Friday, 5 November 2010

Responses to Anti-Vaccine Activism

Housekeeping: Due to an upcoming marriage preparation course my fiancée and I are undertaking this weekend, this post must needs be a great deal more abridged than the others.

Responses to Anti-Vaccine Activism

Having superficially examined anti-vaccine activism this week, I want to wrap it up by reviewing some of the possible responses. I would like to touch on how we can respond to anti-vaccination activism in terms of policy, in terms of media, in terms of scientific inquiry, in terms of interpersonal communications, and in terms of self-reflection.

For another viewpoint on this subject, from a veteran of the vaccine debate, check out today's post at Respectful Insolence (check out the suggestions from the commenters and the exchange when commenter Kelly appears on the scene.

Policy Response

In my opinion, it so happens that in Canada and the US there is not, in fact, a great requirement to alter our status quo policy on mass immunization in response to anti-vaccine activism.

To be sure, pediatrician/pediatrics associations, public health agencies, and ministries of health & safety should continue to encourage high rates of vaccine uptake and to vigourously challenge blatant falsehoods when they appear.

But that is about it.

As an aside, I do think it is a reasonable idea for Canada to implement a compensation programme for people who suffer long-term harm from demonstrable adverse effects from vaccination (as I noted in Monday's post, no nation-wide programme exists in this country), or to at least implement plans at the provincial level, or to at least ensure that public insurance plans offer some sort of compensation.

After all, at least one of the calculations made in deciding to vaccinate oneself or one's children is the knowledge that it is not just a self-interested move, but also in the aggregate interest of everyone. Also, in Ontario (and indeed almost any other jurisdiction), having children immunized is prerequisite to putting them in school.

Media Response

By contrast, I think a very robust media response is required in the face of anti-vaccine activism. The response in the online media, to the Mercola-NVIC 'Vaccine Awareness Week' has been very well undertaken (more on that tomorrow), and as long as there are those consistently dedicated to spreading awareness of what we know of immune system function and vaccines and of demonstrating how anti-vaccine activists offer up demonstrably false claims and misleading advocacy, I think that anti-vaccination efforts online will come to naught.

In the print and broadcast media, there is much to be done. It is less likely that anti-vaccine activists will be quite as vituperative when appearing on television or radio, or when writing for major newspapers. But they will more carefully screen their intentions. At the same time, there are a lot of well known traditional-media personalities who are altogether too indulgent of demonstrably incorrect statements of fact (Larry King, Oprah, and Bill Maher come to mind) on the subject. There is also a tendency, in the name of journalistic balance, to give anti-vaccine pronouncements credibility approaching that of the present mass of evidence. Finally, journalists are like the rest of us: ordinary human beings, subject to the same cognitive biases and heuristics and vulnerable to the power of stories.

Scientific Inquiry

In this field, as with policy, there is also, I think, little reason to mount a specific response to anti-vaccine claims or activity. In my post on double standards, I showed that there is a great deal of ongoing research activity into vaccines (current or new), and as long as that remains the case, I see little reason for it to change.

In particular, researchers who find some plausibility in a specific anti-vaccine claim will find a way to do further work on it, and some of it may even bear fruit in terms of revising the manufacture of certain vaccines. On this point, it is important to emphasize that anti-vaccine activists could have positive effects on vaccine safety, as long as they are willing to either undertake or fund proper (that is, methodologically rigourous and ethical) epidemiologic research on the matter (instead of studies like the retraced Wakefield and Hewitson papers).

Interpersonal Communication

This is a tricky arena in which to respond to anti-vaccine activity. One hardly wants to let demonstrably false claims stand unopposed when they are uttered in public - but how to challenege a misconception without either starting an argument in the wrong context (say, when someone casually utters some standard anti-vaccine claim at a party), or alienating the wrong people (what if that someone is a family member or friend, or your boss?), or turning fence-sitters or, for lack of a better term, "swing vaccinators" away (either to non-vaccination or even anti-vaccination)?

The four conclusions I can definitely make in this regard are:
  1. It is important to presume good faith on the part of others, until it becomes clear that such a presumption is no longer warrantable.
  2. As an extension of the above, it is better to be civil than not.
  3. Work with, not against, known heuristics (in humans, these are cognitive shortcuts) and biases, although it is important not to be manipulative - that is the domain of the anti-vaccine movement.
  4. Although anecdotes are not a substitute for evidence (again, that standpoint is best left to anti-vaccine activists), they are a good way to highlight it, illustrate it, and humanize it.

The exceptions to these conclusions are when people are obviously:
  • So extreme in their position that they are obviously in the thrall of crankery or denialism (recall commenter Vaccine.Explorer in the Age of Autism post I linked to on Wednesday). Once someone starts arguing the equivalent of black == white, then some pointed mockery may be required
  • Profiting financially off the misinformation that anti-vaccine activism propagates, off the fear of well-meaning parents who are undecided on whether to vaccinate their children or not, and/or off the false hope they offer to parents with sick children or children on the autism spectrum. Making money is okay. Making money from dishonesty is fraud, and there is no reason why people should tolerate fraudsters.


Self-reflection, in terms of dealing with the claims and aims of the anti-vaccine movement, has two components.

The first, which I encourage anyone reading this to engage in (and to encourage others to engage in) is metacognition: thinking about thinking.

The second, which I also encourage every reader to do (and encourage others to do), is to examine the sources of their current beliefs and conclusions on vaccines.

Who do you trust, and why?
Who don't you trust, and why not?
What is the evidence that leads you to conclude what you do about the safety and efficacy of vaccines and the severity of the diseases they prevent?
If you are relying on others' testimony or expertise, what do they say when you ask them about the evidence supporting their position?
What evidence would be required for you to change your mind on how safe vaccines are (or aren't)? Or how well they work (or don't)? Or how comparatively dangerous the diseases they prevent are (or aren't)?

If you are staunchly in favour of vaccines, if you are grappling with whether or not to vaccinate your children, or even if you have decided not to (or are convinced vaccines are dangerous), I encourage you to engage in this sort of self-reflection, whenever you get the chance.

What is the Goal?

As I said on Sunday, October 31, I am unabashedly in favour of mass immunization (incidentally, I went and got my influenza vaccine on Tuesday, November 2). So my goal in writing this series of posts is to influence people in the following way:

(1) Give people some insights into the anti-vaccine movement, the kind of claims it makes, and the evidence that supports them (or not, as the case may be).
(2) Prevent anti-vaccine activism from gaining recruits.
(3) With any luck, change the minds of people who adopt anti-vaccine or non-vaccine positions.

Even if I haven't managed any of these, I will at least hope I made people think about the subject.

Concluding Remarks

Tomorrow is the final day of Vaccine Awareness Week.

I feel, however, that I have done my bit for the week. As I noted on Sunday, tomorrow I plan on sharing links to other activity going on around the Internet this past week.

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