Misrepresenting the Debate: Measles’s Other Problem

Kids line up for vaccines in the 1940s. Courtesy of Library of Congress and The New York Times
Kids line up for vaccines in the 1940s. Courtesy of Library of Congress and The New York Times

I found myself rolling my eyes every time a news anchor looks solemnly into the camera and reports on another minuscule facet of the measles debate. I thought news agencies were whipping up a fervor that just didn’t exist in the general populous. But then I began to grow concerned… what if I was wrong? As an Emergency Manager (EM), it’s my job to deeply understand my constituents. Whether people live, die, or lose everything depends on my ability to make my warnings intelligible, acceptable, and actionable. Besides, I should probably stay sharp on current events, no?

Unfortunately, at the top of Google searches are lots of bloggers and pundits blaming elitist liberals or recalcitrant conservatives. I’m not interested in the vitriol associated with blaming this group or that group. While I disagree with anti-vaccine arguments, I want to know who they are and why they are. Is it true that they are a large group, especially given that the scientific and political communities seem to agree vaccines are necessary?

Fortunately Dan Kahan, the Elizabeth K. Dollard Professor of Law and professor of psychology at Yale Law School, was as curious as I was. He surveyed 2,316 U.S. adults in order to assess public perceptions and attitudes about vaccines. As Time reports, those opposed to vaccines are generally random.

There was a modest minority of respondents who held a negative orientation toward vaccines. These respondents, however, could not be characterized as belonging to any recognizable subgroup identified by demographic characteristics, religiosity, science comprehension, or political or cultural outlooks. Indeed, groups bitterly divided over other science issues, including climate change and human evolution, all saw vaccine risks as low and vaccine benefits as high. Even within those groups, in other words, individuals hostile to childhood vaccinations are outliers.

Indeed, “There is deep and widespread public consensus, even among groups strongly divided on other issues such as climate change and evolution, that childhood vaccinations make an essential contribution to public health,” says Kahan.

Click for larger view
Pew Research Results

In fact, it seems like the greater debate is about whether the government should mandate vaccines or whether it should be up to parents. Pew Research Center reports that the majority of older Americans tend to believe vaccinations should be mandated while 41% of Millennials (18-29 y/o) think parents should decide. (See graph.)

So what?

Who cares what anti-vaxxer demographics look like? The important thing is that they’re wrong, right? Well, not exactly. It turns out accuracy about public perception is incredibly important for one simple reason: self-fulfilling prophecies. When public educators like the CDC, politicians, doctors, scientists, and Emergency Managers believe that there is resistance to their message, they will act in such a way that actually arouses the resistance they feared. Kahan states in the abstract of his research paper: “…that ad hoc [off the cuff without consideration for broader context] forms of risk communication that assert there is mounting resistance to childhood immunizations themselves pose a risk of creating misimpressions and arousing sensibilities that could culturally polarize the public and diminish motivation to cooperate with universal vaccination programs.” In other words, when people believe there are two fighting sides, they will pick one to join. So when news agencies give voice to an outlier minority, they are in fact stirring up damaging controversy and making mine and the CDC’s job harder.

But we have to be fair, don’t we?

No. We have to be accurate. Misrepresenting the strength and validity of an opposing argument is not fair. Kahan urges those working in public health to (1). use empirical data to assess public opinion; (2) discourage risk communication (public health messages) which are based on anecdotal evidence or gut reactions as to the broader context; (3) “publicize the persistently high rates of childhood vaccination” in conjunction with “…[the] high levels of public support for universal immunization in the U.S”; and (4) correct communications which misrepresent U.S. vaccination coverage and its relationship to the incidence of childhood diseases.

#3 is especially important because when people hear that most people are vaccinating their children, they tend to be more willing to vaccinate their own children (advertisers use this principle all the time). I think as public health educators, we’re worried that when people hear that most everyone is vaccinating their children they’ll think it isn’t as important to vaccinate their own children.

Looks like we need some data to back that up. In the mean time, let’s stick to what we know for sure.

Further reading:

  • CDC says Measles is so infectious that if one person has it, 90% of the unprotected people around him/her will catch it. Furthermore, if it doesn’t kill you, you could be permanently brain damaged, blind, or deaf.
  • PBS says there’s no cure once you catch Measles. Only prevention. If you do catch Measles, all doctors can do is treat symptoms and hope your body is strong enough to resist.
  • Concerning “eradication” and “herd immunity” : CDC FAQ page
  • NPR reports on psychological considerations RE: why parents won’t vaccinate
  • NY Times “Fear of Vaccines Goes Viral” article
  • Time Magazine: vaccines are non-partisan
  • Harris Poll on what people believe about vaccines
  • Pew Research Poll on what people believe about vaccines
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