The surprising history of how medical science's greatest success has become vilified by so many people.
by Brian Dunning Skeptoid Podcast #662 February 12, 2019
They are considered the
greatest single advancement in the history of medicine, responsible
for saving more lives than all other public health measures combined.
And yet, stunningly, vaccines are also the victim of the most
successful misinformation campaigns and conspiracy theories in
modern history, resulting in countless preventable deaths. Vaccine
denial is rampant, and has been since the very beginning. Today
we're going to look at the history of vaccine denial, when and
how it began, why it persists today — and perhaps most importantly,
how we can realistically hope to help move deniers toward acceptance
of this crucial protection.
The history of vaccination is most closely tied to the history
of smallpox, one of the most deadly diseases to ever ravage the
human species. As early as the 10th century, Chinese had discovered
that grinding up month-old smallpox scabs and administering the
powder nasally would produce a mild case of the disease, but the
person would always recover and would then be immune. This was
called variolation, and variations on the procedure spread through
Europe for centuries, with much good success. It was Englishman
Edward Jenner who, in 1796, developed the first safe and effective
smallpox vaccine using cowpox. He coined the term vaccination,
as vacca is the latin for cow.
As use of the vaccine spread rapidly, its development was seen
as a matter of national pride. However, anti-vaccine sentiment
arose almost immediately. There were religious objections because,
coming from an animal, the vaccine was considered "unclean".
There were objections based on disagreement over the cause of
smallpox. But most significantly, as mandatory vaccination acts
began to appear throughout Europe, many protested vaccinations
on the grounds that it was a violation of their personal liberty.
Throughout the 1800s, anti-vaccination leagues appeared worldwide,
and in response, governments introduced both conscientious and
religious exemptions to mandatory vaccination. But the battle
still raged: in 1905, Jacobson v Massachusetts made it all the
way to the United States Supreme Court, in which the court affirmed
the right of the state to force Jacobson to be vaccinated for
the greater common good.
Although it was some 80 years after Jenner's smallpox victory
before the next vaccine was developed, by the end of the 20th
century a staggering list of diseases had been conquered, that
had killed countless millions: cholera, diphtheria, rabies, rubella,
anthrax, plague, tuberculosis, polio, typhoid, yellow fever, whooping
cough, measles, influenza, meningitis, hepatitis, tetanus, encephalitis,
chickenpox.
These triumphs were not without cost. There were mistakes from
which we had to learn the hard way. In 1948, 68 children in Kyoto
died from a diphtheria vaccine that had been improperly manufactured.
In 1955, just two years after Jonas Salk became a worldwide superhero
for his development of the polio vaccine, 200 children were given
the disease by a batch of the vaccine containing the wrong version
of the virus, and five of them died. Despite being overshadowed
by the countless lives saved, these disasters continued to stoke
skepticism and fear of vaccines.
During the Red Scare in the United States that followed World
War II, many Americans were suspicious of large public health
initiatives because they smelled a little bit like socialism.
Such initiatives included mandatory vaccination and water fluoridation
— a fear lampooned in the movie Dr. Strangelove. This gave
yet another boost to vaccine denial based on fear of government
overreach and loss of personal choice.
But it was Andrew Wakefield's infamous 1998 paper that found "gastrointestinal
disease and developmental regression in a group of previously
normal children" caused by the MMR (measles, mumps, rubella)
vaccine. The paper was soon retracted, but not before a credulous
media gave it massive attention, and provided vaccine deniers
all they'd ever need to claim vaccines are unacceptably dangerous.
It was soon also revealed that Wakefield had fabricated the entire
study, and that his motivation had been to further the interests
of his own single-disease vaccines that he was developing. By
this we know that Wakefield is, even today, consciously deceptive
in his promotion of opposition to vaccines. He was rightly stripped
of his medical license, but has since made tens of millions of
dollars writing books, making media appearances, and collecting
speaking fees to trumpet the dangers of vaccines.
His activism has been a powerful driver of vaccine denial's sweep
of trending pop culture. For much of the past 20 years, it has
become — almost incredibly — a fashion statement. One
reason that Hollywood celebrities proudly show off things like
circular hickeys on their back from cupping is that all things
holistic are trendy. It's the basic manifestation of the modern
Western Esotericism movement: shun the modern, the technological,
the scientific, and embrace the natural, the holistic, the metaphysical.
A loud-and-proud virtue-signaling statement like cupping bruises
is the same as being seen shopping at Whole Foods. Vaccine denial
slots into this movement very neatly, so it's now not uncommon
for celebrities to boast of their holistics-based rejection of
vaccines.
This was not lost on Oprah Winfrey. Beginning in 2007, Oprah made
her ultra-popular TV show into a platform for celebrity anti-vaccine
activist Jenny McCarthy — just as Winfrey had been doing
for the past three years for that other famous opponent of science
based medicine, Dr. Oz. It was this partnership of Winfrey and
McCarthy that propelled Andrew Wakefield to superstar status —
where he has remained ever since, now a movie producer and reportedly
dating supermodel Elle Macpherson.
