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In the wake of Wakefield: Risk-perception and vaccines

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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.

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

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