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The Lesson of the Fear of Vaccines.

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


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Time for Society to Say Enough is Enough.  

       The science community laments that people deny the evidence science produces. Usually this complaint is merely descriptive, intellectual frustration sometimes tinged with arrogance. Sometimes the criticism of denialism also offers solutions, which usually include education and communication to make the deniers stop denying, to make them see things the rational way the science community thinks everyone can, and should. Rarely does the conversation get to the uncomfortable final prescriptive answer of what we should do when the intrinsic nature of risk perception causes people to steadfastly deny the evidence, no matter how well-informed and educated they may be, and their behavior puts other people at risk. There is no better example than vaccines.

       For a number of reasons, well-explained by research into the psychology of risk perception, the fear of vaccines has become so entrenched that no amount of communication or dialogue or reason will get some of the people worried about vaccines to stop worrying. These fears are clearly creating danger for the greater community. Usually when people’s perceptions of a risk produce behaviors that harm others…we make them stop. We pass laws or impose economic rules, or find other ways to discourage individual behaviors that threaten the greater common good. We do this all the time. You don’t get to drive drunk. You don’t get to smoke in public places. You don’t even get to leave your house if you catch some particularly infectious disease.

       Then what should we do about people who decline vaccination for themselves or their children, and put the greater public at risk by fueling the resurgence of nearly eradicated diseases? Isn’t this the same thing, one person’s perception of risk producing behaviors that put others at risk? Of course it is. Isn’t it time for society to say that in the greater public interest, we need to regulate the risk created by the fear of vaccines? Yes. It is.

       First, a few facts about the harm caused by the fear of vaccines.

- The European Center For Disease Control reports outbreaks of measles in many countries where vaccination rates have gone down: As of June – France (12,699 cases in 2011, more than in all of 2010 already, including six deaths), Spain (2,261), Italy (1,500), Germany (1,193, one death). There have already been 550 measles cases in England and Wales this year compared with 33 all of last year.

- The U.S. has had 156 cases as of mid-June, compared to a total of 56 cases per year from 2001-2008. The CDC has an emergency health advisory for measles, a disease officially declared eradicated in the United States in 2000.

- A 2008 study in Michigan found that areas with "exemption clusters" of parents who didn’t vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average. In 2010 as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whooping cough.

- The risk is not just to people who have opted out of vaccination. Of the 156 measles victims in the U.S. as of June, nearly one in five of them had been vaccinated but the vaccine didn’t work, or had weakened. Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases where ‘herd immunity’ has fallen too low to keep the spread of the disease in check. Unvaccinated disease victims cost the health care system millions of dollars, and local and state government millions more as they try to bring each outbreak under control. A recent economic analysis found that "…vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs."

       Elsewhere (The Los Angeles Times, BigThink.com) I have laid out a more detailed case for what society might want to consider about how to regulate the behavior of people who decline to vaccinate themselves or their children and put the greater community at risk (make it harder to opt out of vaccinations, encourage vaccination with discounts on the cost of health insurance or penalties for those who opt out, restrict the social/community facilities unvaccinated people can use or activities in which they can participate). Here I’d like to describe some of the underlying psychology that helps explain why the fear of vaccines exists, and why it is so strong, and why no amount of communication or discussion or reason will get people deeply worried about vaccines to stop worrying. Which is why society has to step in and act.

       Risk perception is a largely subconscious subjective interpretation of the facts, as seen through powerful emotional/instinctive filters that we have evolved to help us quickly gauge whether something is dangerous: 

- Children. Any risk to kids worries us more than the same risk to adults.

- Control. Powerless against a risk makes it seem worse. It is entirely understandable that any parent of an autistic child wants answers, and hope, and a sense of control, over the fate they’ve been cruelly dealt.

- Human-made v. Natural. Human-made risks, like pharmaceutical vaccines, evoke more fear than natural ones.

