In the late 2000s, I spent a year in Boulder, Colorado with my family. At the time, my two sons were four and two years old. The older one was in a pre-school and the younger one attended a day care for the last six months of our stay. My wife and I were pleased with both facilities. We had kept both boys up to date with their immunizations, but I confess that we didn't give much thought to whether other parents were doing the same. I'm not sure why, but it should have been on our radar. (I think I was more worried about mountain lions.) Anyway, Boulder may be a beautiful place to live, but it is a bubble of health-obssessed and woo-inclined people, a sizable number who are vaccine-averse. As one writer notes, "an estimated seven percent of parents in the Boulder Valley School District opted out of having their children vaccinated in 2011." Colorado happens to be one of those states with a high number of vaccine-refusers. Several years ago, a local Boulder newspaper reported:
A state study of immunization rates found that parents opted out of the measles, mumps and rubella and varicella (chickenpox) vaccines most often.
The recent Disneyland-centered measles outbreak got me thinking again of my time in Boulder and how my kids were potentially exposed to preventable diseases. I'm fairly certain my older son had gotten both of his MMR shots already, since at the time he was 4 years old, but the younger boy may have just received the first one (with the second coming later). Thinking back to that time makes me shudder now. As Virginia Hughes reminds us at Buzzfeed, this is what measles looks like. Many (especially public health care providers) are justifiably concerned about a highly contagious disease like measles gaining a foothold in communities where parents opposed to childhood vaccines have clustered. So other than tightening personal exemption laws, what are some of the means that can be used to persuade the small percentage of anti-vaccine parents to immunize their kids? Unfortunately, giving them--and I'm talking about those who most strongly object to vaccines--more information (with scary images of sickened children) seems to backfire, as a recent study led by Brendan Nyhan showed. So if science communication isn't working, what about legal consequences? This argument for holding vaccine resisters legally accountable for harm was made in a 2013 paper, whose lead author is a prominent bioethicist. A post this week at Forbes by Dan Diamonds is in favor. His headline:
Measles is Spreading and Kids are at Risk. Sue Parents Who Didn't Vaccinate? Absolutely.
It bears watching if this idea gains traction. Meanwhile, what about public ridicule and shame? Lobbing insults at parents who are already hostile to vaccines is likely to make them dig in their heels. But what about the fence-sitters, vaccine-wary parents with unformed views? A reader in the comment thread of my last post wondered if
maybe some public shaming works on a subset of the fence-sitters. Has anyone asked that? Maybe some people don't want to be in the Venn diagram with people who put their kids at risk unnecessarily once they realize there is an actual threat. And that some people have really strong negative feelings about those that don't vaccinate their kids.
Julie Leask, an Australian social scientist who studies risk communication strategies (particularly as they apply to the vaccine issue), responded:
This is a really good question. Vaccination is a social practice - parents are influenced by what they perceive their peers to be doing, what social norms are at play in their communities, whether vaccination symbolises good parenting (or not), and when they think others aren't vaccinating. When parents in general see vaccination so strongly reinforced as a societal norm and the outrage at non vaccinators, perhaps this provides an extra 'shield' against being influenced. We don't know but let's imagine that shaming as a purposeful and condoned public strategy worked in preventing some tip over towards non-vaccination or even getting some selective/delaying vaccinators to change their minds. Would the ends justify the means? How much of an effect would public shaming need to have and what would be the unintended consequences, including stigmatisation of their children and polarisation and division in communities? As a researcher of vaccination behaviour I say it's an empirical question. As a mother committed to civil society I say let's find better ways. Regardless, it's going to happen anyway, such is the emotion that active non-vaccination initiates. Highly recommend On Immunity by Eula Biss for a thoughtful take on the issues.
Okay, what about smacking down the celebrities who spread fear and misinformation about vaccines? They seem deserving of contempt. The comedian Bill Maher has a long history of absurd and dangerous anti-vaccine statements. (In 2009 he famously told his Twitter followers that they were idiots if they got the flu vaccine.) He was at it again recently on his HBO show, when during an interview with Atul Gawande, he said:
It’s a big scam to make money, but flu vaccines are bullshit. I was right, wasn’t I, Doc?
I understand that social media plays a big role in perpetuating false information about vaccine safety. (Journalists can only play whack a mole so often.) The activists who traffic in this propaganda should be held as accountable as the parents who believe it. And then there are those with huge media platforms, like Bill Maher, who continue to sow doubt about vaccines. That has real consequences. What do bioethicists have to say about that? UPDATE: I saw this USA Today op-ed after my post went up. It's by Alex Berezow, founding editor of RealClearScience, who says flatly:
Parents who do not vaccinate their children should go to jail.
It's a hyperbolic piece, so I'm sure it will fire people up. UPDATE: In his LA Times column, Michael Hiltzik writes that
the best approach may be to step up peer pressure in favor of vaccination, perhaps by making it socially unacceptable.
UPDATE: Via NPR, "To protect his son, a father asks school to bar unvaccinated children."