Holding Accountable Those Who Sow Doubt About Vaccines
In the late 2000s, I spent a year in Boulder, Colorado with my family. At the time, my two sons were four and two years old. The older one was in a pre-school and the younger one attended a day care for the last six months of our stay. My wife and I were pleased with both facilities.
We had kept both boys up to date with their immunizations, but I confess that we didn’t give much thought to whether other parents were doing the same. I’m not sure why, but it should have been on our radar. (I think I was more worried about mountain lions.) Anyway, Boulder may be a beautiful place to live, but it is a bubble of health-obssessed and woo-inclined people, a sizable number who are vaccine-averse. As one writer notes, “an estimated seven percent of parents in the Boulder Valley School District opted out of having their children vaccinated in 2011.” Colorado happens to be one of those states with a high number of vaccine-refusers.
Several years ago, a local Boulder newspaper reported:
A state study of immunization rates found that parents opted out of the measles, mumps and rubella and varicella (chickenpox) vaccines most often.
The recent Disneyland-centered measles outbreak got me thinking again of my time in Boulder and how my kids were potentially exposed to preventable diseases. I’m fairly certain my older son had gotten both of his MMR shots already, since at the time he was 4 years old, but the younger boy may have just received the first one (with the second coming later). Thinking back to that time makes me shudder now. As Virginia Hughes reminds us at Buzzfeed, this is what measles looks like.
Many (especially public health care providers) are justifiably concerned about a highly contagious disease like measles gaining a foothold in communities where parents opposed to childhood vaccines have clustered. So other than tightening personal exemption laws, what are some of the means that can be used to persuade the small percentage of anti-vaccine parents to immunize their kids? Unfortunately, giving them–and I’m talking about those who most strongly object to vaccines–more information (with scary images of sickened children) seems to backfire, as a recent study led by Brendan Nyhan showed.
So if science communication isn’t working, what about legal consequences?
This argument for holding vaccine resisters legally accountable for harm was made in a 2013 paper, whose lead author is a prominent bioethicist. A post this week at Forbes by Dan Diamonds is in favor. His headline:
Measles is Spreading and Kids are at Risk. Sue Parents Who Didn’t Vaccinate? Absolutely.
It bears watching if this idea gains traction. Meanwhile, what about public ridicule and shame? Lobbing insults at parents who are already hostile to vaccines is likely to make them dig in their heels. But what about the fence-sitters, vaccine-wary parents with unformed views? A reader in the comment thread of my last post wondered if
maybe some public shaming works on a subset of the fence-sitters. Has anyone asked that? Maybe some people don’t want to be in the Venn diagram with people who put their kids at risk unnecessarily once they realize there is an actual threat. And that some people have really strong negative feelings about those that don’t vaccinate their kids.
Julie Leask, an Australian social scientist who studies risk communication strategies (particularly as they apply to the vaccine issue), responded:
This is a really good question. Vaccination is a social practice – parents are influenced by what they perceive their peers to be doing, what social norms are at play in their communities, whether vaccination symbolises good parenting (or not), and when they think others aren’t vaccinating.
When parents in general see vaccination so strongly reinforced as a societal norm and the outrage at non vaccinators, perhaps this provides an extra ‘shield’ against being influenced. We don’t know but let’s imagine that shaming as a purposeful and condoned public strategy worked in preventing some tip over towards non-vaccination or even getting some selective/delaying vaccinators to change their minds. Would the ends justify the means? How much of an effect would public shaming need to have and what would be the unintended consequences, including stigmatisation of their children and polarisation and division in communities? As a researcher of vaccination behaviour I say it’s an empirical question. As a mother committed to civil society I say let’s find better ways.
Regardless, it’s going to happen anyway, such is the emotion that active non-vaccination initiates. Highly recommend On Immunity by Eula Biss for a thoughtful take on the issues.
Okay, what about smacking down the celebrities who spread fear and misinformation about vaccines? They seem deserving of contempt. The comedian Bill Maher has a long history of absurd and dangerous anti-vaccine statements. (In 2009 he famously told his Twitter followers that they were idiots if they got the flu vaccine.) He was at it again recently on his HBO show, when during an interview with Atul Gawande, he said:
It’s a big scam to make money, but flu vaccines are bullshit. I was right, wasn’t I, Doc?
