This is part two in a three-part series. Here are parts one and three.
Yesterday’s post introduced the first five misconceptions much of the public and the media have about parents who don’t vaccinate – and I’ve already heard some pushback. Regardless of whether parents fully, partially or never vaccinate, we all have our belief systems, which we guard intensely. Research has shown individuals resist corrective information when it counters beliefs we feel deeply about. The more passionately you feel about vaccination, the less likely you are to believe information, no matter how evidence-based, that contradicts your ideas. Regardless, misinformation can be harmful, even misinformation about a group many already see (legitimately so) as threatening public health. Misconceptions and stereotypes lead to stigmatization, which can further alienate non-vaccinating parents from the public health system. That alienation harms both those unvaccinated children and public health as a whole.
So whether correcting that information fails or succeeds (or makes people dig their heels in further), I’m still going to counter it based on peer-reviewed research and interviews with researchers who specifically study vaccine hesitancy. One such researcher is Daniel Salmon, deputy director for the Institute for Vaccine Safety at Johns Hopkins Bloomberg School of Public Health, who told me of those who don’t vaccinate, “I think people make caricatures out of them.” History has shown us how damaging it is to make caricatures out of a group of people – even a group whose choices may risk the health of young, immunocompromised, elderly or sick individuals. Sure, there are fringe folks who share many of the stereotypical characteristics of a hard-core “anti-vaxxer,” but they’re the outliers, the fringe. Frankly, they’ve always been there, they’ll always be there, and they’re small enough in number that we can usually absorb the risks they pose. But if we inaccurately apply that caricature to the larger group of parents who don’t currently vaccinate but might, if their concerns were effectively addressed, then alienating them may lead to risks we can’t absorb. So on to the myths…
Myth #6: “Parents who don’t vaccinate are stupid and uninformed.” Sorry, they’re not.
Fact: Non-vaccinating parents are often intelligent, very well educated and very well informed – it’s just that it’s nearly always with the wrong information. “We are intuitive risk assessors and weigh the pros and cons of various choices based on how much good they are likely to do, or harm,” said David Ropeik, a former director of risk communication at the Harvard Center for Risk Analysis. “This isn’t perfectly scientific, of course, and therein lies the problem.” Research has shown that motivated reasoning plays a big role in how individuals respond to threats to their deeply held beliefs. Motivated reasoning is, in plain terms, moving the goal posts, but it’s done to protect a belief system. It’s not about intelligence or education – several studies have found pockets of vaccine refusals among more highly educated communities (though this varies geographically) – but rather about how strongly a person believes something.
In fact, some non-vaccinating parents may be so highly educated that that’s part of the problem. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, has suggested to me previously that non-vaccinating parents with higher incomes and higher education may be used to having control over every other part of their lives so they expect they can “do the research” themselves and have sufficient knowledge to come to a conclusion they perceive to be as valid as that of researchers who have spent years studying vaccines. They fall prey to the Dunning-Kruger effect, mistakenly overestimating their own skills in assessing studies. They would likely not presume to know how to repair their computer without specialized tech knowledge, but they don’t see researching vaccines as requiring specialized knowledge. They see it not as fixing a compute but as researching online what computer to purchase. Call it hubris, but it’s not stupidity.
Finally, it’s important not to conflate “uninformed” with “misinformed.” Many parents who don’t vaccinate have invested hours and hours into researching vaccines. To call them stupid or uninformed completely misses the problem. They are incredibly well informed – with cherry-picked or misleading information. Don’t believe it? Try this experiment: get into a conversation with a parent who adamantly and vocally does not vaccinate. Ask for evidence. Prepare for an onslaught of links to medical studies that will make your head spin. The problem is that those studies either don’t say what the person thinks they say, are unrepresentative case reports, are poorly conducted, or have never been replicated and confirmed through other research. What they miss is that it’s about the consensus, not about a random assortment of studies tainted by confirmation bias.
And if you really want to go down the rabbit hole (though, truly, I don’t recommend it), visit the sites of the extreme conspiracy-touting anti-vaxxers, like Sherri Tenpenny and Kelly Brogan, and see how their carefully curated, heavily cherry-picked studies all point in the direction they want you to believe – a direction against the consensus of the evidence, but pseudo-intellectual and convincing to laypersons.
It's not about lack of information about vaccines. It's about misinformation, and the problem has... [+]
Myth #7: “Parents who don’t vaccinate think they’re smarter than their doctors.” Not always.
Fact: Non-vaccinating parents don’t think they’re smarter or dumber than doctors – they think they have better data (even when they don’t.) This misconception somewhat follows the previous one, but it’s more than that. It’s actually reasonable to question your doctor. Consider the old joke: What do you call the person who graduated last in his/her med school class? Answer: Doctor. There are good doctors and bad doctors, and everyone knows that, so why are we pretending it’s any different with vaccines? (In fact, I’ve written previously about doctors who spread misinformation about vaccines.) If your doctor is prescribing antibiotics, it’s reasonable to ask if they’re necessary. If you have concerns about vaccines, it’s reasonable to ask your doctor to address them. And “because I said so and I went to medical school” doesn’t cut it. No doctor can keep up with the mountains of evidence published every week, and parents know this. If they come in armed with a stack of studies showing this or that vaccine may have risks they’re not comfortable with, they might think that’s research their doctor hasn’t seen before. It’s reasonable to ask – that’s part of a doctor’s job. And if their doctor has seen it before, then the parent will want their doctor to address their concerns. This isn’t an insult to the doctor. It’s the way the patient-doctor relationship should work.
