Guest post by Jeanne Garbarino, PhD
The ubiquitous impact of science-based information and technologies in everyday life suggests that misunderstanding how science works can have serious consequences. Yet people’s decisions and strongly held beliefs are often uncoupled from, or at odds with, the conclusions and recommendations of empirical studies and scientific consensus.
In some cases, the implications of misunderstanding or rejecting science are more or less harmless – does it really matter if someone believes the Earth is the center of the Universe? In other cases, they can be critical. Perhaps nowhere is understanding science more important than in the anti-vaccination (anti-VAX) movement. While infant/child vaccination rates have increased for the major vaccine-preventable diseases (2000-2014), there are growing pockets of vaccine refusal in multiple locations across the United States. The real world and serious implication of vaccine refusal is the disruption of local herd immunity, resulting in vaccine-preventable disease outbreaks. For example, regions of California, including Marin, Napa, and Sonoma counties, have seen significant increases in the number of pertussis and measles cases in recent years, largely related to increased intentional vaccine refusal among parents. Similarly, we have seen a revival of measles and mumps cases in and around Brooklyn, NY.
According to survey data, vaccine refusal usually relates to concerns about vaccine safety and perceived efficacy. Specifically, parents either misunderstand or flat out reject the data-based debunking of a causal relationship between vaccination and autism, based on a seriously flawed, and now retracted study (see PLoS Blog: Public Health Takes on Anti-Vaccine Propaganda). Additionally, parents may not see the point of vaccination since many vaccine-preventable diseases, and their serious health implications, have become much less common in the developed world. We now live in a world free of smallpox and almost free of polio, making it difficult for people to connect to the painful consequences of their reappearance.
Parents who choose to forgo or hesitate in vaccinating their children tend to be white, well-educated, and living in households making $75,000 or more annually. Presumably, such parents have ready access to relevant information, spend a lot of time researching the topic of vaccines, and, according to Seth Mnookin in The Panic Virus “take pride in being intellectually curious, thoughtful, and rational.” These are individuals and communities that are generally assumed to support science and are scientifically literate by various measures (for example, they know that the Earth is not flat and that it travels around the Sun, they might even know that antibiotics do not “kill” viruses, although they may not know exactly why this is the case). But, for some reason, these parents become fully invested in exploring the “debate” relating to vaccine safety and efficacy, and are not able to differentiate scientifically supported conclusions from those that are not.
Maybe this mindset is influenced by the “healthcare consumerism” movement, which encourages patients to be more involved in their healthcare decisions, marking a shift away from the authoritarian, doctor-knows-best default. Furthermore, given the growing tax on the already faulty infrastructure of our healthcare system, this “look it up dear” trend has become an accepted norm. The ability to conduct “research” on an aspect of healthcare, and to have an appreciation on what “research” truly entails, is a direct application of science literacy. Assuming “research” is done correctly, the internet can be an excellent source of information for patients, with the potential of filling in any healthcare knowledge gaps.
One immediate driver of the anti-VAX movement, however, appears to be that internet search results on vaccines yield a very mixed bag, potentially compromising the attempts at “research.” For instance, when I plugged “are vaccines safe” into Google (December 2016), sites like CDC’s Vaccine Safety and the US Health and Human Service’s Vaccine Safety appeared in the feed. These sites, however, were outnumbered by anti-VAX (aka fake science) sites that can have the look and feel of a legitimate resource. In fact, the internet is the main platform for anti-VAX messaging; parents who exempt children from vaccination are likely to have made their decision based on information they read online. Interestingly, anti-VAX information is often couched in non-science messages demonizing “lying big pharma,” while simultaneously promoting the value of alternative (that is, non-science-based) medicine – as of 2015, an unregulated (and not completely honest) $30B per year industry. One might suspect that anti-VAX sentiments are reinforced by alternative medicine and nutraceutical lobbying, further demonstrating an inability to correctly identify conflicts of interest and a misunderstanding or flat out rejection of evidence-based medicine.
