The advertisements plastered across city bus stops and flooding television airwaves across Maine make a simple plea to voters: “Reject Big Pharma” by voting yes on a state-wide initiative.
But the referendum that Maine voters will decide on Tuesday, known as Question 1, has little to do with drug prices. Instead, approval would overturn a 2019 law that requires all schoolchildren to receive vaccinations unless granted an exemption by a doctor. The advertisements, meanwhile, are funded in large part not by drug pricing activists but by a nationwide network of anti-vaccine groups.
The media blitz marks a new effort by anti-vaccine activists to win new adherents, and to do so by co-opting public anger toward pharmaceutical companies — not just over exorbitant drug prices but because of the industry’s role in the opioid crisis, which has hit Maine hard.
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If the effort to overturn the mandate is successful, public health advocates fear the momentum could bleed across state lines and jeopardize other recent efforts to ban non-medical vaccine exemptions. It would be the first instance in which a state’s effort to broaden vaccine mandates was overturned by the popular vote.
“I’m not sure why they decided to go with ‘Big Pharma,’” said Dorit Reiss, a professor at the University of California’s Hastings College of the Law known for her work on vaccine policy issues. “They usually aren’t quite as blunt — but they don’t have a lot of other good slogans.”
Public health advocates, however, have fueled skepticism in recent weeks by enlisting large drug manufacturers in their fight to preserve the immunization law. Collectively, the Biotechnology Innovation Organization, Pfizer, and Merck — two of the companies that Maine vaccine skeptics have targeted — have contributed nearly $600,000 to a committee opposing the ballot initiative, known as “Maine Street Solutions — Protect Schools.”
The committee’s principal officer, the veteran Maine political operative Bobby Reynolds, said he actively sought the pharmaceutical companies’ contributions. The repeal effort is a “danger to Maine children,” he said in a statement. “We make no excuses for protecting kids.”
Maine’s new immunization law is less than a year old. It is relatively simple: It forbids parents from citing “religious” or “philosophical” beliefs if they seek an exemption from requirements to vaccinate their children. Under the new policy, unvaccinated children can only attend school if they have received a medical waiver from a physician, physician assistant, or nurse practitioner.
The advocacy coalition that sprang up to try to block the legislation almost instantly shifted its sights once the bill passed. Its new goal: a statewide referendum to repeal the bill by popular vote.
The referendum advocacy is far more centered on pharma-bashing than any of the coalition’s earlier efforts. And it isn’t specific to the “Reject Big Pharma” television advertisements.
At widely attended rallies and press events, advocates spearheading the “Reject Big Pharma” initiative are focusing their energy less on the nuances of vaccine policy than on voters’ more general distaste for drug companies. Last week, Cara Sacks, the committee’s chair, cast the effort as “upholding medical freedom in the face of Big Pharma’s sinister attacks.”
A recent ad barrage from the group zeroes in on Merck, highlighting the roughly $6 billion in revenue the company drew from vaccines during the first nine months of last year. While vaccine sales total billions of dollars, however, pharmaceutical companies’ vaccine profit margins are typically far smaller than for other drugs.
Nonetheless, the messaging has helped to generate a broad coalition of support for repealing the vaccine mandate. Backers of the repeal include five Republican state lawmakers, a University of Maine professor, and at least 11 local chiropractors.
But the group’s biggest contribution came from half a continent away: a $50,000 check from the Organic Consumers Association, a Minnesota group whose anti-vaccine rhetoric helped fuel a measles outbreak in Minneapolis in 2017.
The groups, collectively, have channeled voters’ deep distrust for drug companies into a grassroots campaign that gathered 79,000 signatures last year to place the “People’s Veto” on the ballot.
The campaign has spent nearly $100,000 on television commercials, and enlisted McShane LLC, a conservative political consultancy in Las Vegas, to help place advertisements, according to campaign finance disclosures. Supporters have also contributed hand-knit scarves, essential oil baskets, and handmade jewelry to support a raffle raising money for the campaign to repeal the vaccination mandate.
Some advocates have made clear that they’re not anti-vaccine, and that they’ve vaccinated themselves and their children as a commonsense health precaution. But leaving the choice to Maine parents, they argue, is paramount.
There remains, in Maine, widespread support for the immunization law itself.
Groups of parents, with the support of nearly every medical organization in the state, formed a ballot committees to keep the law in place, known as the Maine Families for Vaccines PAC, and hired Maine Street Solutions, a local government affairs firm, to spearhead the effort. The Maine Medical Association, Maine Hospital Association, Barbara Bush Children’s Hospital, and the Maine Association of Health Plans, among other groups, quickly joined the coalition.
But when the anti-vaccine advocates refocused the debate onto pharma, they left public health advocates in a bind. Either they could decline help from the pharmaceutical industry and squander a deep pot of funding for ads and educational initiatives, or they could expose themselves to further criticism — however baseless — that immunization policy is driven solely by profit-hungry pharmaceutical companies.