As I write this, I can hear all the doctors I’ve spoken to in the past silently cursing me under their breath and muttering about insurance company billing and how short well-child visits are and so forth. I agree – doctors do not have the time (and sometimes current enough training) that they need to address parents’ vaccination concerns, and insurance companies don’t give them a way to bill for extra time. This is a problem, and research shows it takes a toll. But it doesn’t mean parents who have questions or anxieties about vaccines – which is many, many parents – think they’re smarter than their doctors; they have high needs and high expectations.
Yet doctors – whom parents actually overwhelmingly say they trust most when it comes to vaccine safety concerns – may push these uneasy parents even further away. Consider this anecdote: Dan Salmon, now a vaccine researcher at Johns Hopkins but previously Director of Vaccine Safety at the National Vaccine Program Office, noticed his daughter’s pediatrician kept asking him to sign off on receiving Vaccine Information Statement sheets for his daughter’s vaccines but never actually gave him the VIS sheets, an unethical practice at best. Finally, the fourth time it happened, Salmon waited until the doctor had a free moment to discuss it after seeing other patients. But when he raised his concern, “He went nuts on me,” Salmon said. “That’s not terribly reassuring. Instead of listening to what I was saying, he just got really defensive and really aggressive, so when I hear from parents that they came in with questions about vaccines and their doctors became angry and defensive, I’m not surprised.”
Myth #8: “Parents who don’t vaccinate fear vaccines will give their children autism.” Enough already!
Fact: Parents have many, many concerns about vaccines, and autism is often low on the list, if it’s on the list at all. Yes, there was a fraudulent study by an unethical no-longer-doctor named Wakefield that falsely tried to link autism and the MMR vaccine. Yes, it caused a fuss (to say the least). Yes, dozens of studies since then show no link to autism. And yes, there are still parents who worry about it anyway. But for many parents, the “Omigod Autism!” fear jumped the shark long ago, and they have moved on to concerns about “too many, too soon,” or “toxic ingredients.” To keep using autism as a scapegoat for all parents’ concerns is offensive to many (happy) families with autism and insulting to all the parents with other questions and concerns they want addressed.
Myth #9: “Non-vaccinating parents all believe or fear the same thing.” Goodness, no.
Fact: Parents skip vaccines for all sorts of reasons, and their doubt and beliefs are all over the map. Vaccine hesitancy is complex. Really complex. They have fears about vaccine side effects, they have religious or philosophical objections, they incorrectly believe the disease isn’t harmful, or, yes, they don’t trust the government. They may very precise fears about a specific ingredient, or they may have concerns about a specific health condition their child has. They may know someone who believes their child is vaccine-injured. They may have had a bad experience with a past doctor. They may have had a vaccine reaction as a child themselves. They may have had a previous bad drug reaction. They may not trust pharmaceutical companies. They may not trust the FDA. Heck, they may have been all for vaccination until a doctor persuaded them otherwise! One study identified 147 factors that somehow related to vaccine acceptance, delay or refusal. Why does this matter? We can’t address a problem until we understand it. If we lump together all non-vaccinating parents into one monolithic mass and assume we know what all their concerns are, we will fail to address the problem. We will fail them, their children and the public. If this were straightforward or easy, it wouldn’t be a major public health problem stumping the experts. As Jessica Atwell, a PhD student in vaccine research at Johns Hopkins Bloomberg School of Public Health, and her colleagues and advisors have said, “It’s not a one-size-fits-all problem, so there won’t be a one-size-fits-all solution.”
Myth #10: “Parents who don’t vaccinate are all selfish narcissists.” Nope.
Fact: Most non-vaccinating parents care about all children, but they worry about their own child’s safety. Are they looking out for their child first? Absolutely they are, and any parent who says they’re not doing the same is a liar or a bad parent. (Yes, I went there.) We all look after our own children first. “Keeping our kids alive keeps the species going, one of the deepest genetic imperatives of all species,” Ropeik told me. Remember Tara Norman, non-vaccinating mother of two from Montgomery County, Maryland? She told me the only reason she vaccinated initially, despite feeling uneasy about it, was that she was not a selfish person. “They [her doctors] made me feel like I was selfish if I didn't continue,” she said. “I understand there are children who are too young to vaccinate or immunosuppressed. I understand that if there's an outbreak, I will have to keep my kid home. But I'm not [vaccinating] anymore, and don't tell me I'm a bad person because I'm not.”
Are there selfish narcissists who don’t vaccinate their kids and don’t care about others? Yes, there are. And I’m sure there are more than a handful of selfish narcissists who vaccinated their kids but send their kid to class with a peanut butter and jelly sandwich despite a classmate’s peanut allergy. Parents come in all stripes, and there’s not data that more selifishness lives among non-vaccinating than vaccinating parents. Further, alienating a non-vaccinating parent doesn’t solve anyone’s problem, Salmon points out. “If they don't vaccinate their children, are they a bad person? No. They may be misinformed, they may have reached a different conclusion based on the evidence than I have reached, and the science doesn’t support their concerns, but that doesn't mean they're a bad person,” he said. “Most people who actively refuse, they do so because they think that's best for their child.” Frankly, that’s our job as parents. We’re all doing the best we can.
Tune in tomorrow for the last five misconceptions about non-vaccinating parents. If you missed yesterday's, it's here.