I understand that social media plays a big role in perpetuating false information about vaccine safety. (Journalists can only play whack a mole so often.) The activists who traffic in this propaganda should be held as accountable as the parents who believe it. And then there are those with huge media platforms, like Bill Maher, who continue to sow doubt about vaccines. That has real consequences. What do bioethicists have to say about that?
UPDATE: I saw this USA Today op-ed after my post went up. It’s by Alex Berezow, founding editor of RealClearScience, who says flatly:
Parents who do not vaccinate their children should go to jail.
It’s a hyperbolic piece, so I’m sure it will fire people up.
UPDATE: In his LA Times column, Michael Hiltzik writes that
the best approach may be to step up peer pressure in favor of vaccination, perhaps by making it socially unacceptable.
UPDATE: Via NPR, “To protect his son, a father asks school to bar unvaccinated children.”
Like this. Not only is Jay Cutler a lousy QB, he’s a lousy parent: http://articles.chicagotribune.com/2014-03-14/health/chi-kristin-cavallari-jay-cutler-vaccinations-20140314_1_kristin-cavallari-vaccines-and-autism-children Heard on the news last night, measles is visiting Chicago.
I think kids who haven’t been vaccinated should be labeled.
Well, I’m not a mother committed to a civil society. I can never win the “mommy” vaccine wars. I think this puts me in an interesting position–I am not behaving selfishly about my own spawn. I can objectively look over the whole sphere of things.
And I can also be “bad cop” to other people’s “good cop”. I think that may have value on a subset of people–or, there’s no evidence otherwise yet. A lot of the guidance is see on scicomm seems to imagine some kind of idealized conversation that is unrealistic. And until I see the evidence of what consistently works, or what consistently doesn’t, on the vax-hesitant–seems there’s room to try various strategies.
I know I’m being a stickler, by saying your kids are four and two respectively makes absolutely no sense unless you’re giving their names in that order.
Good point. I like crowd-sourced copyediting!
English and all our crazy grammar rules! Nice catch john!
I read the other day about mumps and the NHL… seriously, what is this, the 1960’s?
How about a rating system much like we use to help consumers identify content that is suitable for children. Shows can apply for a “Scientifically Accurate” rating (call it SA for short), and if they put forth content inconsistent with that rating, they lose the SA rating and get a “Bad Science” (call it BS for short) rating. That way consumers know if they are getting scientifically accurate information or BS. (only half kidding here…)
Are unvaccinated children allowed to enroll in school? They shouldn’t be, as they are a danger to other children and themselves.
You would think we’d have moved on about vaccines at this point. Apparetly not.
http://en.m.wikipedia.org/wiki/Smallpox#/image/File:The_cow_pock.jpg
The going to jail might not be all that hyperbolic after all. If one of these infant-measles cases turns fatal *and* if you can track it to a child whose parents chose not to vaccinate him, then I can see an argument for charging those parents with negligent homicide, given that it seems to meet the “careless disregard for the consequences” requirement.
Sending a parent to jail isn’t without consequences for their child. How about we go with sterilization instead of jail…
They can just sign a conscience or religious exemption clause, like Jehovah’s Witnesses.
On the other hand, you can’t send a kid to school nowdays with a peanut butter sandwich for fear that it will endanger the health of the others.
It is a very interesting legal question.
I agree with Berezow 100%. There should be no exemptions except legitimate medical ones. When vaccination became a choice? When I was a kid you couldn’t get anywhere near a school without proof of vaccination.
Note how the author of this article isn’t even certain what vaccinations his own two sons received and when they received them. In other words, he either doesn’t have the documentation or he is too lazy to check it. Liberals really are pathetic.
I’m a conservative but I would give him the benefit of the doubt that he is a responsible parent, no?
Considering students are being barred from attending school because they cannot prove they have been vaccinated, a move that the author supports, I would not give him the benefit of the doubt.
So you might try to isolate unvaccinated kids in private anti-vax schools, or home school them. They still play with other kids and interact with them at the mall, soccer league, etc.
