Anti-vaccine sentiment: a mile wide but an inch deep

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In the wake of the Disneyland measles outbreak, I wrote about what I believe to be the drivers of anti-vaccine sentiment: privilege, defiance and parental ego.

We have to confront anti-vax parents where they live — in their egos. When refusing to vaccinate your children is widely viewed as selfish, irresponsible, and the hallmark of being UNeducated, anti-vax advocacy will lose its appeal.

It turns out that it was even simpler than that. Anti-vaccine sentiment collapses nearly completely when it costs parents time or money.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Anti-vaccine sentiment collapses as soon as a parental cost is imposed.[/pullquote]

That’s the take home message from Emily Oster’s piece in today’s NYTimes, After a Debacle, How California Became a Role Model on Measles:

Data from a county-by county analysis shows that in many schools with the lowest vaccination rates, there was an increase of 20 to 30 percentage points in the share of kindergartners vaccinated between 2014 and 2016. One law changed the behavior of impassioned resisters more effectively than a thousand public service announcements might have.

That law was California SB 277 and it barred unvaccinated children without medical exemptions from public and private schools. For parents, it suddenly imposed a personal cost to anti-vax sentiment; the price for belief in pseudoscience became the need to homeschool your children. Vaccine rejection collapsed, especially in schools where anti-vax sentiment was driven by privilege, defiance and parental ego.

At the Berkeley Rose School, in Alameda County, only 13 percent of kindergarten students were up to date on vaccinations in 2014…

In the Berkeley Rose School, a private Waldorf school, all of the unvaccinated students (87 percent of the kindergartners) had personal belief exemptions…

By 2016, 57 percent of entering students were vaccinated — a huge change, and that was only in the first year of the law.

When there was apparently no personal cost to refusing vaccination, 87% of the parents refused. As soon as a cost was imposed, the refusal rate was immediately cut in half to 43%. No doubt it’s been cut further still in the past year.

The same thing is happening in Australia with the “No Jab, No Pay” policy.

As the Washington Post reported:

…[A] year ago, the country’s leaders took action. They launched the succinctly titled No Jab, No Pay campaign, which said simply — if you don’t vaccinate your kids, we’re not going pay out the customary $11,500 child-care welfare credit to you. “Conscientiously objecting” on nonmedical grounds wasn’t an option anymore. And all parents had to report their kids’ status to the centralized Australian Childhood Immunisation Register. Parents were given until March 2016 to get their children on track.

…[A] year in, it looks as though the program has had some success. Because of the policy, 200,000 more children received their vaccinations.

When there was apparently no personal cost to refusing vaccination, the parents of more than 200,000 children refused. As soon as they were hit in the pocketbook, the refusal to vaccinate evaporated.

In both California and Australia, anti-vaccine sentiment was a mile wide but only an inch deep. Anti-vaccine sentiment never really reflected fear of vaccine harm; it was just a status symbol among the privileged. It collapsed as soon as a parental cost was imposed.

As Oster notes, regarding California:

When SB 277 was passed, people worried about the possible effects: Would children be pulled out of school? This concern was misplaced. Over all, there has been no change in enrollment, even in schools with the lowest vaccination rates in 2014. People worried that parents would substitute (fake) medical exemptions for belief exemptions. This did happen, a little, but not nearly enough to offset the increases.

In the end, the effect of the law was simple: More children were vaccinated, and the risk of disease outbreaks has gone down.

What does this tell us?

It tells us that anti-vaccine sentiment doesn’t represent principled opposition to vaccines.

If parents truly thought that vaccines were harming their children, barring those children from public and private schools (California) or reducing the child care tax credit (Australia) would have almost no impact on vaccination rates. Parents, fearing serious injuries to their children, would simply homeschool them or do without the tax credit. But when the rubber hits the road — when refusing vaccines imposed a cost on them — parents decide they aren’t really that worried about vaccines after all.

  • The Vitaphone Queen

    Off topic: Check out this petition to American Girl for an Autistic Girl of the Year in 2019!
    https://www.thepetitionsite.com/198/069/509/american-girl-doll-company-create-an-autistic-character-for-girl-of-the-year-2019/
    I can’t sign it myself because I don’t want to give out my street address. Just thought you might like to see this.
    I would love for Autistic girls to see that they’re not destined to be criminals. Especially in this era of armchair-diagnosing the mass shooters and the serial killers.

