Another week, another dire report from the Centers for Disease Control (CDC) on the historic measles outbreak winding through America. As of May 10, 839 measles cases have been confirmed across 23 states, a hike of 75 cases in the past week alone, according to the agency. There are now more than ten times as many confirmed measles cases in 2019 as there were in 2010, when the highly infectious disease had nearly been wiped out in the United States.

We’ve dedicated significant space to the harm anti-vaccination movements have done to public health, and how social media platforms such as Facebook have made it easier than ever to spread demonstrably false anti-vaccine propaganda. But it’s worth exploring: Just what is it that makes someone a vaccine skeptic or an “anti-vaxxer?”

It’s a fascinating question because some elements of vaccine-skeptical or vaccine-hostile groups have no discernible relationship to each other. There are the conspiracy theorists who believe vaccines are a nefarious government tool, and that inoculation campaigns are hatched by a shadowy cabal of feds and big pharma companies. Anti-vaxxers are found all along the political spectrum—among both right-wing critics of big government dictating what we put in our bodies and anti-corporate liberals who believe vaccines to be a money-seeking scam. I read a tweet from a fellow health reporter this morning who said an anti-vaxxer had emailed her to insist she be (in her eyes more accurately) referred to as an “anti-toxxer” instead.

There’s been some fascinating sociological research looking into what unites (and divides) the varying degrees of anti-vaccination activists. And these kinds of subtleties are important to the broader work of public vaccination campaigns.

“Although many may characterize all individuals who eschew vaccines as ‘anti-vaccine’ or ‘vaccine deniers,’ in reality there is a broad spectrum of individuals who choose not to have themselves or their children vaccinated,” wrote Kent State University’s Tara C. Smith in a 2017 paper. “These range from individuals who are solidly antivaccine, frequently termed ‘vaccine rejectors’ (VRj), to those who may accept or even advocate for most vaccines but have concerns over 1 or more vaccines.”

Smith goes on to expound on a three-pronged taxonomy people who don’t trust one or more vaccine types: Vaccine rejectors, vaccine refusers, and the vaccine hesitant, in descending order of resistance to vaccination. And while the vocal “vaccine rejector” group tends to whip up the most media attention, Smith points out it’s possible the vast majority of of those who question vaccines fall under the latter two cohorts—and those people may still be persuadable by the science.

But that also depends on an effective communication strategy. As multiple studies have shown, yelling, “YOU’RE WRONG!” at avowed anti-vaxxers tends to push people into their entrenched positions. The World Health Organization (WHO) actually has a useful guide on how to approach anti-vaxxers. Some of the main morsels of advice? Know exactly who your audience is (and adjust accordingly), speak respectfully, and direct the issue back to the science while emphasizing everyone’s common goal of protecting our children and preventing human suffering.

Read on for the day’s news.

DIGITAL HEALTH

Grail now has a favored liquid biopsy method. Grail, a startup in the "liquid biopsy" space—i.e., a group of companies attempting to create blood tests to detect cancer earlier—has settled on a pretty critical part of that effort: Choosing the actual method of its cancer testing in two big clinical studies. That winnows three proposed methods down to one called "methylation" the company says can both detect the cancer and sniff out its area of origin. Grail has raised more than $1.6 billion through a massive set of funding rounds. (STAT News)

Livongo touts digital diabetes platform's ROI. Digital health upstart Livongo is highlighting a recent study finding that its Livongo for Diabetes platform saved participants $88 in out-of-pocket health care spending per month compared with patients who didn't use the technology. The study was conducted in collaboration with drug giant (and diabetes specialist) Eli Lilly; Livongo's platform connects diabetes patients with online coaches and communities to nudge them toward behavior changes to control blood sugar, blood pressure, and other chronic conditions.

INDICATIONS

44 states sue drug giants over alleged price fixing. Nearly two dozen major pharmaceutical companies are facing lawsuits from nearly four dozen U.S. states alleging a pattern of price fixing. Attorneys general of 44 states have accused companies including Teva, Novartis unit Sandoz, and others of manipulating the prices of more than 100 generic drugs used to treat everything from cancer to diabetes to arthritis in an anti-competitive scheme. Teva and Novartis, among others, have strongly denied the allegations and vowed to fight them. But the suit, led by the attorney general of Connecticut, specifically names some 15 high-level executives at the various companies under investigation. “We have hard evidence that shows the generic drug industry perpetrated a multibillion dollar fraud on the American people,” said Connecticut AG William Tong in a statement. “We have emails, text messages, telephone records and former company insiders that we believe will prove a multi-year conspiracy to fix prices and divide market share for huge numbers of generic drugs.” (Associated Press)

Pharma companies maintain medicine's highest profit margins. Speaking of drug prices—an Axios analysis of health care industry profits concludes that drug makers continue to maintain the highest profit margins of companies in the medical sector, largely thanks to their carte blanche pricing power. "12 of the most profitable drug companies in Q1 collectively reported more than $29 billion in profits," writes Axios' Bob Herman, adding that "a dozen [health care] companies had net profit margins above 30% in the first quarter [of 2019], 9 of which were pharma firms." (Axios)

THE BIG PICTURE

It's not just the kids these days who text while driving. There's a fair bit of hand-wringing over The Kids These Days driving around while texting on their fancy smartphone doohickeys. But, apparently, The Parents These Days aren't much better. A new survey by Harvard Medical School researchers suggests that more than half of Americans text while driving (even while most of them find that behavior to be dangerous). This is a cross-generational problem and a general social reality: The more phones have become necessities rather than luxuries, the more this kind of behavior grows. (Reuters)

REQUIRED READING

How to Invest During a Trade War, by Rey Mashayekhi

Senior Executives Are Getting Phished More Frequently. Here's an Urgent Tip!!! by Robert Hackett

These Are the U.S. Goods Affected By China Tariffs, by Natasha Bach

How Apple, Facebook, and Oracle Compete for Best Silicon Valley Headquarters, by Adam Lashinsky