While I value the opportunity for access to scientific and medical information, and believe that patients owe it to themselves to research areas specifically related to their health/illnesses, such information is often presented in a context that assumes a general understanding of underlying processes that are fundamental to the given explanation. For instance, when delivering information about vaccine science, is it to be assumed that readers are familiar with how the immune system works? Are parents aware of the impact of withholding vaccination on their, and their neighbor’s child’s well being, or the potential immediate and long term effects of contracting the disease that the vaccine protects against? Do readers have a handle on autism spectrum disorder, and what we know – and don’t know – about related genetic and environmental influences? When explaining a “why,” such as why someone should vaccinate their child, “you have to be in some framework that you allow something to be true, otherwise you are perpetually asking why” (Feynman on BBC, 1983). In presenting materials on vaccines, have we clearly established what needs to be understood and accepted? Does our audience have the foundational knowledge to understand the arguments for and mechanisms behind vaccination? These are questions that extend beyond vaccination, and generally go well beyond what is meant by scientific literacy.
Confounding the difficulties associated with being a critical consumer of healthcare information is the tendency for humans to connect with stories – particularly stories with negative outcomes – regardless of factual content. According to a McKinsey research summary on healthcare consumerism, “there is often a disconnect between what consumers believe matters most and what influences their opinions most strongly.” This can also relate to the concept of biased assimilation, where people unknowingly engage in cherry picking to find the arguments that best support the values held by those in their community. In the context of the vaccine discussion, parents can be influenced by the (abundant) stories linking vaccines to the onset of a spectrum of health issues, even if they doubt the validity of the story, even more so if they are a part of a community that supports anti-VAX sentiments. This natural human behavior is reinforced by celebrity-backed, widely-publicized campaigns that falsely link vaccines to autism — despite retraction of the original study AND numerous subsequent studies disproving these claims – likely sustains anti-VAX momentum. Given the incoming presidential administration’s suggested openness to anti-VAX arguments, this momentum could be amplified.
Vaccine hesitancy and rejection is not restricted to the United States. In fact, nearly every country experiences pockets of vaccine-preventable disease outbreaks, resulting from vaccine hesitancy or refusal, as described in a recent WHO working group report on the topic. Similar to trends seen in the United Sates, the choice to align with anti-VAX sentiments has complex underpinnings, often relating, in part, to personal/community belief systems and distrust of healthcare providers and institutions. As an extreme example, the Taliban [link] are vehemently opposed to vaccinations as they view vaccination programs as antithetical to their traditional beliefs and culture; such programs can be seen as a nefarious plots to “inject” Western culture into traditional societies. One result has been terrorist attacks targeting polio workers in Pakistan, killing 60 since 2012.
At the risk of oversimplifying the issues related to vaccine hesitancy and rejection, people’s decision’s for themselves and their children might have less to do with the message, and more about how — and in what context — the message is delivered. In fact, a meta-analysis on persuasive techniques common to anti-VAX websites suggest that these sites go far beyond simply providing (inaccurate) information on vaccine safety. These sites are making genuine connections to parents’ values (i.e. freedom of choice) and lifestyles (i.e. healthy eating), adeptly contextualizing anti-VAX sentiments as being a part of holistic well-being. Such sites skillfully cultivate feelings of trust and credibility by aiming their message to hit the more human side of things. These sites get human behavior, while pro-objective evidence sites often do not. When looking at the anti-VAX movement, we see the power of personal stories and of presenting anti-VAX “science” alongside related messages that promote the values and ideals of the target population.
So how do we apply these lessons to improving the public’s understanding of particular science-based decisions? While it may feel counterintuitive, perhaps we should stop trying to win arguments using the traditional academic approach, with data, error bars, and p-values, as these risk strengthening the emotional appeal of anti-evidence, anti-scientific viewpoints. Instead, we can present data-based conclusions in compelling and effective ways, keeping in mind the connections and disconnections between human emotion and rationality. As the world’s population continues to soar, the importance of humanizing our messages, arguments, and conclusions is paramount.
There is no universal equation governing scientifically literate decision-making, it is unlikely that one will ever be identified simply because human behavior is difficult to predict. From a practical perspective, this may mean that “scientific literacy” as an over-arching concept is less useful than fostering a deeper understanding of relevant issues in science and medicine. In recognizing the need to provide people with specific knowledge to make informed, data-based decisions, it is implied that facts (empirical observations) are clearly differentiated from non-facts. However, this idea is much more complicated, and the interpretation of “facts” is impacted by the context of individual experiences (the Saigon, 1965 episode of the Revisionist History podcast provides an excellent example of such an analysis). The inability to predict how someone will interpret empirical evidence is the giant wrench stuck in the gears of the science literacy machine. With regard to the anti-VAX movement, we are dealing with an emotionally-charged phenomenon that is deeply intertwined with human nature (the need to protect ourselves and our children), and the process goes beyond answering general true-false questions. While difficult, the effort to better understand and meaningfully correct points of failure in communicating any controversial science issue is likely to be beneficial, particularly when we consider the consequences of scientific illiteracy.