  • Melissa Wickersham

    I always hate having to fill out paperwork because it reminds me of multiple choice tests and written exams that I needed to take in school. I have to remember the correct information that I need to fill in the paperwork.

  • Melissa Wickersham

    I got my flu vaccine this month. The only thing I dislike about getting vaccinated is the paperwork that I have to fill out. I hate having to sign paperwork, answer questionnaires, and list my primary care provider on the paperwork. I think I misspelled the name of my primary care provider on the paperwork that I filled out. I hate bureaucracy and red tape. I just want to go in to the pharmacy, get the vaccine injected into my arm, and leave without needing to fill out paperwork.
    I don’t mind the pinprick of the needle being inserted in my arm, I don’t care about any adjuvants, and I know that vaccines are safe and effective…..I just dislike having to fill out paperwork in order to get vaccinated.

  • momofone

    BustedHalo, I know this is difficult, but if you can WAIT FOR YOUR COMMENTS TO BE MODERATED, I guarantee you will have plenty of engagement with commenters here. If your certainty that your comments have been deleted are any indication of your certainly about anything immunology-related, it will be quite a discussion.

    • Who?

      Another one, hey? What a treat.

      I see ‘common sense’ is invoked: one of my least favourite reasons for anything.

  • Roadstergal

    Busted, since you can’t seem to take a deep breath and wait for your comments to get out of moderation so you can become a contributing member of the community, the reason why people are laughing at your Gish Gallop is because this same Gallop has been answered many, many times, here and elsewhere, and we’re loath to start the Galloping again from someone we don’t know is amusing enough to be worth it. On that score, once you’re out of moderation (patience, grasshopper, we’ll still be here later tonight, tomorrow, next year):

    Do you stand by your initial comment that we can only make immune responses to living things? I don’t want to distract from your stellar immunological credentials before wading in farther.

    • MaineJen

      I just…I LOVE it when they try to explain immune response. There is nothing more beautiful. I think maybe I’ll ask this one if she can explain the complement cascade.

      • Roadstergal

        Make it easy, ask for just one of them. 😀

      • Considering that ze thinks that every human is a unique entity with an entirely different immune system, and there are no common principles of immune response across humans, this should be fascinating to watch.

        I mean, I’m not a medical professional at all. I’ve learned a ton from all the comments and rants of the medical personnel here, so I’m looking forward to your exposition on the immune system, but I don’t pretend to know much about it. I have the high school biology + YouTube videos version lol.

  • Roadstergal

    Yo, busted halo. Your comments aren’t deleted. Slow down, tiger. I can read them in all their glory. Take a deep breath, stop spamming, and they’ll get out of moderation.

    Word salads of immunological terms only sound impressive to people who don’t know what they’re talking about. They make you sound kinda clueless to everyone else.

    It’s interesting that you ask about antigens, because the antigenic load of vaccines has actually been decreasing over time.

    Yer average vaccine has far fewer antigens than a kid encounters from skinning a knee. The whole schedule does, actually.

  • BustedHalo

    Funny that the immunocompromised are ‘advised’ to not get vaccinated. What’s it gonna do, kill them?

    If a compromised immune system can’t handle the injection, then it stands
    to reason that the injection is life-threatening to the compromised, and
    likely life-threatening to the healthy.

    All newborns ARE vaccinated with the HepB shot, because all their moms are whores, needle junkies and alcoholics. That’s the premise. What if that mom has been tested, and is negative for the HepB infection?

    The purpose of any vaccination is to elicit and hyper-stimulate an
    artificial immune response to the injected viral strains – creating a
    systemic (that’s the entire body) immune response.

    The lab strains are “inactivated” – the integrity of the virus is preserved – not killed. Otherwise, no reaction.

    The body (a living organism) can’t elicit an immune response to something dead.

    How can a vaccinated person protect another? If the injection actually compromises, weakens, that person’s countenance?

    Ultimately, how can a non-vaccinated person be a threat to anybody, then? Their immune system is not compromised by artificial hyper-stimulation.

    Vaccines are just injections of infections. Nothing more, nothing less. With
    booster shots of infections for a lifetime, because immunity is not
    achieved.

    That’s the same as believing that a sickly, diseased, and medicated person is healthy.

    The contradiction is clear, no PhD is required. Just common sense.

    • MaineJen

      The immunocompromised cannot receive live vaccines. That’s all. And as for this comment “The body (a living organism) can’t elicit an immune response to something dead,” are…are you trying to be funny? If not, you’ve succeeded anyway.

