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In the wake of Wakefield: Risk-perception and vaccines

The views expressed are those of the author and are not necessarily those of Scientific American.

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Last May British medical authorities stripped Dr. Andrew Wakefield of his license to practice medicine. In case the name isn’t familiar, Wakefield was the lead author of the 1998 paper published in The Lancet (and later retracted) that set off worldwide fear of vaccines. Now the British Medical Journal has jumped in, publishing an investigative report calling the Wakefield study “an elaborate hoax”, suggesting that Wakefield manipulated his findings to help him get rich by suing drug companies.

The press will give this latest aspect of the story its 15 minutes of fame. But the coverage will mostly be about Wakefield. Little attention will be paid to the larger lesson here. Thousands of people are now getting all sorts of diseases that had been nearly eradicated, diseases which are resurgent now that people around the world have become fearful of vaccines, thanks both to Dr. Wakefield and to the innate way the human animal perceives and responds to risk. The lesson is that sometimes what we do to protect ourselves feels safe, but makes things worse. Examining how the psychology of risk perception played out in the Wakefield affair, and continues to play out in public concern about vaccines, can tell us a lot about how to avoid this risk in the future…the huge risk that arises when we get risk wrong.

Wakefield et al. looked for a link between autism and the MMR (measles, mumps, rubella) vaccine. In their now retracted paper the authors said "We did not prove an association between measles, mumps and rubella vaccine and the syndrome described." But in the news conference announcing the paper, Wakefield suggested taking the vaccines one at a time rather than together, just in case. The parents of the autistic kids who were studied…all TWELVE of them…desperate for an explanation for their tragedy, leapt at that hint, and 12 years later fear of vaccines of all sorts has spread worldwide. Vaccination rates are down. Herd immunity to some diseases has dropped so low those diseases are spreading again, in the U.S. and around the world.

As surely as we now know that vaccines do NOT cause autism, we also know from research on risk perception that several specific psychological characteristics played (and still play) a huge role in people’s fear of vaccines.

o We know that human-made risks are scarier than those that are natural. Vaccines are human-made.

o We know that a risk will seem more threatening if it comes with little benefit, and vaccines protect us from diseases that are mostly gone (thanks to the vaccines), so their benefits are perceived as minimal (even though the risk remains).

o We know that a risk imposed on us feels scarier than one we choose to take on our own, and vaccination is imposed by government (though one can opt out).

o We are more afraid if we don’t trust the people in charge of our health and safety, and many people don’t trust vaccine makers or the government health agencies overseeing vaccine programs.

o Finally, we know that any risk to kids evokes more fear than the same risk to adults, and the whole fear of vaccines movement got started, and still largely focuses on, autistic children.


It is not at all unreasonable to respond to risk this way. When it comes to the perception of potential danger, which is ultimately about survival, we have developed these affective characteristics – trust, choice, kids, risk v. benefit, among others – as tools with which to judge a situation quickly, instinctively, subconsciously, for its ‘riskiness’. This is neither rational or irrational. It’s just how we do it.

But this affective risk response can lead to what in my book I call The Perception Gap, a dangerous gap between our feelings and the facts that can be a risk in and of itself. Sometimes we’re more afraid than the facts say we need to be (vaccines). With many of the bigger threats, we’re not afraid enough (infectious disease). The gap between our fears and the facts can be dangerous all by itself. Just ask the parents of the thousands of kids worldwide now getting, or dying of diseases that vaccines had pretty much controlled.

We need to start paying more attention to what the psychology of risk perception has to teach us about why we react to risk the way we do. We need to be honest with ourselves and recognize that, as right as our feelings about a given risk may be, those feelings may raise new dangers. We do have to fear fear itself…too much or too little. As we have studied risks like vaccines and autism, so we have studied the psychology of risk perception, and identified its pitfalls. We can…should…use that knowledge for wiser overall risk management in the choices we make as individuals and as society.

And we need to do this proactively, as risk-related issues arise, before our feelings become too deeply set. Because we also know from risk perception studies that, once we’ve made our interpretations of what’s safe and what’s not, it’s very hard to get those interpretations to change. One American parent in 4 is worried about the danger of vaccines to their kids and hundreds of thousands now refuse to have their kids vaccinated. This latest investigation against Dr. Wakefield won’t change that. The harm he and others have done will persist for a long time…and will continue to serve as a reminder of the risk we face if we don’t recognize that the way we perceive risk can be a huge risk in and of itself.

About the Author: David Ropeik is an Instructor at the Harvard Extension School and author of "How Risky Is It, Really? Why Our Fears Don’t Always Match the Facts".

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. ejwillingham 10:13 am 01/6/2011

    I’ve blogged from the perspective of an autism parent and a scientist about the perception of risk related to vaccines. There’s something so parent-directed about the process: the willing delivery of a little fat thigh to that pain for an invisible defense against something most of us have never witnessed. The pain of watching the shot is sufficient; add to that worries about a reaction, especially a dire one, and the parental catastrophizing can dial up to 11. Wakefield, with collusion from the news media, magnified that even further. The news media seemed to take it as its job to incite emotion–to be "clickable"–and that behavior continues. I think, though, that for the average parent, seeing these retractions and characterizations of fraud will help allay some of those natural, headline-driven fears about a connection between vaccines and autism.