Jeanne Garbarino, PhD, Director of Science Outreach, The Rockefeller University, NY, NY
Jeanne earned her Ph.D. in metabolic biology from Columbia University, followed by a postdoc in the Laboratory of Biochemical Genetics and Metabolism at The Rockefeller University, where she now serves as Director of Science Outreach. In this role, she works to provide K-12 communities with equitable access to authentic biomedical research opportunities and resources. You can find Jeanne on social media under the handle @JeanneGarb.
16 thoughts on “What can the anti-vaccination movement teach us about improving the public’s understanding of science?”
“Yet people’s decisions and strongly held beliefs are often uncoupled from, or at odds with, the conclusions and recommendations of empirical studies and scientific consensus.”
This is the problem Jeanne, medical peer review amounts to no more than the collective opinion of selection bias experts who inherently believe in vaccination. When studies show vaccines are failing, they ignore them or dismiss the messenger.
Society is learning that self confessed experts are not very good at telling the truth, look at the banking crisis as a parallel.
Doctors are trained in pathology, not how to stay well, they have no idea about advising on good diet for example. Patients with a diagnosis of arthritis are just given painkillers or immune suppressants and this is not scientific in any sense of the word. Rockerfeller funded the Flexner report that effectively banned anything that wasn’t drug orientated, it is a broken model.
Look at the 1939 cancer act, it is a criminal offense to even discuss anything else but radiation, chemo and surgery for treatment. If I talk about diet as an approach, I am a criminal. This is ridiculous, many people have turned round terminal diagnosis of cancer by changing their diet, billions are wasted looking for cures for diseases that are deficiencies, this stranglehold on science is draconian and dishonest.
There are so many reasons why ordinary people have come to the conclusion that doctors should not hold the monopoly on therapeutics, doctors pushing for compulsory medicalisation are the worst kind of self interest criminals out there. Bill Gates, a celeb, pushing his companies products on third world countries and then rebranding diseases to make them disappear is not science – it is marketing.
[Vaccination] during pregnancy leads to dopaminergic hyperfunction and cognitive impairment in the offspring, and may promote schizophrenia. — Journal of Biological Psychiatry
[Vaccination] during pregnancy was found to promote neurodevelopmental mental diseases, including but not limited to schizophrenia in the offspring. — Journal Brain Behavior and Immunity
Maternal immune activation alters fetal brain development, and may predispose children to schizophrenia and autism. — Journal of Neuroscience
Inflammation during a critical postnatal period causes a long-lasting increase in seizure susceptibility. — Journal of Neuroscience
Excessive vaccination during brain development may promote autism spectrum disorders. — Journal of Medical Veritas
Hepatitis B vaccine is associated with an increased risk of multiple sclerosis. — Journal of Neurology
Vaccination is associated with a rare autoimmune neurological condition transverse myelitis. — Journal of Lupus
Hepatitis B vaccination significantly increases the risk of a wide range of autoimmune diseases. — Journal of Autoimmunity
In the US the highest number of cases of Guillain-Barre syndrome are associated with influenza and hepatitis B vaccines. — Journal of Neuromuscular Disease
All these findings plausibly implicate Aluminum adjuvants in pediatric vaccines as causal factors contributing to increased rates of autism spectrum disorders in countries where multiple doses are almost universally administered. — Journal of Toxicology
Autistic disorder change point years are coincident with introduction of vaccines manufactured using human fetal cell lines, containing fetal and retroviral contaminants, into childhood vaccine regimens. Thus, rising autistic disorder prevalence is directly related to vaccines manufactured utilizing human fetal cells. — Journal of Public Health and Epidemiology
Note: This information is from a slide presentation by Dr. John Bergman, chiropractor.
Courtesy: The Outliers
Please realize vaccine science equals ‘cigarettes don’t cause cancer science’. Just follow the money.
The author is missing some very big pieces to the puzzle — the failure of modern science to account for the rise of chronic disease. Until there is a viable answer, people will correctly think that vaccination is behind the problems.
