The logic of reciprocity-and the illogic of empirically uninformed vaccine risk communication - Cultural Cognition of Health

One of the aims of the CCP Vaccine Risk Perception and Ad Hoc Risk Communication study was to examine the impact of empirically uninformed vaccine risk communication.

By “empirically uniformed risk communication,” I don’t mean vaccine-risk mis information, such as the claim that childhood vaccines cause autism. I take as a given that false assertions like that generate unwarranted public concern.

Rather, I’m using “empirically uniformed risk communication” to denote information that accurately conveys the risks of childhood vaccines–likely for the very appropriate purpose of counteracting misinformation– but that nevertheless embeds that information in empirically insupportable representations about the extent, sources, and consequences of public unease toward universal immunization.

Disseminated by journalists, advocates, and even some public health professionals, this kind of vaccine-risk communication is the type that ordinary members of the public are in fact most likely to be exposed to.

It’s core message is that public health in the U.S. is being threatened by a “growing crisis of public confidence” in vaccines.  No longer confined to “[t]he fringe who don’t believe in medicine for religious reasons,” a “growing distrust of vaccinations” is now sweeping across “our nation’s parents,” we are told (& told & told & told).

The resulting “erosion in immunization rates” is “predictably … leading to the resurgence of diseases considered vanquished long ago” including whooping cough and measles. “From Taliban fighters to California soccer moms,” one source concludes, “those who choose not to vaccinate their children against preventable diseases are causing a public health crisis.”

The CCP study didn’t purport to test these claims. Instead, it deferred to sources that employ valid empirical methods specifically suited to measuring immunization rates and the incidence of childhood diseases.

These sources belie the claim that vaccination rates are declining at all , much less “eroding.”

According to data compiled by the U.S. Centers for Disease Control, coverage for recommended childhood immunizations—including MMR, pertussis, Hepatitis-b, and polio—have all been holding steady at or above 90% (the target threshold) for well over a decade (CDC 2013a, 2008, 2006). The proportion of children receiving no vaccinations has persisted at or below 1%, despite the ready availability of nonmedical “exemptions” from state-administered universal immunization policies for objecting parents.

Rather than a “large and growing number” of “otherwise mainstream parents” refusing to vaccinate their children, the CDC reports (in annual press releases, the language of which varies little from year to year) that“ ‘nearly all parents are choosing to have their children protected against dangerous childhood diseases’ ” (CDC 2010)

There are local enclaves, the CDC cautions, in which vaccination rates are significantly lower than the national average. These enclaves are often the site of recurring localized outbreaks of diseases, like measles, which public health officials have deemed eliminated in the United States but which can be introduced into such communities by individuals infected during travel abroad (CDC 2013b).

Fortunately, “[h]igh MMR vaccine coverage in the United States (91% among children aged 19–35 months),” the CDC states, “limits the size of [such] outbreaks,” which averaged 60 cases per year over the last decade ( ibid. ).

The incidence of whooping cough, which has not been eliminated in the United States, is also likely higher in low-vaccination enclaves (Atwell et al. 2013; Glanz et al. 2013; Omer et al. 2008). But “[p]arents refusing to get their children vaccinated,” according to the CDC, are “not the driving force behind the large scale outbreaks” of this disease in recent years (CDC 2013c). In addition to “increased awareness, improved diagnostic tests, better reporting, [and] more circulation of the bacteria,” the CDC (2013c) has identified “waning immunity “from an ineffective booster shot as one of the principal causes, a view shared by public health experts (Cherry 2012).

Pockets of resistance to vaccination pose a serious and unmistakable public health concern. They merit considered attention informed by empirical methods suited to assessing the influences that generate them, the contributions they make to the incidence of childhood diseases, and the measures that might be employed to counteract and contain them (Opel 2011, 2012; Mnookin 2011; Omer et al. 2008).

But the existence of anti-vaccine enclaves and the dangers they pose do not furnish empirical support for asserting that there is a “growing crisis of public confidence” in childhood vaccines, that “immunization rates with MMR have dropped in . . . the US,” or that a “rising tide of … vaccine reluctance” has generated “a resurgence of diseases gone so long that some doctors don’t even recognize them.”

Such claims reflect not an “epidemic of fear” among ordinary parents, but an epidemic of hyperbole among a diverse collection of actors resorting to ad hoc, empirically uninformed alternatives to genuinely evidence-based forms of risk communication.

I’m sure those engaging in empirically uninformed vaccine risk communication are not doing so in bad faith.

Most probably just don’t know what they are talking about—in part because of the prevalence of empirically uninformed vaccine risk communication.

But some probably do realize that they are in fact grossly mischaracterizing the extent of vaccine avoidance in the U.S., and misattributing to it disease outbreaks that in fact stem from other causes such as the ineffective pertussis booster shot.

They probably figure that this fact-disconnected style of risk communication is okay because it will grab people’s attention and stir them to anger at parents who are not vaccinating their children and definitely should be.