Vaccine refusal is the equivalent of drunk driving

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Vaccine refusal stems from ignorance of immunology, so it would make sense that correcting their erroneous beliefs with facts would reduce the incidence of vaccine refusal. Unfortunately, the opposite is what actually happens.

Nyhan and colleagues tested a variety of vaccine information interventions and found:

None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.

In other words, more education did not change uneducated beliefs.

That’s not surprising when you consider that anti-vax advocacy is based nearly entirely on motivated reasoning, cherry picking poorly done, non-replicated findings instead of relying on the massive body of scientific literature that shows vaccines to be safe and effective.

Moreover, anti-vax advocacy is not about vaccines or even about children. It’s about parents and how they wish to see themselves: educated, defiant of authority, and empowered. Within certain “natural living” communities, vaccine refusal has become a social norm. Therefore, to address it we need to make it an unacceptable social norm — just like we have done with drunk driving.

In truth, vaccine refusal is no different from drunk driving.

They share several important characteristics.

Over-estimation of abilities: Anti-vaxxers are sure that they are smarter than the average person; drunk drivers believe that alcohol does not impair their fantastic driving skills.

Harm to others: Anti-vaxxers rarely harm themselves since they refuse vaccines on behalf of their children. Sure, they put their own children at risk but they put other more vulnerable children (infants, children suffering from cancer) at much greater risk. Similarly, while drunk drivers can and do kill themselves, they pose a tremendous threat to other drivers and pedestrians, not to mention the people who are in the car with them.

Defiance of authority: Those rules about vaccination and drunk driving? Those are for other people, not them.

Empowerment: Anti-vaxxers imagine themselves to be empowered by “doing their own research” and driving drunk makes some drivers feel powerful.

I’m old enough to remember when drunk driving was acceptable. That has changed dramatically through public relations campaigns designed to shame drunk drivers. These campaigns contain information on the harms and risks of drunk driving, but more importantly, they characterize drunk driving as selfish, irresponsible and socially unacceptable. These campaigns succeeded where merely providing information had not.

We need to make vaccine refusal equally socially unacceptable and for the same reasons; both involve individuals who harm others while overestimating their own abilities, defying authority and enjoying a sense of empowerment and both reject the facts.

But won’t that backfire? Won’t anti-vaxxers just get angry and refuse to listen? The existing research on drunk driving suggests that it will not.

Since vaccine refusal is about parents and how they want to view themselves, it would be very hard for them to present themselves as educated and empowered if everyone else believed them to be ignorant and selfish. When declaring yourself to be an anti-vaxxer brings only eye-rolls, condemnation and pity, most anti-vaxxers will start vaccinating their children once again.

Obviously any attempt to increase vaccination rates will need to be multi-pronged, but I suspect that painting anti-vaxxers as reprehensible is going to be by far the most effective strategy. They are no better than drunk drivers and should be treated with similar scorn.

  • MayonnaiseJane

    This is exactly the sort of tactics that should be used on the fact-averse population. There’s always some naive hopeful wandering around asking everyone to be civil and respect one another, and saying shaming and other social pressures don’t work, and only serve to make us look like the bad guys. They advocate that we should talk it out rationally, but time and time again we see that for people entrenched in dangerous and counterfactual beliefs, only social pressure will work. The only real progress made, for example in Racism (which isn’t fixed by a long shot, but has seen significant movement) is that it came to me socially unacceptable to express racist views. The backslide we’re seeing now is because people dislike the social response they get to that and are trying to change that rather than modify their behavior. If the social pressure continues, they will eventually be forced to capitulate. We should never underestimate the power of social restraint within communities.

  • Eva

    https://m.youtube.com/watch?v=5vG_emYtgV0

    Vaccines are good, but why not try to make them safer and better? What’s the harm? Science is always changing and advancing, so let’s use it.

    • MaineJen

      Seriously???

    • Azuran

      And what makes you think that we aren’t already doing that?
      Vaccines are already practically the safest medical tool we have and many of them are extremely effective. And we are still constantly trying to make them safer and better.

    • Chris Preston

      Medical science has been making vaccines safer and better for more than 50 years. It does so by analyzing the adverse events doing research to understand why they occur and making changes to the vaccines when necessary. The move from whole cell vaccines to acellular vaccines for pertussis is one example of a change to increase safety.

      Kennedy and De Niro are doing absolutely nothing for vaccine safety with their stunt. All they are doing is encouraging people not to vaccinate, which risks the return of harmful diseases. In 2015, there was the first death from acute measles in the US for over a decade. This death was due to the activity of anti-vaccine people.