• why are allergy rates increasing? It was discovered by von Pirquet and Richet over 100 years ago that injecting foreign proteins via a hypodermic needle causes both allergy and anaphylaxis. The term “allergy” was coined by von Pirquet specifically as he as studied the adverse reactions to horse serum — aka one of the early types of vaccines. Vaccines are full of foreign proteins (see the CDC website for the complete list). Further, we know that vaccination moves the organism toward atopy, i.e. the tendency toward allergy.
• why are autoimmunity rates increasing? The Institute of Medicine first accepted causality between the MMR and an autoimmune condition in the early 90s.
“The committee found that the evidence established causality…between measles-mumps-rubella vaccine and thrombocytopenia.”
Adverse events associated with childhood vaccines other than pertussis and rubella. Summary of a report from the Institute of Medicine, JAMA, 1994
And that was just one of them. Guillain-Barré syndrome (paralysis from an autoimmune reaction associated with several vaccines but especially the flu shot) is now so common that it is being added to the vaccine table of injuries for rapid compensation. (Federal Register Proposed Rule Change 80 FR 45132).
Regarding allergies, WHO says “Primary prevention is difficult because the reasons for increased sensitization rates are unknown.” (World Health Organization. White Book on Allergy 2011-2012 Executive Summary)
Regarding autoimmune conditions, the NIH wrote in their report to congress, “…collectively [these diseases] affect 14.7 to 23.5 million people in this country, and – for reasons unknown – their prevalence is rising. Since cures are not yet available for most autoimmune diseases, patients face a lifetime of illness and treatment.” (National Institute of Health. Report to Congress. Progress in Autoimmune Diseases Research, 2005).
The obvious place to look is the ever-expanding vaccination program for both the allergies and the autoimmune conditions.
Until science comes up with a reasonable explanation for these rising rates of chronic disease, it seems that the number of people who reduce or refuse vaccinations will continue to grow.
Dear Jeanna and Mike, Please use your scientific insight to discover the cause of the appalling epidemic of ASD. Forget your issues with those who are leery of vaccination. After all, until the cause of Autism is discovered, people will continue to forego any risks that are inherent with the vaccine protocols. Thank-you.
This post (correctly, I think) states that vaccine rates of infants and children for the major vaccine-preventable diseases have been increasing. One detail: I’d be interested in a citation for the statement that “there are growing pockets of vaccine refusal in multiple locations across the United States.”
Have you read the recent book by Susanne Humphies? She is a real spokesperson about concerns around vaccines. There seems to be a lot of science in that book and seems to be well researched. Every aspect of society gets criticism. Its normal. Including the pharmaceutical industies and doctors. Every person and certainly an anpect of society (ie our healthcare) has vunnerable part to it. We should be discussing it. It does not get much attention in the main media. The vaccines and the way they are run have issues. Have you spoken to these scientists and doctors that are bringing forth these studies that bring on concerns with vaccines? They are making good points worth exploring
What a stupidity to mention people who vaccinates children as white well-educated people earning $75k. Recent researches proved that majority of not vaccinated are from this group. And on other hand we can see poor people who chase medicare services for easy money if they vaccinate their children on time. Nobody cares about possible problems with health of such children in the future. Even more – pharmaceutical companies don’t worry about full and continuous analysis of their new vaccines because it costs additional money – instead they do basic researches and push their shit to mass market. Though such products with unknown effect to human body in 1-5-10-20 years must not go live so fast! 😦 Majority of antivaxers just do not want to push unclear and not deeply researched shit to body of their children that’s all.
Iris, This is the best explanation I have ever seen. I’m not out to debate science–I can’t. I have no idea what I’m talking about, and so much of it is flawed, as many scientists are saying now. I have healthy, unvaccinated children. Why? Because the research showed me many years ago, before this was even a debate, that the ‘science’ is funded by the very people who stand to lose by an unfavorable outcome–namely big pharma. So, I said no. But I have seen in others, and heard stories of exactly what you describe, and those people go unnoticed and they are ridiculed. The pro-vaxxers’ (and I am talking about those who wish to take MY choice about MY child away. I have no problem with anyone who, by choice, chooses to vaccinate.) cruelty and erudite posturing only serves, I believe, to drive the fence sitters to question, and perhaps, like me, never vax. Thank you, Iris, for your brilliant words on an emotional subject that will not go away.
We are a social species, and bear a responsibility to one another – that your child is well (and relatively safe) is due to the fact that others have vaccinated theirs. Understanding the science is critical. In any case, while vaccines, like all medicines, can cause side-effects – they certainly do not cause autism.
An intriguing read concerning the anti-vaccination movement