- Risk versus Benefit. It is understandable for a parent to decline vaccinations they fear might be a greater risk to their kids (even if the risk is low) than the diseases the vaccines have largely (but not entirely) eliminated.

- Imposed or Voluntary. A risk imposed on us worries us more than if we engage in it voluntarily, so it’s understandable that people are troubled by state-mandated vaccination (though the individual liberty argument rings hollow against the fact that in 21 states people can opt out of having their kids vaccinated for “philosophical reasons”, and in 48 states for religious reasons – without any proof that their faith actually bans vaccination).

- Trust. We fear risks from institutions we don’t trust, like the pharmaceutical industry, and government, and even, for some of us, big business generally.

- Cultural Cognition. Some people feel that that society should be more fair and flexible than it is and that people should not be constrained by rigid social or economic class hierarchies. These people, known in the study of Cultural Cognition as Egalitarians, criticize the major institutions of the modern economy – big corporations (and their products) – which Egalitarians blame for contributing to unfair and restrictive class structures. (Egalitarians are commonly politically liberal, like the population in Marin County.)

Mistrust, lack of control, human-made risks imposed on our kids, risks that seem to outweigh the benefits,…given these powerful instincts, the fear of vaccines is understandable, even if it flies in the face of overwhelming evidence. As irrational as those fears seem to the science community, it is also irrational for that community and policy makers to ignore the overwhelming evidence that risk perception is a subjective mix of facts and how those facts feel. It’s irrational for these ‘rationalists’ to continue to expect that an evidence-based argument alone will change vaccine opponents’ minds.

So it is time for us to act, and regulate the behavior of those who refuse to vaccinate themselves or their children. But the vaccines issue teaches a larger lesson. The affective/subjective/emotional perception of risk comes from such deep survival instincts that it sometimes can not be closed with communication and reason, and while these instincts often protects us well, they sometimes produces a Perception Gap which can be a risk all by itself.

Rather than struggle against this intrinsic facet of human nature by calling it science denialism and irrationality, a more holistic approach would accept that sometimes we get risk wrong in dangerous ways. This approach would allow us to account for and manage the dangers of the Perception Gap with the same tools we already use to manage myriad other threats. And in the case of vaccines, it should mean that we do what we always do when one person’s behavior threatens the greater community. We make them stop.  

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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Comments 13 Comments

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  1. 1. lynda lovon 7:46 pm 07/18/2011

    Below I have posted Ropeik’s client list from his conulting website (http://www.dropeik.com/dropeik/clients.html)for which creates spin on Risk. Note how many pharmaceutical corporations he spins for. It is pretty bizarre for a scientific magazine to invite such a biased person – essentially a lobbyist – to comment on a subject that is so subjective and distrustful. So now, not only do folks not trust vaccines, they don’t trust Scientific American! This blog is complete bogus spin and I find it, as a parent and scientist, insulting. Next you’ll have him blogging about the false risk of nuclear power when he is a spin doctor for the nuclear industry – his primary client! Oops! I see you already have had him blog on many subject he spins for!! Sad.

    * American Institute for Biological and Medical Engineering
    * Sherrin and Lodgin, LLC
    * Wegmans Food Markets
    * L’Oreal
    * Abbott Pharmaceutical
    * The U.S. Public Affairs Council
    * Swiss RE
    * The U.S. and International Plasma Protein Therapeutics Associations
    * The Cellular Telecommunications Industry Association
    * The American Meat Institute
    * The Consumer Federation of America
    * The Society of Environmental Toxicology and Chemistry
    * The American Nuclear Society (northeast chapter)
    * The College of Physicians and Surgeons of Nova Scotia
    * The 2004 conference of the Institute of Food Technologists
    * The Japanese dairy industry
    * The Heart Rhythm Society
    * Dow Chemical
    * DuPont
    * Entergy Power Corp.
    * The Edison Electric Institute
    * The Electric Power Research Institute
    * ValueMedics
    * Environmental Health and Engineering, Inc.
    * The Environmental Institute for Risk Management of Denmark
    * The American Dental Association
    * The Jack Kent Cooke Foundation
    * The International Association for Public Participation
    * The Guidant Corporation
    * Bayer CropScience
    * The Institutional Review Board, Partners HealthCare
    * The Pennsylvania Dentists Association
    * Center for Risk Communication
    * The Nuclear Energy Institute.
    * The C8 Science Panel, epidemiologists studying PFOA in West Virginia
    * Air and Waste Mgmnt Assoc., NE chapter
    * Massachusetts General Hospital, Clinical Research Department
    * The Consumer Specialty Products Association
    * The Research Institute for Fragrance Materials
    * The Focus Group
    * Boston Scientific