      This whole stunt by Kennedy and De Niro is extreme nonsense. Other than multi-vial flu vaccines (and these are not normally given to pregnant women or infants) there is no thimerosal in pediatric vaccines and hasn’t been for 15 years. So proving thimerosal is safe is completely irrelevant.

  • yentavegan

    And with media celebrities ( Don and Diedre Imus) promoting anti-vaccine legislation we are headed for a tsunami of preventable illnesses.

  • Laura

    I agree. Anti vaxxers are not persuaded by real information. We need to stop waiting for anti-vaxxers catch up to what the experts have already agreed on. Anti vaxxers should be shunned.

  • Mariana

    OT. I need to vent… I am so done with the conspiracy theory nuts I work with! I only get a short, 15 min break to have dinner (let’s not get started on that…). Every other week the topic at the table seems to be “how cancer is so prevalent these days and how big pharma will never let us have a cure…”. It’s so much misinformation together it gives me a headache…. Like, someone is “hiding” THE cure of cancer (as if it was a single problem). Kennedy promised to put a man on the moon and find the cure for cancer… He put a man on the moon, so someone is hiding the cure for cancer somewhere… (sure… It’s the same thing. Politicians never make promises they can’t deliver, right).

    The problem? I can’t even talk to them rationally… I have a background in literature (as they do too). They say I don’t know enough science to say what I say, I’m simply uneducated.

    I don’t have a background in science… True… But how can I convince these people that just because someone said something on the internet it doesn’t make it true? Or that big pharma would make even more money from the cure of cancer than with the current treatments? Or that big pharma executives and CEOs also die of cancer, like everybody else (so why would they be hiding a cure?).

    Yesterday I just got up and left to finish my dinner out in the hall…

    • Roadstergal

      It’s so massively frustrating. :

      I always recommend the book The Emperor of All Maladies. It does a good job of explaining the massive diversity of illnesses that is cancer – but also the long, tough road of developing better treatments for some of them.

      If your co-workers are the readin’ type, it’s a Pulitzer-prize winner and a really engaging read.

    • Kelly

      They don’t have a background in science either so I am not sure of why they think they know more.

    • mabelcruet

      It’s very frustrating. There’s no such disease as just ‘cancer’. There are hundreds of different types of malignancy affecting all of the organs, and each individual organ can develop multiple different forms of malignant disease (hopefully not all at the same time). It makes absolutely no sense that there is a single cure because it’s not a single disease. Some are of low mortality (basal cell carcinoma of the skin, for example, or follicular carcinoma of the thyroid), whilst others are very high risk of mortality (the nasties like esophageal carcinoma or pancreatic carcinoma). Some respond to hormones which can affect their growth or inhibit their growth. Some are extremely sensitive to radiotherapy and shrink right down when treated, others have no response to it. There simply isn’t some form of superdrug out there that we are keeping secret. It’s a bizarre belief.

  • Mel

    I suspect that many anti-vaxxers are secretly motivated by cowardice; being anti-vaxx lets you avoid the unpleasant experience of having your kid get shots.

    Parents don’t have the luxury of being cowards.

    I’ll admit that watching Spawn get his two-month vaccinations was a bit nerve-wracking for me. He needed three shots into two very small legs! Even with a dose of sugar water, he did cry when the shots were given. And…then he stopped crying and fell asleep.

    He was more cranky than usual for the next day so I came into the hospital early and started rocking him. That worked pretty well – he’d fuss, I’d give him his paci, I’d rock while shushing or cooing and he’d fall asleep for 15 minutes to a half-hour and the cycle would start all over. I was enjoying being able to comfort my baby effectively and giving myself a pat on the back when he started fussing again. I couldn’t get him to root because his OG tube tape was blocking his lower lip so I gently maneuvered the tape…and had a solid inch of tape drop out of his mouth.

    Turns out he was freaking out because medical tape tastes terrible – or as Nico put it, “Ahhh! My paci went bad! Ahhhh!”

    Spawn cried a whole lot more at the terrible, horrible, mean Mom and nurse re-taping his OG tube (a painless procedure) than he did at his shots, FYI. After that, he slept for 45 minutes to an hour at a time…..

    • Kelly

      I always tear up at my kid’s first shots. It is so sad to watch but I swear they cry more because they are being held down than the actual shot itself. I love how they have such spunk even when they are little and helpless.

