There is pervasive cultural consensus on the value of childhood vaccines in the U.S.; so why do people *think* that being anti-vaccine reflects any particular cultural predisposition?

A reporter who was covering the current measles outbreak asked me a question about the connection between vaccine hesitancy—the reluctance of parents to get their kids vaccinated—and the contribution cultural or political predispositions make to vaccine risk perceptions.

In the background of the question were a couple of facts that this reporter gets but that a lot other reporters and people generally don’t: first, that parents in the US along with rest of the general public in this country are overwhelmingly pro-vaccine; and second, that the people who belong to the small segment of the population that is anti-vaccine are big time outliers in all the social groups—cultural, political, religious and so forth—that make up our basic inventory of “who” people are.

On the first point, briefly: Despite the media din to the contrary, the US has enjoyed impressively high childhood  vaccine rates—over 90%, the public health target, for all the recommended universal vaccinations, including MMR—for going on 15 yrs.  The percentage of parents not getting their kids vaccinated has remained below 1% that entire time.

Fortunately, the Wakefield affair, which did have a significant impact on vaccine behavior in the UK (maybe other countries, too, but the truth is, many European countries have lower vaccine rates than they should have had for a long time), didn’t have a comparable effect in the US.

On the second: As documented in various places including the CCP  Vaccine Risk Perceptions and Ad Hoc Risk Communication study, there is no meaningful correlation between vaccine risk perceptions and the sorts of characteristics that usually indicate membership in one or another cultural group.

The correlation between such risk perceptions and political outlooks, e.g., is close to nil.

Likewise, contrary to the empirically uninformed, illiberal, counterproductive “anti-science trope,” the cultural groups whose members are divided on climate change and evolution are in fact in overwhelming agreement that vaccine benefits outweigh their risks.

Still, the reporter wanted to know, given all this, how come it appears to him and others that there is a correlation between anti-vaccine, or concerned about vaccine risks, and a cultural style that is, I guess, left-leaning in politics, anti-industry or –capitalist, highly “naturalist” etc.

Very reasonable question.

What’s more, I don’t have an answer that I’m particularly confident in!

I do have some conjectures, and so I thought I’d share them here & ask others what they thought.

Also, at about the time I was writing this email, Chris Mooney was addressing this same question in thoughtful essay that I encourage others to read—I think my views are pretty close to his!

My thoughts on this question:

I’m really not sure what to say, but my hunch is that there is a huge sampling bias risk here when we try to draw on own experience to figure out vaccine risk perceptions.

It’s clearly the case — just no arguing w/ it, really! — that the vast majority of people in US, including parents, are not hostile to but in fact very favorable disposed to childhood vaccinations.  This is true across all the sorts of cultural groups that normally come to mind when we think of risk issues like climate change etc. where there really are very deep & strong cultural divisions.

Yet some people are clearly anti-vaccine. If we see them, what are we to make of them?

It’s hardly a surprise that they will have integrated their views into their cultural understandings generally.  That is, there will be coherence, for them, in their positions on vaccines and their ones on various other issues.

So if they happen, say, to be the kind of person who has an egalitarian, collectivist style & is anxious about environmental issues & suspicious of corporations and the like, then their positions on vaccines will likely be of a piece with that.

But then if we were to say to ourselves, — “a ha! Being anti-vaccine coheres with being that sort of person!,” we’d be making a mistake.  At a minimum, we’d be making a mistake b/c we’d be neglecting to consider all the people who share that person’s cultural style — and indeed hold the standard collection of risk perceptions that go along with it — but who don’t have anxieties about vaccines!  Those people would outnumber the anti-vaccine mom or moms we are talking about — by orders of magnitude.

We’d also be at risk of making another mistake.

That particular anti-vaccine group of moms you ran into — they might not even be representative of all the other anti-vaccine folks.  Indeed, if you met them at whole foods (I have no idea if this applies to you, but you’ll get the idea), then likely your sense of what the anti-vaccine people are like is undercounting all the anti-vaccine people who don’t shop there.  They don’t shop there b/c doing so would be contrary to their cultural style.  They might be very conservative — maybe they are religious fundamentalists of one sort or another.  Those might be people you never happen to run into!  As a result, the people who are like that who are anti-vaccine will be missing from your mental census.

Of course, so will all the people “like that” who are not anti-vaccine.  They will, just as in the case of the moms at whole foods, outnumber the anti-vaccine members of their groups by orders of magnitude.  But possibly b/c they are more likely to encounter anti-vaccine types in the community in which they interact w/ people most of the time, they might also have a misimpression that anti-vaccine people actually are more likely to hold values like theirs!

Now one more really really important thing:  I actually am pretty convinced that most of the parents whose kids miss vaccinations are not part of any movement.

The “movement” is there, but it is small & gets way more attention than it deserves precisely b/c it is loud, in people’s faces, and really good at provoking hysterical denunciations of them.

But more importantly, there’s every reason to believe that most of the parents whose kids are not getting vaccinated don’t belong to any movement at all.  These are parents who are just nervous, not agitated.

They aren’t loud and obnoxious.

They aren’t demonstrating or getting in anyone’s face.

They are not wearing buttons saying “vaccines give kids autism! McCarthy for President   in ’68 ’16!”

And for that reason it’s actually hard to find them–which is very unfortunate b/c almost certainly they could be reassured by a good public health professional trained to give them sensible, evidence-informed risk counseling.

The best work being done on vaccine hesitancy is the research to develop a screening instrument for new parents to identify which ones are likely to end up w/ kids who miss vaccination.  With that sort of instrument in hand, ongoing empirical research to develop an effective risk counseling protocol targeted at these very parents could be carried out much more effectively too.

Rather than propagating the misimpression that a “growing crisis of public confidence” among “a large and growing number” of “otherwise mainstream parents” has generated an “erosion in immunization rates”  in the U.S. (these are in fact demonstrably false claims), those who truly want to make universal vaccination in this country even more effective should be calling for more resources for the scientists doing this excellent and vital research.

It’s fine to criticize the small cadre of attention seekers who are spreading misinformation about vaccines. They are a bunch of idiots & a menace etc.

But engaging in relentless, self-important, attention-grabbing displays of denunciation in return is itself dangerous for the vaccine science communication envirionment, and distracts us from what’s really needed: the development of valid, reliable methods that practioners can use to identify the much larger group of parents who are merely anxious and supply them with tailored risk counseling that would give them the same sense of relief & happiness that everyone else gets from knowing that their kids won’t get the horrible disease that were our grandparents’, great grandparents’, great-great grandparents’ et al’s biggest nightmare.

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