The latest measles outbreak in California has brought vaccines back in view for a new round of public comment. “You should get your kids vaccinated,” said a blunt President Obama in an interview with NBC News, “I understand that there are families that, in some cases, are concerned about the effect of vaccinations … [but] the science is, you know, pretty indisputable.”
On the other side, by contrast, was New Jersey Gov. Chris Christie, who didn’t endorse anti-vaccination beliefs but left a little space for them to breathe. “Mary Pat and I have had our children vaccinated, and we think that it’s an important part of being sure we protect their health and the public health,” said the likely Republican presidential candidate while in Cambridge, England, “I also understand that parents need to have some measure of choice in things as well, so that’s the balance that the government has to decide.”
And Kentucky Sen. Rand Paul, weighing in Monday, not only said that vaccination should be voluntary, but claimed outright that vaccines were tied to autism. “I've heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines.”
The president, of course, is right on this question. Public health depends on near-universal vaccinations. It’s how we protect children, the elderly, and others from diseases that can easily pierce weakened immune systems. But while I support mass vaccination—and would vaccinate my children, if I had them—I can also understand the forces that drive parents to try to opt out of this particular obligation to society.
Chief among them is fear. Read anti-vaccination websites or listen to anti-vaccination advocates—or just talk to the anti-vaccination believers in your life—and you’ll sense the fear that permeates the movement. One father, writing for the website Modern Mom, acknowledged the risk of disease and the sometimes awful consequences of childhood contagions, but countered with this: “[T]he same image runs through the mind of a parent who has fears about their child’s 12-month [measles, mumps, and rubella] shot. ‘Will my baby have an anaphylactic reaction? Could she be that 1 out of 1,000 that will have febrile convulsions?’ ” Likewise, the New York Times quotes one mother who can’t bear to imagine what would happen if scientists were wrong about the MMR vaccine and autism:
“It’s the worst shot,” she said, with tears in her eyes. “Do you want to wake up one morning and the light is gone from her eyes with autism or something?”
And this Arizona father, quoted by CNN, is willing to put other children at risk to protect his sons and their “purity”:
“I’m not going to sacrifice the well-being of my child. My child is pure,” he added. “It’s not my responsibility to be protecting their child.”
CNN asked Wolfson if he could live with himself if his unvaccinated child got another child gravely ill.
“I could live with myself easily,” he said. “It’s an unfortunate thing that people die, but people die. I’m not going to put my child at risk to save another child.”
The irony is that this fear is a product of success. By the end of the 20th century, Americans had defeated the deadly illnesses that still claim children in other parts of the world. Indeed, we were so thorough in cleansing our country of epidemic child illness that we lost our memory of the time before vaccines, largely before World War II, where thousands of infants died of now-preventable diseases. It is a testament to our triumph that, for today’s parents, a disorder like autism is more real—and the cause for more fear—than a disease like measles.
It’s this fear that, when coupled with deep skepticism toward authority, the erosion of ideas of public duty or obligation, and a large community of cultural fellow travelers, produces a wide and easily entered gateway to anti-vaccination belief and practice. And once in, it’s incredibly hard to pull someone back from the world of vaccine skeptics. On social media, the popular strategy is ridicule and disdain. It doesn’t work. Like any affiliation, anti-vaccination beliefs become stronger when attacked by outsiders. But then, reason doesn’t work either.
In a 2014 study for the journal Pediatrics, political scientist Brendan Nyhan tested four different pro-vaccine messages, all centered on the MMR shot: One based in the science of vaccines, one based on the risks of catching an illness, one based on the “true” story of an infant who caught measles, and one showing images of incredibly sick children. Could any of these messages—three of which were based on information from the Centers for Disease Control—budge anti-vaccine parents away from their beliefs?
No. The most graphic approaches—which illustrated the dangers of disease with pictures and stories—prompted a backlash. Hearing the narrative almost doubled the odds respondents would think the MMR vaccine had dangerous side effects, while looking at the images increased subjects’ belief of a link between autism and vaccines. And while the more sober messages didn’t cause a reaction, they didn’t persuade either; respondents all but shrugged after learning the facts on vaccination, autism, and disease.
So far, we don’t have a sure answer for how to convince parents to choose vaccines. But that’s not to say we don’t know how to increase vaccination rates. We do, and it’s through force. The two states with the highest vaccination rates are West Virginia and Mississippi, and they achieve this with strong public health programs and mandatory vaccination laws with strict standards for exemptions. Neither state, for instance, allows religious or philosophical exemptions to vaccine requirements for schools. Either you vaccinate your child, or she doesn’t attend class.
The pharmaceutical industry is large, wealthy, and prone to bad behavior. That some Americans would respond to this with deep distrust of the medical establishment isn’t unreasonable, and that some of this would turn into fear of vaccines isn’t absurd. But while vaccine-anxious parents deserve our empathy, that doesn’t mean they can dictate the health of the public.
Put another way, I want to persuade these parents that vaccines would be best for them and their children. But if persuasion doesn’t work, then I’m OK with coercion, too.
Read more of Slate’s vaccines coverage, including: