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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It’s Time to Leave the Ivory Tower

Valencia’s City of Arts and Sciences; a very striking feature of the city where the conference was held. The architecture is stunning, but public engagement with science requires more than expensive buildings.

Last week, I attended an early career researcher conference in Valencia, Spain. As an historian, I was a bit of an odd duck in a conference fairly dominated by more quantitative methods, but that’s a discussion for another time. Today, I want to address a much more pertinent issue that came up in a roundtable discussion. The roundtable featured four speakers from academia, industry, policy, and politics, who discussed the relationship between our academic discipline and the real world of innovation and innovation policy that exists in business, policy, and politics.

The discussion started out pretty tame. The representatives from the academic, business, and policy spheres each had interesting things to say. To me, the most obvious theme to all their talks was that academics in innovation studies are still in a bit of an ivory tower. There are, apparently very few ways for academic ideas to find their way into business or policy practices. People working in business or policy rarely read academic journals, and while some of these people may have postgraduate training, the theoretical knowledge gained from this is not always relevant to their day-to-day work.

These ideas however, they were somewhat overshadowed by the speech delivered by David Hammerstein, a Green Party activist who was invited to represent the political sphere. Hammerstein wasn’t kidding when he warned that his talk would be a little bit confrontational. His speech aggressively criticized what he perceives as the blindness of scientists and other researchers to their social context, and used some very choice words to describe some of his least favourite research policies. Among his targets were the European Union’s experimental fusion reactor, and the common practice of private companies to turn the findings of publicly funded research into proprietary corporate secrets. The general thrust of his talk was that scientific and technological research needs to be better attuned to matters of genuine public interest, and that we PhD students need to promote public debate about scientific and technological issues.

I think that Hammerstein had a point. The social, political, economic, cultural, and environmental influence of scientific and technological research today is massive. And yet far too often, scientists and engineers are assumed to function in a sterile, apolitical world where they are servants only to objective natural truths and (maybe) economic incentives. It will not do for either the public or the scientists themselves to go on believing this. Science and technology are as political as anything else, not least because scientists and engineers are human beings with political opinions. As long as new technologies have the potential to bring about radical social changes, the public will have a stake in what kind of research is done, and how it is applied.

There are a few promising developments which might help the public realize that stake. Crowdfunding of both technology and science are fairly promising, as is the precendent set by Neil Degrasse Tyson’s Penny4NASA campaign”. But for the public to constructively engage with science and technology, they need to be able to critically evaluate science and technology. The good news here is that this critical engagement has been going on since at least the 1960s in at least three academic fields. History of Science and Technology has a tradition of considering scientific and technological achievements in light of their social context, Science and Technology Studies critically considers the links between science, technology and society and Innovation Studies attempts to describe the circumstances under which new technologies and practices are created. The bad news is that the public remains mostly ignorant about all three of these disciplines. It isn’t enough for a handful of academics to be discussing these things at conferences. The material complexity of the modern world demands that the public engage with these ideas as well.

And so I believe that it’s time for scholars in all three fields to start popularizing their work. In the fifty-odd years since their creation, all three of these disciplines have matured considerably and have made some impressive findings. The time is now ripe to diffuse that work more publicly. We need televised documentaries about the history of science and technology that explicitly link scientific and technological developments to their social contexts, rather than depicting great men of science. We need scholars active in science and technology studies to start writing science fiction which incorporates their ideas. We need innovation theorists to get involved in the discussion every time a politician tries to use words like “innovation” or “excellence” in soundbytes. And we need to bring all this research to bear on crucial societal problems such as climate change and medical research.

This is much easier said than done. If, as the roundtable pointed out, academic ideas have so little traction in policy and business, then the task of popularizing them among lay audiences will be extremely difficult. It will take some very clever people to take the arcane, academic jargon of these three fields and translate it into something that will interest the public. But the task is absolutely essential. If we are going to have more informed debates about scientific issues such as climate change and vaccination, or about technological ones such as pharmaceutical development and fusion power, then we need to make academic research about these things accessible to the public. Hopefully this blog can be a small part of that effort.