The ongoing measles outbreak in the U.S., which has spread to 14 states, has provoked a rising vilification of parents who refuse to vaccinate their children. This vilification is understandable, but it’s also potentially dangerous. Many who are being castigated aren’t changing their minds. Under attack, they are instead defending their choices more fiercely and working ever harder to promote their anti-vaccine arguments and influence other parents still trying to figure out what to do.
Unlike larger past outbreaks elsewhere, the concentration of cases associated with iconic Disneyland is provoking increased media attention and alarm. It’s natural that people—and many media pundits—would react by blaming the seemingly selfish parents whose unfounded fear of vaccines prompts them to place the safety of their own kids above everyone else’s. Parents who have chosen not to vaccinate their kids at all (refusers) or those don’t follow the recommended vaccination schedule (hesitants) have been threatened with legal action, and they and their children are being shunned and treated as social pariahs. Doctors are kicking patients out of their practices who don’t vaccinate. Some suggest parents who don’t vaccinate their kids should go to jail.
But show me a group of parents who have chosen not to vaccinate their kids, and I’ll show you a group of parents who… care about their kids. They may also oppose vaccination because of strong libertarian, ‘get-government-out-of-my-life’ views, or because their back-to-nature environmental values lead to sweeping concerns about anything human-made. And they may share these views among the friends and neighbors they’ve chosen to live among, producing the isolated geographic pockets of vaccine hesitancy reported in a recent paper in the journal Pediatrics. But at their core, parents who don’t vaccinate their kids or who vaccinate less than health officials recommend, are only doing what good parents are supposed to do: keep their kids healthy and safe.
This is not to defend the choices they make, choices that put not only their own children but also other people in their communities at risk. Looked at from outside the homes of vaccine refusers and hesitants, it is easy to call those decisions selfish, ignorant “science denialism,” informed more by passion than reason.
But consider those choices from inside the homes of the parents making them. Put yourself in their shoes. Parents trying to figure out what’s best for their infant or toddler are thinking about their own kid, not anybody else’s. That’s not selfish. That’s being a good parent. Parents who feel that government is butting into their lives with mandatory childhood vaccination are unlikely to trust the government’s health recommendations about what’s safe for their kids. Parents who feel that the industrial world has befouled the natural one might be motivated to oppose chemicals like vaccines that they assume to be harmful just because they believe they’re unnatural.
Yes, vaccine refusal and hesitancy do real harm, not only to unvaccinated kids but to many others: infants too young to be vaccinated, people in whom vaccines don’t work or with weakened immune systems, communities that have to spend millions to control outbreaks. Yes, that harm results from parents thinking more with their hearts than their head. But let’s be fair. We all do the same thing. The study of the psychology of risk perception has established that our judgments and decisions about any possible danger are the product of both the facts and an emotional assessment of how those facts feel. Concerns about vaccines may not match the evidence, but to the people who hold those concerns they feel correct.
This means that vilifying and demonizing vaccine refusers for the way they feel is counterproductive to public health. Calling people trying to protect their kids selfish and irrational is tantamount to saying “I don’t care how you feel. Your feelings are wrong. You should feel the way I feel.” One need not be an expert in risk or health or science communication to see how that is likely to make things worse, not better. Views stiffen. Minds close. If parents are attacked for being a Whole-Foods-shopping, Prius-driving greenies or an anti-government, Don’t-Tread-On-Me-right-wingers, any ambivalence they might have about whether to vaccinate their kids is overwhelmed by the instinct to stick up for and promote the common views and values of their friends and neighbors and the groups with which they identify.
Sadly, while school records can identify where parents live who have chosen not to vaccinate their kids, we are only speculating about why they make those choices. Distrust of government or industry, environmentalism, and religion all seem to be playing a role, and of course many parents have become hyper protective of their kids. But research needs to confirm why people make the choices they make about vaccines because any effective communication effort to influence people’s views must be based on an understanding of their values and feelings. That doesn’t mean agreeing with their views. It just means empathizing with how people feel before offering information about vaccination, from a trustworthy source that specifically responds to the various reasons why they feel the way they do. Respectful communication is more than just presenting the facts the communicator wants to present. It requires acknowledgment of the other parties’ feelings, and it sure doesn’t include calling people names.
This matters, because while a small number of parents have proven impervious to information and education and refuse to vaccinate their kids at all—fewer than 1 percent of children in America between 19 and 35 months old are completely unvaccinated—many more parents are hesitant, picking and choosing which vaccines their kids get or delaying when they get them. As a result the CDC reports that the rate of measles, mumps, and rubella (MMR) vaccination is below target levels in 17 states, and rates of childhood vaccination for several other diseases are also below recommended national levels for optimal public health.
Effective, respectful communication and education can still help shape the choices of the wider group of hesitant parents. It can influence the millions of parents who do vaccinate their kids, but harbor some doubts about the safety of vaccines generally. It can certainly help with the millions of Americans who have heard about vaccine fears and don’t vaccinate themselves. (Fewer than half the Americans who should get flu shots each year do, and many say they don’t because of fear of vaccines.) Respectful risk communication is also vital to counteract the commercial hucksters and anti-vaccine propagandists making a living from feeding people’s fears.
Unfortunately, the passions about vaccine refusal or hesitancy run deep and no amount of communication will change some minds. Society has a right, well established in law, to protect itself in response. It should be harder for parents to opt out of school vaccination programs, which in most places is as easy as signing a form. Several states are already working on this. Economic costs via higher health insurance premiums or deductibles should be imposed on those whose health choices impose risk and costs on the wider community. Yes, children who are not vaccinated must be treated as a health risk and quarantined from participation in social activities and kept out of their schools when there is even the possibility that they might be infectious. The vilification of vaccine refusers and hesitants will likely make it more politically feasible to take such steps.
But before the vitriol toward vaccine refusers and hesitants grows too shrill, those of us who criticize vaccine refusal and hesitancy as a selfish emotion-driven denial of the evidence and a threat to public health, need to consider how we level that criticism. Dismissing such fears as irrational and vilifying vaccine refusal and hesitancy as ignorant and anti-social may be factually accurate, and understandable as the fear of a resurgent disease spreads, but it is emotionally arrogant and combative, and could make the problem, and public health, worse rather than better.