Vaccine refusal stems from ignorance of immunology, so it would make sense that correcting their erroneous beliefs with facts would reduce the incidence of vaccine refusal. Unfortunately, the opposite is what actually happens.
Nyhan and colleagues tested a variety of vaccine information interventions and found:
None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.
In other words, more education did not change uneducated beliefs.
That’s not surprising when you consider that anti-vax advocacy is based nearly entirely on motivated reasoning, cherry picking poorly done, non-replicated findings instead of relying on the massive body of scientific literature that shows vaccines to be safe and effective.
Moreover, anti-vax advocacy is not about vaccines or even about children. It’s about parents and how they wish to see themselves: educated, defiant of authority, and empowered. Within certain “natural living” communities, vaccine refusal has become a social norm. Therefore, to address it we need to make it an unacceptable social norm — just like we have done with drunk driving.
In truth, vaccine refusal is no different from drunk driving.
They share several important characteristics.
Over-estimation of abilities: Anti-vaxxers are sure that they are smarter than the average person; drunk drivers believe that alcohol does not impair their fantastic driving skills.
Harm to others: Anti-vaxxers rarely harm themselves since they refuse vaccines on behalf of their children. Sure, they put their own children at risk but they put other more vulnerable children (infants, children suffering from cancer) at much greater risk. Similarly, while drunk drivers can and do kill themselves, they pose a tremendous threat to other drivers and pedestrians, not to mention the people who are in the car with them.
Defiance of authority: Those rules about vaccination and drunk driving? Those are for other people, not them.
Empowerment: Anti-vaxxers imagine themselves to be empowered by “doing their own research” and driving drunk makes some drivers feel powerful.
I’m old enough to remember when drunk driving was acceptable. That has changed dramatically through public relations campaigns designed to shame drunk drivers. These campaigns contain information on the harms and risks of drunk driving, but more importantly, they characterize drunk driving as selfish, irresponsible and socially unacceptable. These campaigns succeeded where merely providing information had not.
We need to make vaccine refusal equally socially unacceptable and for the same reasons; both involve individuals who harm others while overestimating their own abilities, defying authority and enjoying a sense of empowerment and both reject the facts.
But won’t that backfire? Won’t anti-vaxxers just get angry and refuse to listen? The existing research on drunk driving suggests that it will not.
Since vaccine refusal is about parents and how they want to view themselves, it would be very hard for them to present themselves as educated and empowered if everyone else believed them to be ignorant and selfish. When declaring yourself to be an anti-vaxxer brings only eye-rolls, condemnation and pity, most anti-vaxxers will start vaccinating their children once again.
Obviously any attempt to increase vaccination rates will need to be multi-pronged, but I suspect that painting anti-vaxxers as reprehensible is going to be by far the most effective strategy. They are no better than drunk drivers and should be treated with similar scorn.