I had an unvaccinated friend and part of her philosophy was that it was irresponsible as a species. That her immune system was strengthened by having to fight bugs and diseases without the help of vaccines and that “natural selection is needed” to ensure healthy progeny, not vaccines. So, basically she didn’t care if children died, because it was natural selection. Now, she also strongly believed it was a government scheme and you were at risk for getting sick, but her overall philosophy was “vaccines make you weak.”
That was my experience in talking with an anti-vac person and the moment I realized they are beyond reason.
We could also get rid of laws and police, as well as the rest of medical care to really enjoy the benefits of Darwinian selection.
You either can’t read or are deliberately lying. I’m specifically referring to the MMR shot. Both my kids got them, along with all their other vaccinations. I was simply referring to a six-month window when my now 8 yr old was turning two and got only the first of two MMR shots.
I can barely remember what I had for breakfast this morning. You think I’m going to remember when exactly he got the second shot, which likely was when we returned back to NYC and visited our regular pediatrician.
Give me the benefit of doubt for what? That I vaccinated my own kids. You must be trolling.
It’s legal for people to make the choice they are making about vaccines, so the go to jail statement is both a scientifically irresponsible and click baity thing to say.
Want different consequences? This is a state police power issue.
Convince the legislature in your state to tighten the vaccine exemption laws. Colorado and California both have personal belief exemptions, which means just about any reason at all is enough to gain an exemption from the law. I personally think Art’s paper was an intellectual exercise rather than a viable policy option. Suing one another is an untenable approach, isn’t likely to get people to buy the public health protection argument, and it will create new “victim” groups.
“…what are some of the means that can be used to persuade the small percentage of anti-vaccine parents to immunize their kids?”
It’s simple. Their kids will start getting these diseases. A self resolving problem. If you immunize your kids, they won’t get it. There is no need to criminalize it, it is a self defeating position once enough people start opting out and these preventable diseases start taking hold.
Criminalizing and shaming?
Yeah. ‘Cause that works so well for controlling so many other human behaviors?
Let’s throw anti-vaxers in jail for a couple of years. I’m sure that will make fine citizens out of them, who would certainly turn into pro-vaccination activists.
I think there is a balance to be struck between individual liberty, freedom of conscience and your responsibility to the community. Allow parents a conscience clause to opt out of vaccination. Buy if it later turns out that their Typhoid Timmy infected and harmed other children the aggrieved party can sue the pants off the anti-vax parents for monetary damages and possibly press criminal negligence charges. It will give reasonable parents a strong motivation to vaccinate, or at least make them look at the pseudoscience a lot more critically. The tiny minority of children left unvaccinated would likely be epidemiologically insignificant.
hahahhaahha! *wipes eyes*.
You just made my morning.
This is a bit like the confusion around the 1st amendment. Freedom of speech does not mean there are no consequences to you speaking your mind – you are not protected from losing your job, or your company being boycotted etc – it means the government can’t stop you from speaking your mind (e.g. you are protected from being arrested).
I think a similar logic should be applied here. Sure, you have the freedom not to vaccinate but you need to realize that this could lead to social ostracization, the inability to send your child to a public school (they would be better homeschooled anyway, yeah?) and/or civil lawsuits. Since most of the people choosing (because freeeeeeedoooommm!) to not vaccinate their children are rich, the civil suits should work pretty well.
…and the prisons would turn into hotbeds of vax-jihadism and make the problem worse!
Suing is no consolation if your child dies of a preventable diseases.
I never got a Rubella vaccination. The reason was doctor’s orders: Due to the egg base of the vaccine at that time, and due to allergy, my parents were informed to opt out for medical reasons. For the same reason it was decades before I got a flu vaccination, until there was a better understanding of possible reactions and that I was not at risk.
I mention this because there are, indeed, valid reasons some can’t take particular vaccines, and none have mentioned it so far. This includes previous reactions. Are parents, then, to be held accountable?
The idea from the Australian sociologist, that this is driven by peer-pressure, borders on idiotic, and does not address that some parents have concerns, ill-founded as they are. It’s not peer-pressure; it’s fear. And while I’m a strong advocate of vaccinations, I acknowledge that fear, because it comes from concern for their children. Is this fear irrational? In my opinion, yes. Yet it is still fear, and if fear is not addressed, you will have violators, whether there are exemptions based on belief or not.