      • Empress of the Iguana People

        my daughter had ivs first (she’s fine) so the vaccine needles weren’t quite as bad, but oh the outrage! Bad nurse! Bad Mommy! Bad, bad bad! okay i’m ready for my snack now

        • Kelly

          In my opinion, IVs hurt so much worse than shots. Poor baby and mom. They can’t understand that by hurting them you are actually helping them.

          • Empress of the Iguana People

            aye. My son was a fairly bright 20 month old but he couldn’t understand the IVs when he got them, either. (he had a broken femur). No pin prick ever compares to listening to you child sob uncontrollably betweeen multiple iv sticks and a broken leg.

      • Steph858

        If it’s any consolation, my 2-year-old son’s picked up Conjunctivitis from his nursery (it’s been going around there). Trying to get a single drop of Liquid Chloramphenicol in his eyes is a lot harder than holding him while a nurse gives him a shot. It also results in a lot more crying. It’s got to the point now where I have to hide the bottle behind my back till he’s safely pinned down because he’ll run away, kick and scream with all his might if he catches sight of that bottle.

        While eye drop sting a little, they don’t hurt THAT much. So yes, they’re crying because you’re holding them down more than because of the pain of the shot itself.

    • Amazed

      Prepare yourself, Mel. You seem to have a storm of energy waiting to come home. On the plus side, looks like you won’t ever have to worry about Spawn suffering in silence… he WILL make his misery clear to everyone within an earshot. Handy, I think,

  • myrewyn

    a close friend of mine has a daughter who had a serious adverse reaction to a vaccine. This was years before we met so I don’t know details but I do know she was hospitalized, medical consensus was that it was indeed a rare vaccine reaction, and she was given a medical exemption from future vaccines. So did my friend, living in the crunchy PNW, turn rabidly anti vax? No, she made sure her other two daughters were vaccinated to help protect the one who couldn’t be, although I’m sure it scared the shit out of her. So what makes some intelligent, educated people react like my friend did and others cling to fear of something extremely remote?

    • Roadstergal

      How many people whose kids have bona fide vaccine reactions go anti-vaxx, though? All of the ones I’ve heard about have kids with ‘vaccine reactions’ that aren’t.

    • Steph858

      Slightly OT, but your story jogged my memory.

      When I was a kid, I discussed vaccines with my mum (yes, I was interested in all things scientific even at the grand old age of 8). She told me: “Just before you were due for your MMR (this would have been around 1992 give or take a year if anyone wants to do the googling I can’t be bothered with), I saw a news story that said that vaccines manufactured before a certain date should be avoided. With this in mind, I took you for your MMR and asked which batch they were going to give you. Turned out the vaccines they had were from the old batch. I told them about the news story I’d seen and they said they’d look into it. I refused the vaccine then and brought you back a couple of weeks later when they’d swapped out the old ones for the new ones. Just think: if I hadn’t kept up-to-date with current affairs, you could have ended up severely disabled! Now let me finish watching the news, chatterbox!”

      I always thought she was referring to side-effects of the old vaccines when she said I could have ended up severely disabled. But when I discussed this story with her again when I was a bit older, she explained that the old vaccines were less effective than the new ones, meaning a kid vaccinated with an old vaccine would be (very slightly) more likely to catch Measles, Mumps or Rubella. When she said ‘severely disabled’, she was referring to the potential effects of catching one of the aforementioned VPDs, not to a side-effect of the vaccine itself.

      But even when I was under the misapprehension that the old vaccine was associated with a higher risk of a severe reaction, I still thought “If I had been born a few years earlier, before the new vaccines were invented to replace the old ones, I still would have wanted to get the MMR jab as the slight risk was well worth the benefits.”

  • Empress of the Iguana People

    It’s scary how many anti-vaxxers actually do have an education. Obviously not in immunology, but they do have one. My elderly uncle was under the interesting belief that I should be slow tracking my kids’ vaccinations (something he’d been hearing about in his circles) and he’s got a phd and was a professor! Fortunately, he backed off when I diplomatically said some version of bugger off, i’m siding with the kid’s pediatrician. (this was when BoyBard was GirlBard’s age)

  • Adelaide GP

    Excellent article, as always! Another approach that has worked here in Australia is to hit the hip pocket. The “no jab no pay ” program was introduced in early 2016, and makes immunisation an essential requirement to access family assistance payments . http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/67D8681A67167949CA257E2E000EE07D/$File/No-Jab-No-Pay.pdf
    Conscientious objection and vaccination objection on non medical grounds is no longer a valid exemption.
    It has worked very well! But obviously we do have a different system to US re government payments / family tax benefits etc )

  • Sheven

    This is definitely the strategy. Get them in the ego.