    It’s oh-so-human, isn’t it, to worry about a needle prick in a little leg while likely not thinking twice about buckling a tiny fragile human body into a 2-ton behemoth to drive it to the doctor’s office in the first place among other speeding behemoths. Those significant everyday dangers bother us so much less than the one in millions shot that a shot is going to do harm. It’s difficult to intellectualize that and let emotion take second place to statistics.

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  2. 2. sbscienceny 12:30 pm 01/6/2011

    There are so many things wrong with this article that I do not know where to start. Yet, another journalist jumping on the bandwagon of Wakefield bashing to promote his book. (The Scientific American should give Dr Wakefield a chance to respond.)

    I am afraid to say that The Scientific American has become The Pseudo-Scientific American.
    For disclosure, I am a scientist but I am not doing research in autism, and do not have kids with autism.
    The only fact in the MMR vaccine debate that is true is that we still don’t know what causes autism. All the statistical studies that have been done since the original Wakefield study have been faulty (I know it is a big statement but it is true). It is almost impossible to design a statistically solid study with so many unknown variables. What we need is more mechanistic studies to understand how vaccines influence the immune system. Our job as scientists are to minimize the risk of vaccine related injuries. We cannot do our work if we have to be afraid that we will be the subject of a witch hunt if our findings go against that of business interests and the interest of government bureaucrats.
    To me the Wakefield case represent a different cautionary tale. The media jumped on this issue and sensationalized the findings that were still preliminary. UK government bureaucrats pulled the single measles vaccine off the market without waiting for the follow up studies, clearly under the pressure of business interests.
    We see a terrible replay of this now with a pentavelent vaccine that the WHO is heavily promoting despite serious concerns.
    People might say that the risk from vaccine related injury is still smaller than not vaccinating. I say that we have the tools to make vaccines safer and it is our duty to do that, and to have a honest debate about the risks.
    To EJWillingham: I wish you were right about the retraction. I think it is a face saving act by the journal. Parents have the right to decide for their children if they want to take the risk of a vaccine related injury just like taking the risk of driving them around in a car.

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  3. 3. DJ6ual 12:39 pm 01/6/2011

    Just because he knew the children he took the blood from and it was not a "blind" or random sample tested does not mean the findings were not correct. The medical field is just running scared now because they know what is coming. Vaccines do cause Autism along with a ton of other Mercury Poisoning Neurological Disorders. I know that I am not stupid enough to stand in line to poison my family and I hope other aren’t either!
    Article: Mercury May Be What Is Killing Us All

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  4. 4. respite4all 12:03 pm 01/7/2011

    Ask parents with a child(ren) that have Autism. MY youngest son was fine. He had his MMR. Immediately. He had a reaction. Whether the vaccines caused it or set it off, I don’t know. What I DO KNOW is that my son was developing typically before we went in for his scheduled vaccinations…when we left, the reaction was immediate. He was lethargic. Then over the next few days, weeks and months he regressed developmentally and socially.
    Parents aren’t lying. We aren’t making this up about our children.
    NO STUDIES have been done to test what happens when you give a baby multiple doses of vaccines at one time.
    IF it isn’t the vaccines…WHY is our governement NOT conducting the research and study of vaccine safety?
    I will not vaccinate my children until I know that it’s safe.
    Comparing vaccination to riding in a car isn’t fair. I make INFORMED decisions on how to keep my children as safe as possible. I put them in ONE vehicle and ONE safety seat at a time. Comparing the vaccines to putting my child in a car and safety seat is only fair IF I purchase 4 of the safety seats and put them on TOP of each other then strap my child in them INTO any vehicle (unknown to me) without checking safety & study ratings of the vehicle. We’re vaccinating our kids WITHOUT knowing what ingredients are in the multiple vaccines (given in one shot) that have NOT been studied to be safe when given together at a time at such young ages.
    As a parent I make informed decisions. I won’t just blindly trust what I’m told. I choose the safest vehicle based on information from automobile safety TESTS, ONE safety seat – for MY child.
    Who puts their child in a foreign, unknown vehicle and then straps their child into a safety seat that sits atop two or three other safety seats? Who injects our children with unknown ingredients with multiple vaccines without having ever studied them being piled on top of each other?

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  5. 5. sbscienceny 3:07 pm 01/7/2011

    To be fair to the government, they DO sponsor vaccine safety studies and test vaccines. Part of the problem is the notion pushed by some and supported by vaccine manufacturers, and insurance companies that our immune system can handle multiple shots at a time without any problem. There are no studies on this because vaccines are tested individually not in combination with others. Parents have to be vigilant and ask their physicians to spread out vaccines and do not give shots to children who have a fever or taking medications for an infection.
    Science will catch up eventually if we are allowed to do our job, and the journalists start reporting science responsibly.