If you think tighter laws will help, examine the effectiveness of the War on Drugs.
The best way to seed doubt is half-true information. If you clearly leave out one half of the story and if you exaggerate the other side, you’ll set off a chain reaction of doubt, mistrust and conspiracy theories.
PS: If I’d believe in vaccines being a conspiracy, I’d see this article as a reason to doubt vaccines even more (see the link behind “showed”). Would you qualify to go to jail then? Or do you exclude those who honestly believe they are doing a good deed, even though they do harm? That’s what the other people do.
I repeat myself, I believe in honest and complete information.
The larger point is that this is one of the unintended consequences of political movements that view anything produced by a corporation as automatically suspect.
Shots, corn, rice, nuclear power plants…
Your colleague here had an interesting post that could help with communication:
http://blogs.discovermagazine.com/neuroskeptic/2015/01/28/team-rivals-science-adversarial-collaboration/#.VMp12FqGWTA
OK, I’ll bite.
What part of the article you reference (the one behind “showed”) would make one doubt vaccines more? That article is more about human nature and effective communication than it is about vaccines.
Your “clearly leave out one half of the story and if you exaggerate the other side” quote sounds exactly like things creationists and climate change denialists say. Just because an article is one sided doesn’t mean there is a valid other side. If one were to write an article about Moon missions would they have to commit half of the words in the article stating the opinions of those that think we’ve never been to the moon?
I imagine I’d focus on the parts where non-vaccination is described as a crime and not even discussing the possibility of staying at home when being sick. (Remember, you’re trying to convince people who are _not_ convinced yet, that’s the point of convincing!)
There is a valid other side. If there wasn’t, you’d get vaccination against all the diseases on earth, not just the local and important diseases and maybe if you’re smart the ones you might encounter during holidays.
We must be talking about different articles. I was reffering to the article you identified as the “link behind “showed””, which is this article: http://www.nbcnews.com/health/health-news/pro-vaccine-messages-actually-backfire-study-finds-n41611
So I’m assuming you are talking about something else, perhaps the link added at the bottom from USA Today. Which the author of this article stated is “a hyperbolic piece”? Calling the USA Today article hyperbolic seems to be calling out that it is ridiculous to make not vaccinating a crime.
How great would it be if there were a vaccine for every disease on earth. We could eradicate disease the same way we’ve done with smallpox! I hope you are being hyperbolic in your assertion that it would even be feasible to vaccinate against all diseases.
I’d say of about equal likelihood, Tom.
But the point is that maybe some folks would find something cathartic about criminalizing or shaming, but absent any evidence that it might actually do something, maybe something evidence-based would be a better way to go?
I think people who don’t vaccinate their children are the price we pay for living in a free society.
I think such people are, almost literally, insane. But I also think it’s their choice not to vaccinate. If you don’t like it, form a school where those children aren’t allowed, while yours are. Take legal action if you think they’e infected your child. But don’t force them, unless you’re prepared to be forced somewhere down the line — on GM foods, on CO2, or somewhere else.
Except it’s not that simple. Some kids can’t be immunized due to immune system disorders. They are vulnerable as long as anyone one doesn’t vax.
“Liberals really are pathetic.”
Sure, a third of the entire country are “pathetic” because of what you imagine about the author.
You are the problem.
Keith: you’re falling victim to a phantom.
Your kids are thousands of times more likely to experience a serious health threat from guns or cars or just the flu – vaccine or no – than from a person who doesn’t have the MMR vaccine.
It’s fair to point fingers at the anti-vaxxers for their ignorance. It’s fair to say that if everyone did what they do, there would be a serious threat. Just the same, as it stands now, the threat they create is pathetically small.
What are the chances of getting measles during this “outbreak”? So far, very roughly, in WA OR and CA, something like 1:400,000. A person can suffer immensely from measles – certainly no one wants to get it. Just the same, the chances of permanent harm or death are about 1000x smaller – 1 in 400,000,000, one in four hundred million – even during the outbreak.