Reynolds, the committee’s principal officer, insisted the choice was obvious.
The committee aiming to preserve the vaccine mandate “appreciates every cent we’ve received from medical groups, the grassroots organization Maine Families for Vaccines, individuals, and the manufacturers of these lifesaving vaccines,” he said.
And when Reynolds sought help from drug manufacturers, they responded quickly.
Sharon Castillo, a Pfizer spokeswoman, echoed Reynolds, saying the company’s $250,000 contribution was an “easy decision.”
“We believe repealing the law could have a negative impact on the health and well-being of Maine’s children,” she said in a statement, “and set a dangerous precedent for disease prevention nationwide.”
But outside vaccine advocates have fretted that the public health campaign would be more effective without the burden of pharmaceutical industry support.
Rachel Alter, a medical student and prominent vaccine advocate, said she did not expect drug companies to give away vaccines for free, and that she welcomed their support for local public health initiatives. But she worried that high-profile forays into vaccine politics by Pfizer, Merck, and the drug industry more broadly — however well-intentioned — could backfire.
“Engaging in debate may make it look like they are influenced solely by capitalism and not by evidence-based practices,” she said. “I really don’t think they should be taking a public role in promoting vaccines at all.”
Vaccination laws have entered the spotlight in recent years as immunization rates have dipped in communities across the country. In recent years, groups including the Organic Consumers Association launched a disinformation campaign targeting the Somali-American community in Minneapolis, promoting the debunked claim that vaccines are linked with autism. Vaccination rates in the community quickly fell, and Minnesota suffered its worst measles outbreak in three decades, recording dozens of confirmed cases.
More recently, anti-vaccine groups targeted ultra-Orthodox Jewish communities in New York, causing a similar dip in immunization rates — and a familiar series of clustered measles outbreaks.
In response, states have taken action to dramatically limit parent’s ability to seek exemptions from vaccine requirements for personal or religious reasons. In California, a landmark law similar to Maine’s removed “personal belief” as appropriate grounds for a vaccine exemption.
Janet Mills, Maine’s Democratic governor, argued in a recent radio address that the state ranks seventh among the 50 states in non-medical opt-outs. In 2018, the state’s whooping cough rate was the nation’s highest.
By broad scientific consensus, vaccines are credited with eradicating diseases like polio in developed countries, and diseases like smallpox globally.
But skepticism over vaccines’ safety and efficacy persists, fueled by very rare instances in which individuals suffer allergic reactions. Advocates opposed to vaccination requirements often cite the National Vaccine Injury Compensation Fund, a federal program that provides financial compensation in those rare situations. For every million doses of vaccines delivered in the U.S., the program reports having paid out roughly one claim.
Public health officials have long held that the minuscule chance of a vaccine-related adverse event is dramatically smaller than the public health impact of declining to be vaccinated for disease like the flu, which still kills tens of thousands of Americans per year.
It is common for anti-vaccine activism to center on mistrust for drug companies, said Reiss, the UC Hastings professor. But the Maine effort’s explicit “Reject Big Pharma” focus goes further than normal.
“The reality is that they have a limited number of arguments they can make,” Reiss said. “The ‘Big Pharma’ argument is not horrible, in the sense that most of us don’t trust Big Pharma and we have good reason not to. The problem is that it’s not just Big Pharma behind the vaccine mandate.”
Despite the broad public health consensus about the benefits of mandating vaccinations, the issue in Maine has become starkly partisan.
When Maine’s legislature passed the law last year, nearly every Democrat supported the legislation, while all but four Republicans opposed it.
Mills, the state’s Democratic governor, has devoted two consecutive weekly radio addresses to touting the law’s benefits and urging Mainers to vote against its repeal. In one, she cited the ongoing coronavirus outbreak as a reason to remain vigilant in guarding against infectious disease, and accused the initiative’s backers of conflating vaccinations with issues like the opioid crisis, the Portland Press-Herald reported. The state’s Democratic Party has also publicly urged voters to vote “no.”
Five Republican lawmakers, all of whom voted against the legislation, contributed to the campaign to repeal it. One is Rep. John Andrews, whose wife is a physician and who has vaccinated his children, he said in an interview. But he wrote a $100 check to the committee “to reject Big Pharma,” he said, to preserve choices for Maine parents.
Jason Levesque, the GOP mayor of Auburn, Maine, also donated to the committee. And in a Facebook ad, the Republican Party chapter in York County, just north of the state’s border with New Hampshire, urged voters to “reject Big Pharma’s attempt to sell us the same bill of goods about the safety and efficacy of all vaccines for all of us that they sold us about opioid medications.”
The Maine Republican Party did not respond to STAT’s request for comment.
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