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  6. 6. bucketofsquid 2:06 pm 01/12/2011

    Since vaccines no longer contain the mercury that wakefield said he was concerned about, how do you explain the steady increase in autism rates? I also noticed that the study did NOT find a connection between the vaccines and autism so just what exactly are you basing your paranoia on? It is also interesting that population groups that consume foods high in mercury such as deep sea fish, do not experience the high autism rates that certain other population groups do. I suggest you get some mental health assistence.

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  7. 7. bucketofsquid 2:19 pm 01/12/2011

    Actually you bring up a valid concern. It has been proven and verified that exposure to pathogens in vitro or when a small child increases the risk of certain mental disorders such as schizophrenia and pychosis. I don’t view it as a stretch that vaccinations may increase the risk of autism spectrum disorders. The other side of the coin though is that before vaccinations roughly 80% of people born died before having children of their own, most of them as small children.

    Not to be harsh but reality is harsh. If you had the chance to have an operation on your son that has an 80% chance of killing him and a 20% chance of making him normal, would you take it? Neither of my sons has autism or any other significant mental challenge so I can’t say what I would choose. I like to think I would say no but until I’m in that situation I just don’t know.

    My children had their vaccinations and nothing went wrong. Perhaps for some there is no risk and for others there is a meaningful risk. Until we know more about autism and what can cause it, it is all simply speculation with a very heavy emotional burden no matter what you decide.

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  8. 8. JDahiya 2:21 am 02/10/2011

    An excellent article on the perception of risk, and a very thoughtful comment by ejwillingham on how it plays out in real life!

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  9. 9. JDahiya 2:27 am 02/10/2011

    Your comment makes me wonder. Could it be that before vaccines, more kids with the likelihood of having autism didn’t survive the diseases now blocked by vaccines? That would show autism up as positively correlated with vaccination as well. In that case, the risk faced by parents would be no kid vs. autistic kid instead of autistic kid vs. normal kid. I’m not sure the data can be teased apart to find if this is so, but if it is, it should reassure a lot more parents. Having contracted a childhood disease despite vaccination (failure of cold chain, most likely), believe me, any parent will find watching the child wailing at the vaccination minor, compared to watching the child struggle to swallow on getting diphtheria (extrapolate to disease of your choice).

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  10. 10. wilcoxft 3:55 am 01/19/2012

    If you thinking about how humans deal with risk then you will definitely find this interesting ..

    Link to this
  11. 11. comefullcircle 5:55 am 03/8/2014

    Vaccines have NOT been adequately tested for safety using methodologically sound scientific studies, so their long-term health effects are unknown. Even though the
    government acknowledges that vaccines have dangerous side effects, the CDC today continues to recommend giving children 49 doses of 14 different vaccines by the
    time he/she turns 6!

    Moreover, the effects of multiple vaccines given together have not been adequately tested. Babies receive several vaccines at once — they may receive 8 vaccines or more
    simultaneously at a doctor visit (between 2 and 15 months of age). Vaccine “layering” may increase the risk for a serious vaccine reaction. As well, the pharmaceutical
    companies have financed nearly all vaccine research to date, which introduces enormous bias. The vaccine industry is a multi-billion dollar industry – and physicians as well as the government have financial ties to the vaccine industry. This means they have a vested
    interest in pushing vaccines.

    It should be noted that during the Polio vaccine project that began in the 1950′s, a scientist discovered that the vaccines were contaminated with viruses because the cultures had not been checked for cross-contamination before they were made into vaccines, and subsequently administered to millions of American children. Particularly significant was the fortieth virus she discovered – they named it “SV40″ (the “SV” signifying “Simian Virus”; the “40″ signifying the fortieth virus
    that was discovered in the vaccines). SV40 is a cancer-causing virus, and is responsible for the soft-tissue cancer epidemic in Baby-Boomers – and the SV40 marker is evident in the cancers. The really bad thing about that whole scenario is that even after the contamination was discovered in the vaccines – the government put a lid on the information – and they did not recall the plethora of contaminated vaccines sitting on shelves across America.
    Rather, they continued to knowingly dispense them because of the financial investment. That is very telling, as relating to the controversy regarding the vaccines of today. You should ask yourself, “would they do it for the money at our expense and at the expense of our children’s health?” The answer’s a no-brainer, because they proved back in the 1950′s what they would do for the money. Believe me, I understand how difficult this is
    to realize – we should be able to trust the people that we should be able to trust. But my sisters and I were administered that contaminated polio vaccine in the 1950′s … and I understand that my parents did what they were told was best for us. They had no idea of the big picture. But if you are a parent and you’re reading this, you do. You have a wealth of information at your fingertips – please use it and think carefully before you
    blindly just succumb to allowing your child to receive vaccines without researching them thoroughly. It’s a choice – make an informed and intelligent one.

    Preventing natural immune responses to
    environmental pathogens may not be in your child’s best interest. Healthy children
    receive life-long benefits from naturally occurring immune responses – with vaccination,
    you are merely creating an antibody – vaccines do not impart long-term immunity.
    Vaccines do not strengthen the healthy functioning of the immune system; but may actually
    weaken it.

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