So while you hammer away at the anti-vaxxers, don’t lose your perspective. Far more people are harmed by drunk drivers than by anti-vaxxers
I’m talking about this article here and using the linked article as a description on how this will affect a sceptic, because I think I’m bad at describing it myself.
Or maybe I misunderstood this article?
vaccination is part of healthy living .parent must aware children about socially useful health scheme .govt must create positivism and trust in society.
what total pap. the “danger” from an unvaccinated child is akin to the “danger” of being hit by lightning.
Get a grip. Antivaxxing is stupid but, at it’s *current level*, it poses pretty much zero risk to society as a whole.
If you expect people to accept your positions based on the claim that they’re legitimized by science, don’t then turn around and make ridiculously exaggerated claims and try to paint them with a scientific brush.
While we like to rarely agree with each other, we agree here. I think most people who support authoritarian responses like this rarely see themselves being a victim of such policies in the future.
Try to recognize when people are actually agreeing with you.
Right, there are exceptions. But we don’t eliminate bees because people are allergic to them, but we don’t put bee hives on school property either.
Only pointing out that their action’s negative consequences are mostly borne by them. In this case it is usually not necessary to have society step in past educating them and public awareness. Things like drunk driving are different.
Your analogy is specious because lightning’s actions don’t encourage other lightning to do the same thing. And natural forces don’t have responsibilities as society members.
There are other exceptions, e.g. actually trying to eradicate a disease or really really dangerous diseases.
Hard to recognize when it happens so infrequently.
🙂
Getting traction around anti-vaccination is clearly a difficult activity. For my parent’s generation who knew children killed by diphtheria and maimed by polio, not vaccinating (unless positively advised not to by the doctor) was not an option. The fact that these diseases are rarely seen now means that people have forgotten how dangerous they once were. I am seeing this at the moment with people stating that measles is completely harmless.
What is really concerning me over the current measles outbreak is the number of doctors who are coming out telling lies about vaccinations like Jack Wolfson. And doctors such as Jay Gordon and Bob Sears that are pandering to their patient’s whims rather than providing good advice. Surely, getting such doctors out of the system would be a good way on making sure parents are getting good quality advice from their family doctor.
It’s freedom of speech, not freedom to speak exactly what you’re told to, or else …
If you state your valid opinion, you should be protected from your fascist boss firing you just because of that, or from the school banning your kid because you don’t participate in a campaign for your current major.
Otherwise, freedom of speech would be reduced to an unfulfilled promise, just like in the GDR and Russia.
While jailing is probably out of the question there is legal remedy via tort….it is entirely possible that a lawsuit against parents who’s failure to vaccinate their children resulted in harm to another individual would not only be heard, but ultimately win.
What angers me more than parents opting out for religious reasons or just plain ignorance, is medical professionals who wont vaccinate or recommend vaccinations. I think state licencing boards should examine whether a practicing physician who advocates non-vaccination should have their medical licenses revoked…behavior like this among individuals entrusted for the health of society is clearly a violation of the Hippocratic oath.
The problem as I see it traces back to those who made the bogus connections between vaccines and Autism and other things. The self interested groups who proffered the results of these studies are also the problem, though in my mind they wouldn’t have influence the way they do if it weren’t for people like Andrew Wakefield. Parents who decide against vaccination based on the claims of the self interested opportunists who exploit the research of opportunistic scientists are also the problem, but cmon it’s hardly their fault. Point the finger of blame at the opportunists first. Parents simply want what is best for their kids.
Every State in the nation implements a policy of banning unvaccinated children from school during epidemics of vaccine-preventable-diseases.
And….you have a problem with that policy….because?
Smart parents are now inquiring about their children’s playmate’s vaccine status. Too bad it had to be a major measles outbreak for parents to understand how one deliberately non vaccinated child can infect other children who have valid medical contraindications for receiving certain vaccines.
I, OTH, don’t blame the deliberately non vaccinated children, whose parents put them at risk, and put other children at risk.
Zeig heil! Follow ze example of us wit the jews. He he. We labeled them too.
If their child is vaccinated and they are so convinced they are “protected”, why are they worried?