      • BustedHalo

        It’s vaccine science, if you read it, to understand it.

        • Yes, she does. You, however, clearly do not understand vaccine science.

          • Or how to put together a coherently-expressed, logically-sound argument that fits known facts.

          • momofone

            And s/he knows how to incorrectly post five versions of the same post and claim they’ve been deleted. We can see them. Please don’t post it again.

        • MaineJen

          B%^&, my “industry” is transplant immunology. I’ve forgotten more about immune responses than you ever knew. COME AT ME

          • Charybdis

            Get’em, MaineJen!!!!

            *shakes pom-poms*

          • MaineJen

            Seems like I won’t have to. He/she has retreated.

      • BustedHalo

        You know that in a free society you’re free to be owned by that industry. If you want to be a lifetime junkie, that’s your right to be.

        I’m only stating the facts. You don’t want to know, you’re also free to bypass my comment and be none the wiser.

      • Roadstergal

        I can’t reply to the original comment, because he’s An Idjit, but – word salads taken from Immunobiology are bad, mmmkay? :p

  • Russell Jones

    “Gimme free stuff, but don’t you dare place any conditions on my right to receive said free stuff!”

    Everyone else paying to educate my child = God-given right

    Vaccination as a condition of attending school = Tyranny most foul

    I loathe anti-vaxxers a little more with each passing day.

    • Who?

      Exactly.

      All about rights, zero interest in responsibility.

    • The Vitaphone Queen

      Tommy Tibble: “Gimme!”
      https://youtu.be/sfr3weCnz-U
      (It’s at the 17:38 mark. Sorry, couldn’t resist.)

  • Ayr

    I’ve said it before and I’ll say it again, unless there is a legitimate medical concern, people who object to vaccinations are just looking for attention.

    • Emilie Bishop

      And when there is a legitimate medical concern, those families often do everything they can that won’t endanger their child. My cousin’s daughter had Guillaume-Barre when she was 3 or 4 and had to delay certain vaccines. She got them as soon as her pediatrician would allow and took extra precautions until then. If there’s no medical need, don’t come looking for sympathy in my family.

      • Ayr

        Precisely! My brother was allergic to everything as a baby so his vaccines were delayed, but my parents did everything they could to keep him safe and healthy, he still got chicken pox at 4 and gave it to me, but that was the worst thing that happened to us. I have no sympathy for anyone who is anti-vax without a legitimate medical reason.

  • Tigger_the_Wing

    It just goes to show, it is exactly as many people have been saying – apart from the proselytising sociopaths, most of the few parents who fail to vaccinate their kids do so for a mixture of reasons; namely: cowardice in the face of needles, an assumption that the diseases have already gone, or nearly gone, away so that the risk is negligible, and a bizarre ‘keeping-up-with-the-Joneses’ attitude.

    Social attitudes to drunken driving where I used to live changed rapidly from the eighties to the nineties; from being regarded as ‘a bit naughty, but understandable’ (because of the rural area) it became universally frowned upon. The same can happen to attitudes to vaccines, as Australia and California have shown. In the drink-driving cultural shift, it was simple. There was a massive educational effort on TV, radio, and in newspapers, and at the same time I started up a taxi business specifically to serve the patrons of all the pubs in the area so that there was no longer the excuse that they couldn’t get home without driving.

  • Sheven

    I’m wondering how the news that there was a measles scare at O’Hare in Chicago will drive vaccination rates up as well. Worked with Disneyland.

  • Emily

    My master’s thesis was on the constitutional feasibility of a federal vaccination policy modeled off of the National Minimum Drinking Age Act, wherein states would lose 1% each year of their federal education funding if they did not pass a law banning religious and philosophical exemptions (a la WV and MS at the time). That is the only way this is going to happen. State mandating of vaccines is the only way to ensure a vaccinated population, people at the individual level don’t have enough stake in the matter to change their opinions.

  • PeggySue

    Just joining to note I saw a news story this AM that someone with an active case of measles apparently went through O’Hare airport in recent days. What could possibly go wrong with THAT?

  • Bored Now

    Agreed. An article about the March protest in DC begins “Dozens of activists”. I think that says it right there. People who are critical of vaccines call the defenders sociopaths, murderers, criminals, shills but they can’t even muster the turnout of a medium sized anti-abortion rally.

