Anti-Vaxx: Misunderstanding or Mistrust?

A mother brings a child with a high fever, diarrhea, and swollen lymph nodes into a hospital emergency room. The physician on duty orders a series of blood tests and quickly determines that the child has measles. At the same time, another child is admitted into a different hospital in the same area with similar symptoms and, is also determined to have measles. The local public health department is contacted and, they start a campaign to try and prevent a further spread of the disease.

This hypothetical scenario has now become a reality the United States where there are at least 121 cases of Measles have been documented in recent weeks. Considering that measles is a vaccine preventable disease there has been considerable outcry from the public as to how this was allowed to happen. Why were so many people not vaccinated? 

The outcry over why people were not vaccinated is more recent. Over the last decade there has been a growing number of people who are choosing to not vaccinate. These are not only people who have religious objections but, also people who believe that vaccination is potentially unsafe. The most famous of these anti-vaxxers is Jenny McCarthy. She is famous for arguing that vaccines can cause autism. 

Of course most of these types of arguments are based heavily on a now discredited New England Journal of Medicine article that drew a false connection between vaccination and autism. There is an overwhelming amount of scientific literature that demonstrates that vaccines are not only successful but, they are also safe for most people. Though this scientific evidence does not seem to matter to anti-vaxxers.

However, these individuals cannot simply be misunderstanding the literature. Their behavior cannot simply be explained as scientific know-nothing-ness of fundamentalists. The anti-vaxx movement has significant support among the educated, wealthier segments of society. Therefore, the behavior of these anti-vaxxers may be explained by their mistrust of the traditional institutions that guide public health as opposed to a general misunderstanding of the science behind vaccines.

Over the past couple of weeks there have been countless debates in all media outlets over how to tackle the problem of non-vaccinated individuals. Generally, the supporters of vaccination will repeat similar talking points highlighting the misunderstanding of the science by anti-vaxxers and ultimately endorsing policy change that would force everyone to get vaccinated. However, this approach may not be as successful as advertised. 

To clarify, government mandated vaccination has worked (in general). This does not mean that it will always work. Especially, when the group that is being targeted for intervention has a mistrust of the government. Furthermore, these individuals will always have the option to claim religious objection to vaccination (regardless of their true beliefs) as a final form of resistance to government mandated vaccination.

The solution to the problem is health promotion and community outreach. This would involve media campaigns and small town halls at the community level to help convince and, gain the trust of the anti-vaxxers. Simply presenting the data and highlighting the obvious benefits is not enough, as evidenced by the current dilemma. The health promotion and community outreach based approach to advance behavior change has worked. Take the example of smoking. Smoking is a highly additive activity. While the science explaining it deleterious effects on the human body has been widely published since the 1970s, it was not the science alone that led to behavior change. A long term, concerted health promotion and community outreach effort over the last 40 years has changed the United States from a country where smoking was ubiquitous to one where many places are smoke free.

Simply highlighting the research that supports vaccination will not be enough to convince anti-vaxxers. Data by itself does not convince people, people convince people. Health promotion and community outreach may take more time to solve the problem but, it is the more permanent solution.