Dr. Schreiber of San Augustine giving a typhoid innoculation at a rural school, San Augustine County, Texas. April, 1943. Photo by John Vachon.
By Mike Kuczkowski
I live in Marin County, Calif., just north of San Francisco via the Golden Gate Bridge. It is one of the most strikingly beautiful places I’ve ever seen, and I’ve seen a lot of beautiful places. With a median income of $94,347, Marin ranks 13th in the nation in per capita household income[i]. Most people—actually 54.6 percent of those over 25—are college graduates. In short, it’s an affluent and well-educated place.
Yet, Marin is also an epicenter of the anti-vaccination movement. More than six percent of the incoming kindergartners in our public schools have a “personal belief exemption,” which means they don’t have to be immunized against diseases like measles, mumps and whooping cough. (At one local school, the rate is 61 percent.) That’s the highest rate in the Bay Area, one of the highest in the state. By contrast, the entire state of Mississippi, which has a much more stringent policy around medical exemptions, allowed just 17 of the state’s 45,000 kindergartners to not be vaccinated.
With more than 100 confirmed cases of measles, a disease we had nearly eradicated 15 years ago, there’s now a great debate about why we allow people to opt out of immunizations. In Marin, the father of a 6-year-old boy with leukemia and a suppressed immune system due to his treatments, has made national news by asking public health officials to bar unvaccinated kids from his son’s school. It’s the only way, he says, to protect him son from a potentially deadly infection.
The issue of personal belief exemptions, vaccination science and perceived links to autism, which persist despite a complete lack of scientific basis, illustrate just how persistent myths can become, and how hard it can be to change minds. For marketing and communications professionals, it serves as a reminder of how vital it is to continually reinforce even the most straightforward messages and infuse them with humanity and relevance.
First, let’s examine the science. In 1998, the British Journal The Lancet published a groundbreaking study by a British doctor and researcher named Andrew Wakefield, who claimed he had found a link between the measles, mumps, rubella (M.M.R.) vaccine and the onset of autism. Wakefield’s research, which took an in-depth look at 12 autistic children, prompted a sharp decline in the vaccination rate in the United Kingdom and the United States. For many parents of autistic children, the study offered an explanation for a painful and as-yet unexplained phenomenon.
The problem was, the paper wasn’t true. Other researchers who tried to duplicate Wakefield’s results – a key tenet of the scientific method – were unsuccessful. New claims emerged that Wakefield had an undisclosed financial conflict of interest. Eventually, his co-authors backed away from the article’s claims. Since Wakefield’s initial publication, more than a dozen studies including millions of children showed no link between autism and the M.M.R vaccine. In 2010, The Lancet took the rare step of retracting Wakefield’s article. Two years later, British medical authorities stripped him of his license.
That’s as emphatic a “correction” as one will ever see in a peer-reviewed journal, yet many people still don’t know that that study has been thoroughly discredited.
There is another strand of thought that ties autism to a preservative called thimerosal, which has a form of mercury in it that has been suspected of having a role in autism. No connection has ever been proved, and thimerosal is no longer used in most vaccines (an exception being the flu vaccine).
In sum, there is no credible scientific argument against vaccinations. The evidence in support of vaccinations is robust. The lone article that suggested a link has been retracted. End of story.
Yet, it’s not. The genie is out of the bottle. In 2008, nearly one in four Americans said that because vaccinations may cause autism, it would be safer not to have children vaccinated at all. Nineteen percent more said they were not sure. A recent poll by the Pew Research Center showed that 30 percent of Americans say parents should be able to decide not to vaccinate their children.
This issue of choice is a very slippery one. A key precept of mass immunization is that if most members of a community are immunized, outbreaks of a disease are more likely to be contained. By allowing people to opt out of vaccines, the risk that more people will get sick goes up significantly. As policy decisions go, choice sounds appealing, but it also carries risks.
How can there be a clear scientific consensus that vaccines are not harmful, and yet 43 percent of Americans say they either believe vaccines cause autism, or are unsure? I’d suggest there are at least three major factors at play.
First, autism is a scourge, and we don’t know what causes it. It is probably one of the most emotional and fear-laden issues a parent faces – am I potentially exposing my child to harm? The early symptoms of autism tend to emerge at around the same time as children are being vaccinated. Parents may perceive a connection, even if it is merely a coincidence, and they become believers. In the absence of an answer, lots of lay hypotheses take hold. Yet this is precisely why we need science. As recently as the 19th century, people believed that diseases such as cholera were spread through miasma, or bad air, which explained why epidemics centered on poor areas with unhygienic conditions. Germ theory gave us a better explanation. (See Steven Johnson’s The Ghost Map for a riveting account of this transition.)
Second, many people today distrust the government. And while most Americans acknowledge that science has made the world better, they still distrust scientists on key issues, like climate change, pesticides, and even the theory of evolution. As a result, when the American Academy of Pediatrics and the Institutes of Medicine dismiss studies, it’s like white noise.
Third, and perhaps most concerning, people don’t understand science and scientific language in particular. It would seem, from a distance, that science is all about proving things. Electricity lights bulbs. Heart attacks cause death. But in reality, most scientific inquiry is very cautious in its assertions, and very incremental in assembling a body of knowledge. When researchers appropriately list limitations or caveats on their findings, it can seem like they doubt their conclusions. Yet that’s not really what’s going on. If you look at the Institute of Medicine’s most recent study on the adverse effects of vaccines, there is some risk that your eyes will glaze over. (“(E)vidence favors rejection of five vaccine-adverse event relationships, including MMR vaccine and autism…”)
What should we do about all of this?
The first thing leaders and communicators need to do is have the courage to engage unfriendly audiences. We should hear the opponents of vaccines out, but we should also continue to talk about the science.
The second thing we need to do is stick to a singular message and deliver it everywhere. Communications research shows that people need to hear a message 5-7 times before they believe it, and more often if they don’t trust the messenger. That means there should be a significant, sustained campaign to reinforce the benefits and address concerns about vaccines.
But we have tools to do that. We can use social media to respond to people who continue to tout bad science as a basis for anti-vaccine arguments. If we work at it – and use clear, accessible language – we can increase awareness that there is no scientific basis for many of the anti-vaccine movement’s claims.
The third thing we can do – and I think this would be a huge opportunity for the pharmaceutical industry – is trot out real scientists to communicate in clear language their expert perspective on these issues. Utterly unqualified people are standing up and speaking out in favor of a vaccine-autism link, with no credible evidence behind them. Where are the bench scientists, the safety and risk management analysts, the medical leaders of pharmaceutical companies who have a stake in helping the public understand that these vaccines are safe. (Note I did not say, where are pharma’s CEO’s; the reputation of the industry is such that the business leaders are not trusted. Scientific expertise, however, is still valued.)
We can change policies, mirroring more of what Mississippi has done and less of what California has done, to make exemptions harder to obtain. But I think the starting point is a clear, loud, science-based communications effort to help people understand the facts – and the very real risks – about this issue.