world,” he volunteered to go to India to help out the drive to eradicate smallpox – an ancient killer that claimed millions of lives well into the 20th century.

The experience “changed my life,” he said. “I saw this disease with about a 30 percent case fatality rate disappear before my eyes with a vaccine. That’s when I had the desire to become a vaccinologist.”

After that temporary stint at the CDC, he went on to study infectious diseases. In 1980, as the World Health Organization (WHO) declared smallpox eradicated, he returned to the CDC and soon found himself working to fight measles.

Measles moves too quickly to fight the same way doctors fought smallpox – isolating people with the disease, vaccinating anyone they may have exposed, then vaccinating people those contacts may have exposed. Authorities shifted gears, pushing for laws that required schoolchildren to get vaccinated and breaking down barriers that kept poor children from getting their shots. Orenstein, who became head of the CDC’s National Immunization Program in 1993, saw CDC declare the measles eradicated in the United States in 2000.

Another event that he remembers is less positive when the public health world was rocked by a 1998 study that asserted a link between autism and the measles-mumps-rubella vaccine given to infants.

“[Orenstein] had to deal with that as head of the National Immunization Program, and he dealt with it with grace,” said Paul Offit, the head of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a longtime friend. “He helped steer through a very difficult time in the vaccine world.”

But while the vaccine-autism study was retracted, declared a fraud, and its author stripped of his medical license, “the damage is done,” Orenstein said. The retracted study sparked a movement against vaccinations that has led to numerous parents refusing shots for their children. And that’s led to a comeback for measles, where doctors are now fighting the biggest U.S. outbreak in 25 years, and the WHO declared “vaccine hesitancy” a top 10 health threat.

While Orenstein left the CDC in 2004 for a post at Emory University, he and his colleagues are still trying to figure out how to counter the anti-vaccination movement by communicating facts about vaccine safety through trusted channels.

 “What we found internationally was getting people from the community involved, as opposed to people coming in from outside, can have more impact than simply strangers coming in and telling you to get vaccinated…simply countering the myths may not work and can backfire.”

Parents are likely to trust their own doctors, so Orenstein said those physicians should be equipped with the latest information to reassure them. Taking what he called a presumptive approach Johnny will get vaccines A, B and C today, do you have any questions?” produces better results than asking parents which shots they want their children to get, he said. Allowing fewer exemptions to vaccinations for school enrollment brings up immunization rates as well.

Data on vaccine safety is publicly available and shows the benefits “far, far outweigh any risks,” he said. But he added, “You don’t need a randomized double-blind, placebo-controlled study to know that parachutes are good for you if you’re jumping from an airplane.”

Orenstein is also still in the fight against polio, the disease that prompted his own bout of vaccine hesitancy when he was young. In 2008, he took a three-year break from Emory to work for the Global Health Program at the Bill and Melinda Gates Foundation to help lead that charity’s fight to eradicate polio. The disease has been reduced to fewer than three dozen cases in 2018, all in Afghanistan and Pakistan, and Orenstein still advises the campaign.

“We have certainly made progress and hope to finish the job in the next few years,” Orenstein said. But as in Western countries, he said, the fact remains that a vaccine that stays on the shelf doesn’t do anyone any good.