    Heck my best friend lives in a neighbourhood where there’s nearly a dozen people who meet every month to protest the local abattoir. One of them even dresses up in a pig suit. You don’t see that level of dedication among the vaccine critics.

    • shay simmons

      I personally would pay money to see one of them show up dressed as Sparkles the Disease Fairy.

      • Bored Now

        If there’s a line at which people cross over from cranks into self-mockery. That would surely be it (although Melanie’s Marvelous Measles treads pretty close to that line).

        If AutismOne ever comes back to Canada – I’d consider trying to get a troll booth set up on the conference floor.

        • The Vitaphone Queen

          AutismOne, yet NO AUTISTIC PEOPLE. How sad. I wish I could join your troll booth but I’m in ‘Murica. (I’m hopefully going to be joining ASAN soon, though.)

          • Bored Now

            AutismOne is generally in the US. However it was once held at the University of Toronto in one of their medical buildings. Once the medical school got wind of it they quickly disclaimed their involvement with the group.

          • The Vitaphone Queen

            We should start AbleismOne and make sure NO ABLEISTS are involved.

          • BeatriceC

            I don’t know why, but your comment reminded me of a funny situation a couple years ago.

            My middle son had broken one leg playing soccer, then the other leg when he wiped out trying to take his bike down a steep hill, with the first leg already in a cast. So we were at the dinner table and the kid asked me to get something or another for him, and my SO, not even thinking said “what’s the matter, your legs broken?” So middle kid looks down at his two casted legs and says “well actually….” and the whole damned table burst into laughter.

          • shay simmons

            Doc T can delete this for dragging politics into the discussion — but remember the Congressional committee on women’s healthcare issues a few years back that had zero women on it?

        • Jack Sprat

          Let me know, I’ll be there. Can I do the Jabs for Geezuz?

  • The Bofa on the Sofa

    People worried that parents would substitute (fake) medical exemptions for belief exemptions. This did happen, a little, but not nearly enough to offset the increases.

    And that is because the number of doctors who will write such things is pretty small, and generally aren’t your family pediatrician. So, do you go out of your way to find celebrity doctors Bob Sears or Jay Gordon (and pay accordingly) or do you just swallow it up?

    • Roadstergal

      Didn’t one of them do a CA-wide SB 277 ‘informational tour’ where he talked to parents afterwards about his pay-to-exempt service?

      Those two are despicable.

      • Heidi

        Ugh, I can’t stand Jay Gordon. Every time he is mentioned, I feel compelled to remind everyone he let a child die of AIDS because “HIV isn’t the cause of AIDS” bullshit he espouses.

        • Roadstergal

          Yes, he helped kill Eliza Jane Scoville.

    • Gatita

      Spears was charged by the California medical board for writing bullshit exemptions without a proper medical exam: http://www.cnn.com/2016/09/12/health/california-pediatrician-sears-negligence-charges/index.html

    • OC mom

      I mean, ya sure, except he’s close to my area. Which means it’s actually easier to ask someone who their ped is than to ask them their position on vaccines. And although there is a note on his license, I can’t imagine that even slows the flood of rich parents seeking him out.

  • Roadstergal

    *ovation*

  • Empress of the Iguana People

    snort. Yeah, it sucks to make your kid cry, but as our forebears pointed out, better to use the rod than spoil the child. Now, we are finding that actually using the rod is a bad idea but having discipline is a good one. Both my kids have had to have ivs before their 2nd birthdays for physical reasons. That is far worse than a couple seconds worth of needle poking. Especially when the ER nurse kept going through his itty bitty veins. Still makes me shudder. 🙁 He doesn’t remember a thing.

    • The Vitaphone Queen

      Oh, I had pyelonephritis when I was 5, and had to go in an ambulance and get IVs in the back sides of my hands (I can’t remember if the IVs were placed before or during the ambulance ride). I still remember lying on my back in the ambulance and alternating the positions of my hands to alleviate the pain.

    • MaineJen

      Both my kids have had IVs too. 🙁 It’s so sad…my son had his when he was a newborn, and they had to insert it into his scalp because the veins in his arms were too tiny. Quite disconcerting. In pictures the apparatus (Access needle/tube/tape) looks like there is a bow on his head. My daughter was 4, and they used numbing gel before inserting the IV in the back of her hand, which helped quite a bit. The whole thing was taped in place with a splint so she couldn’t pull it out. Once she started feeling better, she started messing with the apparatus to the point that they decided to remove it 🙂