Vaccine Lessons from Mom
Virginia Hughes, who was with Seed back when I was with ScienceBlogs and ScienceBlogs was with Seed, writes about the conversation she had with her mother about why she was not vaccinated as a child. Here’s what she got out of it:
The conversation was revelatory for me, for two reasons. First, it made me wonder whether vilifying anti-vaccine parents — as the press has done repeatedly this week — is a good strategy for increasing vaccine coverage. When parents make medical choices, good or bad, it’s for one simple reason: They’re trying to do the right thing for their kid. Refusing vaccination is not a political statement.
Second, my mom’s story illustrates that data and authority and expertise can have real power, but only when communicated effectively. For whatever reason, the ideas of Dr. Burris, Dr. Taylor, and Dr. Mendelsohn resonated with my parents in a way that mainstream medical voices did not. Why? This is the question I wish more doctors would ask — and more journalists, too. If we did, then maybe we’d better understand how fables about modern medicine are written. And, perhaps, how to erase them.
I go back and forth on this. I’m not sure there is more powerful a tool in the arsenal than social condemnation. I don’t think passing laws will get us there, for example. I am also skeptical that they can be convinced (though I like California’s see-a-physician requirement to try). I think social acceptability – I’ll do my thing, but it’s okay if you don’t – is a big problem here. Carrot or stick? I don’t know.
I did find this Bill Gardner piece convincing, though. (I also thought this Aaron Carroll piece on how the media asks politicians was also really good.
Anyway, what I find myself increasingly concerned about is that the overwhelming degree of animosity towards non-vaxxers will lead to some bad things. Punitive policies that won’t help much and will hurt. This sort of animosity can lead to some bad things. (And before anybody asks, no I have not heard actual proposals along these lines yet, except by some people here.)Report
I have little but anger for the Jenny McCarthy’s of the world, but it’s hard for me to be angry at parents who have been misled. This is the same conversation I’ve had about creationists for a long time now (and, I believe, the exact same phenomenon; that is, anti-vaxxers are basically creationists who’ve been misled by different authorities). For the most part, they’re well-meaning people trying to do something incredibly difficult and stressful, raise healthy children well, and they’ve been misled by people who range from liars to popular fools. Attacking them gets us nowhere, even though I sometimes want to yell at them.
The real difficulty, as I’ve said before, comes in dealing with the authorities the anti-vaccine parents trust: how do you tear them down without tearing down the identity that they’re associated with? It’s not easy; it takes time and thought.
On the other hand, kids getting sick means we’re low on time.Report
Isn’t Jenny McCarthy also a parent who has been misled? The only difference between her and the other parents is that she regurgitated the misinformation she was fed on national television for an audience of millions instead of Facebook for an audience of tens.Report
My point is in there, Brandon.Report
For whatever reason, the ideas of Dr. Burris, Dr. Taylor, and Dr. Mendelsohn resonated with my parents in a way that mainstream medical voices did not. Why?
It has to do with downsides, upsides, and social costs.
What’s the downside of getting your kid vaccinated? If you think that the answer is “the kid will cry and then we’ll have to go to McDonald’s for a Happy Meal”, you’re going to come to a much different answer than if “the kid might contract autism”.
Compare to the upsides of vaccination: “he won’t get measles from another kid with measles” and “I will do my part to maintain my little corner of the herd’s immunity”.
Look at the differences in risks there! If you haven’t encountered the word “measles” since you read the Great Brain books in the 70’s, you might not see the upsides as something that you’re really going to benefit from and the downsides as very real risks you’ll have to encounter.
If you’re thinking that you might have to shell out for a Happy Meal, the cost is negligible. Sure, take care of it. It’ll make paperwork easier when the kid starts kindergarten.
If you’re thinking that the costs include avoidable autism (however remote) without any real benefits and the upsides include avoiding autism without any real costs?
Why *WOULDN’T* that argument resonate?
Making social sanctions part of the costs of failing to vaccinate is one of the few things that might resonate with parents if some weird science paper with big words won’t.Report
This was an article I saw yesterday about the dangers of politicizing vaccines. And I remember a series of articles from last year about studies that showed how trying to debunk the autism-vaccine link with medical information just caused anti-vaccination parents to double down. Other correction techniques ended up being a wash.
This is probably really tricky because parents who vaccinate or want to vaccinate but can’t (because their children are too young or had some other compounding medical issue) are also trying to do the best for their kids and we have two incompatible systems that are clashing and causing serious harm. So it is hard to see how not-vaccinating is just a personal choice. A friend of mine was seriously distraught because of a story of an outbreak of measles at an NYC daycare. His daughter is too young to be immunized and the parents have to work, etc. Another friend mentioned that her friend’s 5-month old came down with Measles.
I do agree that the science and medical community could work more on narrative though. There does seem to be an attitude of “because science”. But I’ve seen people talk about vaccinations for over a year now and I think things are reaching a fever pitch. Last year I would see a ton of more friendly cartoons on social media that said “Billy is immuno-compromised and can’t be vaccinated. He benefits from herd immunity which requires X percentage of the population to be immunized. Please immunize your children for Bill’s sake” or something like that.
People could be friendly when their were not stories about mumps, measles, and ruebella coming back into existence. Now we are experiencing outbreaks and people are worried and angry. Anti-vaccination seemed much more harmless until a few weeks ago.