    Link to this
  2. 2. Bora Zivkovic 8:01 pm 07/18/2011

    David is right. Emotions win over reason (see comment above). Sigh.

    Yes, he is a consultant. Yes, his expertise is needed by many – that is how he makes a living. Big deal.

    Link to this
  3. 3. criener 10:27 pm 07/18/2011

    Lynda, you might have taken some of the space in your large comment to address any of his points. Is whooping cough not a problem in Marin County?

    Link to this
  4. 4. Bora Zivkovic 10:33 pm 07/18/2011

    The funniest thing about anti-vaccers when they take the anti-business angle is that they are not aware how unprofitable it is for pharmaceutical industry to make vaccines, let alone develop new ones. Governments constantly have to nag them, plead with them, give them financial incentives, or, in some countries, force them by law to make vaccines at all. Left to themselves, pharmaceutical companies would never make vaccines as that is a total business loss.

    Link to this
  5. 5. CM doran 9:41 am 07/19/2011

    I think that there will always be people who don’t want to do what they see as risky–even when it is to decrease risk for others. I won’t throw up my hands. I just realize that this is the case and work to educate people not yet caught up in the anti-vaccine nonsense.

    @Bora–you are spot-on about pleading pharma to develop vaccines–an important component of preventative health is lacking in many areas of the world.

    Link to this
  6. 6. mem from somerville 10:15 am 07/19/2011

    A common technique of distraction is to claim "shilling" when you can’t argue on the substance. Lynda #FAIL.

    Link to this
  7. 7. yannisguerra 2:44 pm 07/19/2011

    Lynda’s spectacularly rapid response, with a specific message(that seems to be cut and pasted) and a very long post that buries other responses way below the fold seems to reproduce a pattern that I have seen in many other sites that have posts that have anti "anti-vax" messages (like Seth Mnookin’s). This pattern is typical of astroturfing, where they try to get the first comment to orient the discussion away from the points of the post and also to hide favorable comments, as most of the people that are skimming the article will only read the first couple of posts and will leave with the wrong impression about the post. Also typical of astroturfing is that they never answer their critics, or if they do, they use scripted responses.
    This to me is a very worrisome characteristic, as they are using 21st century communication tools (blogs, google alerts, recent findings in neuropsychology) to propagate their 18th century ideology.
    I wonder if we should have our own rapid response team to post science based responses to science-based posts in the internet(instead of the typical posting in antivaxer’s sites that never do much)

    Link to this
  8. 8. michele 7:38 pm 07/19/2011

    you are very wrong.

    VACCINES are the continuing success story, earning over $27 billion in 2009 alone, despite difficult economic times for the pharmaceutical industry.

    By 2012, vaccines are expected to bring in more than $35 billion in revenue.

    Business development heads must take a long hard look at their company’s pipelines and pursue stronger vaccine portfolios. As the global demand for vaccines and their profitability continue to soar, pharmaceutical and biotech companies are increasingly looking for ways to secure the most lucrative partnerships possible to advance their vaccine platform development.

    http://www.iirusa.com/vbc/welcome.xml

    Link to this
  9. 9. Chuck 9:29 pm 07/19/2011

    @Criener: Whooping cough is no more so a problem in Marin County than in any other county especailly since the vast amjority of cases are in the vaccinated population.

