Parents who refuse vaccines do so from a position of privilege

The privilege that has allowed parents to refuse immunizations for their children comes not from economic or educational status; it springs from the privilege of not having seen the horrific diseases that ravaged U.S. children just two generations ago, and continue to do so worldwide. Vaccine refusal is a disheartening side effect of the success of vaccines. Most young parents have only seen vaccine-preventable diseases in pictures of starving children in the developing world or as comedic fodder in cartoons, suggesting that those diseases can’t happen here or that they are nothing to fear. These impressions could not be more wrong; vaccine-preventable infections are occurring throughout the U.S., and their return is frightening.

Before the measles outbreak that began in Disneyland in December 2014, the last major outbreak of measles in the U.S. occurred from 1989 to 1991, resulting in 55,000 cases and 123 deaths. At that time, there were still enough pre-vaccine era doctors around to recognize measles. But even then, few physicians under 35 had seen measles, and during the early days of the outbreak, afflicted children were frequently misdiagnosed and not properly treated.

That was 26 years ago, and that’s about the average age of new parents, including vaccine refusers. They haven’t seen measles and don’t know that it isn’t just a rash. Measles can be a devastating disease that invades the lungs and chokes the life out of infants and children. The virus can cause deafness or inflame the central nervous system and cause encephalitis, which can rob the victim of basic brain functions such as breathing and eating. Seven to 10 years later, measles infection can cause the meninges (the covering on the brain and spinal cord) to unwind. That condition, called subacute sclerosing panencephalitis, is rare but, is lethal. The complications occur more frequently in children younger than 5, or adults older than 20 years of age.

Measles is easy to talk about now; the number of recent cases associated with the Disneyland outbreak has reached 162. The virus spread because our population had reached a critical mass of unvaccinated — our “herd immunity” has been compromised. But the problem is bigger than measles, and resurgence can happen with any vaccine-preventable disease, as we’ve seen with pertussis (whooping cough) and chicken pox in recent years. No vaccine is 100 percent protective or free of risk; that’s true for nearly all things in life and to expect otherwise is unrealistic.

The idea that vaccines could cause autism is one of the most common fears voiced by  vaccine refusers. But scientific data have repeatedly assured us that no link exists. Andrew Wakefield, the doctor who put forth that association, has been disgraced, his data proven fraudulent, and his original Lancet report officially retracted. His discredited research has done a huge disservice to the world.

Subsequent research has shown that there’s no link between the MMR (measles-mumps-rubella) vaccine and autism, but that has not allayed the vaccine fears and refusals. Why? Brendan Nyhan, a health policy researcher, and his colleagues performed a study about vaccine misconceptions to assess the effects of providing accurate vaccine information to ant-vaccine parents. In the study, parents were given evidence-based information about the MMR vaccine from the Centers for Disease Control and Prevention, images of children with the infections, a dramatic story about an infant with life-threatening measles and data supporting that measles vaccinations do not cause autism.

After reviewing the info, the parents were less likely to believe the myth that a link existed between MMR and autism. Surprisingly, however, the parents most committed in their anti-vaccine beliefs were now even less likely to vaccinate their children. Counterintuitive, right? What could explain this thinking? Robert Cialdini, a social psychologist, has described such behavior as “commitment and consistency” — the idea is that humans strive to act consistently with their previous commitments so as to not be perceived as unstable.

So, what can we do now to give anti-vaxxers the opportunity to reconsider data that could change their positions? Education about the diseases and the vaccines does matter, but the method of delivery is even more critical than the message. Calling names, as some doctors and media have done, certainly won’t encourage vaccine resisters to listen to the message. Think about it; when is the last time you listened to someone who called you “dumb” to start a conversation? A handful of the vaccine-refusers will never hear the message but some will. Keeping in mind the lessons from social psychologists, we need to give vaccine refusers a respectful opportunity to change their minds.

But time for vaccine-refusers to ponder their decisions is a luxury that we don’t have – the resurgence of vaccine-preventable diseases is an imminent threat. In response, lawmakers have proposed legislation to protect the health of the public by vaccinating individuals. The California Senate has successfully passed Senate Bill 277, which removes personal belief exemptions for nearly all children attending daycare and public schools. Exemptions for medical reasons remain intact. The bill,is currently in the state Assembly, and if it passes there, Governor Brown is expected to sign it.

Vermont’s Governor Peter Schumlin beat Governor Brown to the punch. On May 28, Shumlin signed into law, a bill removing all philosophical exemptions to vaccination for schoolchildren in his state. Vermont joins Mississippi and West Virginia as the only states that do not permit non-medical exemptions. 

The laws prohibiting personal belief exemptions are controversial, though the science supporting vaccines is not. As a pediatrician, I wholeheartedly believe that no stable, loving parents would intentional cause harm to their child. I believe this of anti-vaccine parents too; they are acting in what they perceive as the best interest of their children, but choose to dismiss inconvenient facts. The facts are vaccines save lives. In 1900, approximately three in 10 infants died before their first birthday. By the end of the 20th century, in large part due to vaccines and improved standards of living, the rate had decreased to 7.2 deaths per 1,000 infants. Preventable harm is lurking, as we have clearly seen with the rapid spread of measles from the happiest place on Earth to all corners of the globe. It is a small world, after all.

An earlier version of this story was originally published at Neon Tommy.