But there is a tricky balance between doing the best for your child while also doing good for society.Report
People should have been worried and angry last year too, you know.
Influenza kills, and it’s killed more people in the last year than the 1991 Measles outbreak did.
I worry far more about influenza killing people I love, than measles.Report
That’s because most people are immune to measles, whereas most people are NOT immune to the flu.
The problem is the “most” for measles is not as “most” as it should be, and IIRC measles is more contagious than the flu. Ro for the flu is a bit flexible (somewhere between 2 and 10, depending on the strain and how long it’s been going and other stuff) where measles is 18.
It is also, IIRC, considerably more deadly than the flu.Report
I should probably try to put together a post about motivated reasoning (or hot and cold reasoning) and vaccines. Maybe this weekend. The long of the short of it is, if you want to make people who disagree with you less open to facts and arguments, make it personal and emotional for them.Report
“But that creates a dangerous paradox: If everyone made the choice she did, then everyone would get very, very sick.”
Is it just me who sees this.Report
I recall my son’s first pediatrician, who explained to me just how small the viral load in a modern vaccine is, and how benign the rest of the ingredients are. It’s a world of difference from the vaccines I got as a kid 40 years ago to the ones I get for my son. Much of the anti-vax movement rides on outdated information & ideas on vaccines.Report
Outdated information and false information (the autism link). It’s sad, really, that we’ve gotten to this point. We’re here though. The only important question is, what now?Report
People are still screaming “WHAT ABOUT THE MERCURY IN VACCINES”. It was removed in 2002, not because it was doing anything, but because people thought reformulating it to remove a harmless stabilizer would at least stop people worrying about that.
I think the flu vaccine might still use it, but MMR shots haven’t had it in over a decade. People still think it’s there, and won’t believe you when you tell them otherwise.Report
@morat20 All removing that harmless stabilizer has done is made it more expensive and difficult to deliver vaccines to the developing world. So no credit for removing it, but tons of harm.Report
I don’t buy that. People aren’t avoiding the shots because of incorrect technical specifications. They’re avoiding the shots because they have a worldview, and they reject information when it conflicts with their worldview.Report
What is the world view?Report
This seems directly aligned with what that new commenter (was it Emile?) said on the post the other day. And it makes a lot of sense. But it does fall apart a bit in one spot…
“When parents make medical choices, good or bad, it’s for one simple reason: They’re trying to do the right thing for their kid.”
The conversations around vaccines are different than other conversations about “do[ing] the right thing for … kid[s].” Because getting your child vaccines isn’t just about your child; it is about other people. That changes the conversation in some very important ways. If you want to raise your child vegan because you think the ethical benefits outweigh the likely nutritional* harm… well, whatever potential harm done is limited to your child (which doesn’t mean that society can’t still maintain an interest). But if you choose not to vaccinate your child, you raise the risk of direct, physical harm to others.
Saying, “This is in your child’s best interest!” lands differently than, “This is in society’s best interest!”
* I’m not arguing that one can’t maintain a healthy, balanced vegan diet. But my experience working with young children tells me that it is awfully hard to do so for them, especially when the decision is not their own. Also, kids’ dietary needs are quite different from adults’.Report
@kazzy
This is just tangential (a little bit) to the discussion, but I want to comment on your parenthetical here. For some reason, the commentary I’ve encountered seems much more focused on the “herd immunity” aspect of anti-vaccinationism and less on the fact that anti-vaccination parents are putting their own children at risk.
“seems to be more focused” means just what it says. I have only anecdotal evidence to back me up, but I am concerned that the argument seems (to me, the anecdatalogist) to focus more on the herd and not the child(ren) who aren’t vaccinated. The latter seem (to me, the anecdatologist) to be more in danger.Report
I agree, @gabriel-conroy . It seems people may be more concerned about herd immunity than those individual children. There are lots of ways to read that — some of them on the more noble end of the spectrum and some of them on the more cynical end — and I’m not sure which is right (and it probably varies person to person).
I’d be interested to know how many of the people made sick by the recent outbreak are the children of anti-vaxxers and how many are those not-vaccinated for other reasons (e.g., too young, immunocompromised).
And I will say that, “You have to get your children vaccinated so they don’t get sick and die!” rings differently in the ears than, “You have to get your children vaccinated so other people don’t get sick and die!” Not necessarily better or worse… just… different.Report
The interesting thing about the linked to article (which I actually read the whole of, for a change) is that when it tends to go against my hunch that anti-vaccinationists as a rule don’t play the “weighing the benefits against the potential costs” game. I tend to believe–or used to believe, before reading this article, but now I’m not quite sure–that anti-vaxxers opposed vaccines out of some principle, or false belief they were harmful, or maybe some sort of convenience decision (i.e., not wanting to take off work).Report
None of the threads on vaccines have had any mention of the role trail lawyers played in promoting the idea:
http://www.forbes.com/sites/theapothecary/2014/04/28/the-anti-vaccine-movement-and-a-trial-lawyer-funded-climate-of-fear/
http://scienceblogs.com/insolence/2007/01/01/surprise-surprise-andrew-wakefield-was-p/
http://pointoflaw.com/cgi-bin/mt/mt-search.cgi?IncludeBlogs=19,11,3,9,12,15,8,18,19,13&search=Andrew%20WakefieldReport