    Link to this
  10. 10. James Lachman 10:05 am 07/21/2011

    I was left permanently and severely disabled by the military program of vaccines against biological warfare agents, which I received shortly after a long list of more routine vaccines. How many others have suffered a similar fate is impossible to even guesstimate, as there has been no active surveillance, and no research performed by the DoD other than a handful of epidemiological studies which lacked the power to pick up rates of less than about 1%. The mandate for the vaccines was made without any consideration of risk v. benefit, the vaccines (currently against small pox and anthrax) are given to servicemen for whom the threat of attack with biological weapons is negligible, for example those stationed in Korea, and sailors on warships based in Japan with cruising grounds nowhere near hostile nations.

    Common sense screams out that any large restructuring of the natural order will have consequences that no theory will predict, yet the addition of more and more vaccines to the schedule for children over the last couple of decades was done without any testing for unintended consequences of their cumulative impact. It has been broadly accompanied by large increases in a number of illnesses of the immune system including ASD, yet there has never been one single retrospective study into any potential links, perhaps unsurprisingly in view of the potential ramifications for medical authorities. The recent advances in DNA sequencing technologies that have found contaminants such as porcine virus in vaccines raise the question of what else remains to be discovered.

    A recent study estimated that 43% of American children have at least one of twenty common illnesses, and events are turning into one of the great tragedies of human history. Vaccination remains an unstudied potential trigger.

    It is ludicrous to claim that vaccination does not cause autism based solely on studies of potential derivatives such as ethyl mercury, yet it is a claim often made, others go further and claim that autism in a genetic disorder, with the implication that children who are unable to speak, as is the case in 40% of ASD, were going undiagnosed 25 years ago. With such absurdity coming from medical authorities it is no surprise that opinion polls show 80+% of parents having concerns.

    This article is beyond patronising, it is downright terrifying in its contempt for others. It really brings home the old quote about decisions being better left to the first 400 names in the Boston phone directory than to the faculty of Harvard.

    Link to this
  11. 11. maurinemeleck 8:46 pm 07/21/2011

    I really don’t care for all this psychological mumble jumble and that’s what this risk assessment is. Some people think that if you use a lot of psychological terms- you must be smart and have the right answer. We don’t need all this nonsense.
    We know that tens of thousands of parents saw their normally developing children regress into autism following vaccinations. Now our children suffer from this metabolic disorder that includes oxidative stress,
    inflammatory bowel disease, immune dysfunction, encephalopathy, seizure disorders etc.
    We need a new book written called, "Why Mr. Ropeik’s psychological jargon poses no risk to the autism community because it’s all nonsense to mislead the public about the truth .. What is he suggesting here vaccination by knifepoint?
    Maurine meleck SC

    Link to this
  12. 12. BronwynST 11:30 pm 07/22/2011

    The current Whooping Cough outbreak is likely caused by a relatively new and more virulent strain of Whooping Cough, and this information had been covered in the public news.

    http://www.kpbs.org/news/2010/dec/13/investigating-epidemic/

    Additionally, it has been shown that those who have had the Whooping Cough vaccine are particular excellent carriers of the new strain and more likely to become severely ill with the new strain.
    http://www.cidd.psu.edu/research/synopses/acellular-vaccine-enhancement-b.-parapertussis

    Link to this
  13. 13. capricorn45 6:08 am 07/24/2011

    Nobody is disputing that there are huge benefits to vaccination, but these are purely of a financial nature, to the criminals and the needle nuts who profit from this appalling fraud, which should have been abolished right after it was lauched by Edward Jenner, some 200 years ago. As its is, this barbaric practice has resulted in an unprecedented epidemic of chronic ill-health and neurological disorders, including autism. May the pox strike vaccine manufacturers, needle nuts and pharma shills like Ropeik!

    Link to this

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