It’s media hype that you stir up with your thoroughly debunked views that you get from notorious pseudo-science sources.
Yet countless examples exist in society of people making selfish choices which increase the risk of harm to others. The specific case of measles is an excellent example, because one set of parents choosing not to vaccinate one child, for a disease with a mortality rate of 1 in 430 million, doesn’t move the needle off of its inconceivably low probability. Yet we as a society, at best, spend precious effort examining the most important causes of preventable mortality, particularly when we buy into those causes (like using motor vehicles).
Even if (that’s a very big if), children of non vaccinating parents were kept home when they were sick, it still wouldn’t stop measles outbreaks.
After you contract measles, it can take up to 21 days for the distinctive rash to appear…and you are highly infectious for 4 days before you are symptomatic.
Measles are highly transmissible because the virus is spread via small droplets which remain airborne for two hours and viable on fomites (inanimate objects) in the environment.
Every one of the 50 states permits valid medical contraindications against receiving vaccines. Two states (Mississippi and West Virginia), limit exemptions for entry into public schools/daycare centers, to those valid medical contraindications.
Every other state permits “personal belief exemptions” and/or “religious exemptions”.
Read the article before you criticize the author…he was away from home and did not have readily available access to his children’s vaccinations records.
Cyber-stalking me again, Ms. Craig?
I believe you are mistaken with your comment about measles morbidity and mortality:
http://jid.oxfordjournals.org/content/189/Supplement_1/S4.full.pdf
You mean like how you cyber-stalk everyone you hate?
How does this hate-filled retching have anything to do with science?
You and Ms. Craig are cyber-stalking me and you are an “Imposter”.
How do your venom-filled and irrational hatred and personal attacks have anything to do with Science?
Responding to your brainless blathering and vapid hypocrisy does not constitute cyber-stalking. Digging up personal information and publishing it in public forums can…you know, like you’ve done.
If you think I’m actually cyber-stalking you, then ask me politely to stop.
Yes, I’m following your example.
And if you wish to use my real name, that you broke Disqus rules and revealed, I am Dr. Craig.
Do as she says, not as she does.
It was not me who revealed who you are, ex-nurse, Jennifer Craig, PhD.
You shoudn’t hide your your “credentials” as a frequent contributor to the crank anti-vaccine blog, International Medical Council on Vaccination:
http://www.vaccinationcouncil.org/?s=jennifer+craig
You are an “Imposter” whose Disqus account, which is private, was set up to cyber-stalk me.
You have never commented on topic or provided a link that is topical. You’ve also been banned before by Mr. Kloor for your “Imposter” cyber-stalking.
Why do you lie so much? I haven’t been banned, and I even went so far as to comment on the article after this alleged ban.
https://disqus.com/home/discussion/collide-a-scape/robert_kennedy_jr_and_mark_hyman_to_appear_on_dr_oz_show/#comment-1643938477
How does your venom-filled and hate-mongering filth have anything to do with Science? How do your cyber-stalking activities promote Science?
Their parents are “labelled”, anyhow – as “dumb”.
Why are they worried?
You know exactly why, Ms Craig, you have been told why several times before:
1. Vaccines aren’t always 100% effective
2. There are infants too young to be vaccinated who are vulnerable.
3. There are those who have medical conditions meaning they can’t be vaxed
4. There are those with documented allergies to vaccines who can’t be vaxed
Those reasons do you?
Herd immunity protects those individuals, but only if the herd is big enough.
Sure, drunk drivers cause more harm, many things do. But without vaccination, measles would return to affect 90% of our kids, and when the consequences of that are hospital in 20%, encephalitis and death in 1 in 1000, you might not be so blase.
Does a drink driver cause death once for every 1000 times he gets in a vehicle?
But let’s say that there was a vocal minority of people promoting the idea that it was good to drink drive, and that accidents were “no big deal” because ITUs were so good at treating people with traumatic brain injury these days.
Then many people might have a problem with that.
And if you wish to use my real name, that you broke Disqus rules and revealed, I am Dr. Craig.
No you did that.
http://nocompulsoryvaccination.com/2012/06/16/public-health-unit-turns-down-the-offer-to-speak-at-vaccination-seminar-vactruth-com/