How to respond to the anti-vaccination movement

Apparently the anti-vaccination movement is not a new phenomenon. From historyofvaccines.org.

For the last few years, the medical community has been warning us about the public health threat posed by the increasing number of parents who, out of misguided fear of (nonexistent) side effects, refuse to have their children vaccinated. Now, apparently, their warnings have come true: There is now an outbreak of measles in the United States. The public reaction to this has been very well-justified and entirely predictable outrage. There is now a proliferation of articles responding to the anti-vaccination crowd. Many take a tone that is frustrated, if not outright angry. For the record, these articles are absolutely correct. If you have kids, you should vaccinate them. To not do so is to not only to risk their lives, but also to put at risk countless other people who for one reason or another cannot be vaccinated.

That being said, however, I don’t think we, the pro-science public, are responding to this in exactly the right way. It’s perfectly understandable to be outraged by people whose ignorance causes them put others, including their own children, at risk. And it is very tempting to mock these people. But what exactly does mockery accomplish, beyond proving our own intellectual and moral superiority? In this post, I start from the premise that the goal of our response to the vaccination crisis should be to convince as many people as possible to vaccinate their children. Mockery and outrage at the actions of the anti-vaxxers are likely to have exactly the opposite effect, by pushing them further away from the medical establishment, creating an insular community that could jeopardize public health for generations to come.

An alternative to mockery is to simply provide good scientific information about vaccines, in order to counter the myths about them. But this approach also has its problems. The deficit model of science communication has some very serious problems. Anti-vaxxers already have plenty of access to scientific information about vaccines, and they might well have read more of it than you have. The problem is not that they don’t have the information, but that they don’t trust it.

The last strategy you see a lot of is harsh moral condemnation. “Your actions are jeopardising thousands of children!” is the rough message you hear from some in the pro-vaccine camp. The thing is that we have tried this strategy with climate change, and it doesn’t work too well either. When confronted with the absolute worst consequences of their actions, people often go into a reflexive state of denial. Disaster narratives are good for attracting attention, and not much else.

So what we really need to ask ourselves is this: Why has a large group of people living in prosperous first-world countries chosen to reject the institutions of modern medicine? Why is there such a deficit of trust? And how can we address it and get these people to trust doctors and public health professionals once more? Curious about these questions, I had a look at two anti-vaccination Facebook groups to see what kinds of narratives they use to justify themselves. Here are a few revealing quotes:

“…vaccines are a method of population reduction. So is “health care,” which more and more people are becoming aware is more of a “sick care” system that actually harms more people than it helps. Perhaps that’s the whole point of it. Given that vaccines technology help almost no one from a scientific point of view it raises the question: For what purpose are vaccines being so heavily pushed in the first place? Bill Gates seems to be saying that one of the primary purposes is to reduce the global population as a mechanism by which we can reduce CO2 emissions.”

[Responding to a walking dead meme about vaccines] “These idiots obviously have not seen zombie movies. Have they considered that it may be a vaccine that caused the apocalypse in the universe of The Walking Dead, just like other movies where doctors come up with cures for cancer only to result in a global catastrophe.”

“Easy to blame others than actually realise your government lie to you over vaccines.”

What these quotes reveal is not just a basic distrust in vaccines or even medicine, but also in experts more generally. They are appealing to the classic cultural myth of the incompetent or malevolent experts. This story appears not just in conspiracy theories, but also in perfectly mainstream pop culture. How many movies have you seen in which government or scientific authorities who the public trusts to resolve a crisis, instead make the situation worse, either through incompetence or recklessness. Virtually every zombie movie I’ve ever watched comes to mind, as do most other movies about global calamity. We like this story. And so it shouldn’t be too surprising when some people try to look for examples of it in the real world.

This story has, in fact, been played out in the real world. We live in a technocracy, where our everyday lives are increasingly governed by experts. That’s just part of the price we pay for living in a society with nice things like international transportation systems, mass-production of consumer goods, and, yes, vaccines. But these experts are people, and sometimes they screw up. Even worse: Sometimes they get themselves tangled up in self-reinforcing institutions that perpetuate the screwing up almost constantly. We saw a lot of this during the 1960s and 1970s. Much of the early environmental movement was a reaction to this. The government response to the crisis at Love Canal, for example, was completely incompetent.

We still see this kind of thing today, often from the medical community. Doctors are notorious for taking a very paternalistic attitude towards their patients, in which they know best and the patient should just listen. I once had a very frustrating conversation with a doctor about whether or not I should come off a course of medication I was on. The medicine seemed to have done its job, and I was aware that the only risk from coming off it was a relapse of the fairly minor condition that I had taken it to prevent. The medication, meanwhile, had major side-effects and restrictions on what I could do in my day-to-day life. So I wanted an honest appraisal of my chances of relapse, so that I could weigh that against the inconvenience of continuing to take the drug. But all I could get out of the doctor was “You shouldn’t stop taking it. You could have a relapse”. While it is probably just a minority of doctors who act like this, there are enough of them that the profession’s reputation has suffered a little bit.

Distrust of experts, and of the products they oversee, is not just limited to fringe groups like the anti-vaccination movement, either. How do you feel about adding monosodium glutamate to your food? Because it turns out that it’s actually completely safe. So is the artificial sweetener aspartame, though I personally have been distrustful of it in the past. Nobody completely trusts the collection scientific and technological institutions that run much of our world, and that is a good thing, because nobody should completely trust any institution. A healthy scepticism is an important element of citizenship. If you don’t have it, then you wind up buying stuff like radium water.

As with most things, however, balance is key. Too much trust in science and medicine allows imperfect experts to get away without any criticism, while too little results in people not vaccinating their children. So how do we ensure that we have a healthy but reasonable culture of critique for our scientific institutions? I can think of two suggestions. Firstly, robust critique of the experts should happen out in the open, and be featured in mainstream and responsible media outlets. That means that people who are hesitant to trust the experts don’t get driven into echo chambers in little-known blogs and facebook groups. The medical establishment and other institutions like it should be critiqued by people who actually understand the science they deal with, and who can separate the genuine concerns from the conspiracy theories. And secondly, experts should be willing to engage with this kind of criticism. Not with ridicule or paternalistic information campaigns, but with a genuine understanding of the concerns people have. Experts should know that they only have that status by public consent, and that that consent is sometimes precarious.

Mocking and shaming anti-vaxxers might do wonders for our egos, but it won’t do much at all for the health of children. If we really want to inoculate society against these kinds of pernicious conspiracy theories, then we have to be willing to really think about where they come from. That might be uncomfortable, but much like vaccinations themselves, the benefits are well worth it.

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