Vaccine denial has become so mainstream that one of the first
actions taken by Donald Trump during his 2017 presidential transition
was to meet with noted anti-vaccine activist Robert F. Kennedy
Jr. for the purpose of establishing a task force to promote Kennedy's
agenda — which, thankfully, seems to have never materialized.
All this brings us to the most important part of our discussion:
How to help vaccine deniers move away from denial. It's a problem
that's similar to the persuasion of global warming deniers or
9/11 Truthers, both of which are also positions that are blatantly
disdainful of easily verified facts. Our positions on polarizing
matters like these are based on our value systems, not on objective
analysis of data. So to reach someone with an argument they're
likely to embrace, we must base that argument upon the values
they hold, not upon data they've already rejected. This is a branch
of sociology called moral foundations theory, and it seeks to
explain how and why good, smart people cling to opinions and beliefs
that may differ wildly from one person to another.
Let's illustrate this with a familiar example. Values held by
many global warming deniers are patriotism and economic strength.
Thus, arguments in favor of global warming with a chance of being
accepted include that it's a patriotic imperative for the nation
to become a world leader in next-generation renewable energy,
and that renewables are a fast-growing and highly profitable economic
sector; while 19th-century industries like coal are rightly gasping
their dying breaths. Whereas, if you were to approach a global
warming denier with climate data or moral imperatives, you'd be
laughed out of the room.
A 2017 study published in the Nature journal Human Behavior studied
this question from the perspective of the values held by vaccine
deniers. As you can probably guess from our discussion so far,
this study found that there are two basic values upon which vaccine
denial is grounded: first, the value of purity, a sort of holistic
idea in which vaccines are a dangerous pharmaceutical drug which
poisons the body; and second, the value of liberty, in which the
government shouldn't mandate how we raise our children or what
to put into their bodies.
Although we often hear the anti-vaccine arguments that Wakefield
promoted — such as autism risk, vaccine injury, poisonous
and frightening ingredients in the vaccines, and claims that they
are untested — it turns out these are rationalizations, and
not the fundamental values underlying the denial. Most of the
pro-vaccine rhetoric out there has been targeted at these claims,
and it has failed to persuade. The reason is that it's the wrong
argument, and engages a subject the denier doesn't actually care
about all that much. They don't truly know or care about the actual
rates of vaccine injury; it's just a rationalization they use
to justify their denial, which is actually based on the underlying
values of purity and liberty.
If it seems improbable to you that the stated concerns of vaccine
deniers are not the ones they truly care most about, here is some
more interesting evidence in support of this. A number of papers
have been published in recent years with the finding that opposition
to vaccines correlates with less knowledge about them. The louder
an anti-vaccine protester shouts, the more likely it is that he
has a minimal knowledge level. A 2018 paper in Social Science
& Medicine found that this could largely be attributed to
Dunning-Kruger effects, meaning that their own low knowledge level
was sufficient to them, and they were unaware or didn't care that
other people might know more. The authors argued that policy for
dealing with anti-vaccine sentiment should be guided by this fact,
and that fact-based arguments were unlikely to be effective.
If you want to be persuasive, formulate an argument based upon
the values the person embraces that form the true core of their
opposition to vaccines. We need pro-vaccine arguments based on
the body's purity, and based upon liberty. Fortunately, these
arguments are both relatively easy to construct, and they're good
ones.
Pro-Vaccine
Argument #1: Purity
Vaccination prepares a body to combat a disease agent using nothing
more than its own natural immune system. Should such a child be
exposed to a disease, they will be naturally protected drug-free,
and will not risk contracting the disease and needing to be treated
with pharmaceutical chemicals.
Pro-Vaccine
Argument #2: Liberty
Vaccination is an emphatic act of protecting one's own health,
and eliminating potential reliance upon a flawed and corrupt healthcare
system. No bureaucracy can protect you as well as your own maximally-prepared
immune system.
I don't claim that these outlines are ideally framed or presented,
but they do convey the general idea. If we take the example of
a parent who is on the fence, who might be conflicted because
they firmly hold the purity and liberty values but are concerned
by the statistics of unvaccinated children hospitalized with a
preventable disease, it's easy to see how they might warmly accept
these arguments with an enormous sigh of relief. Because, in essence,
it is true that vaccination is an act of protecting the body's
purity, and that it does maximize your potential to maintain liberty
from oppressive healthcare.
And so, one potential solution to the public health crisis triggered
by vaccine denial lies not in the study of the history of such
denial, but in the study of ourselves and how we think. Clearly
no single solution will solve the whole problem, but employing
moral foundation theory gives us at least one more tool in devising
effective arguments. Little by little, skepticism and critical
thinking can indeed make the world a safer and saner place.
Cite this article: Dunning,
B. "Vaccine Denial: Failure Mode Analysis." Skeptoid
Podcast. Skeptoid Media, 12 Feb 2019. Web. 13 Feb 2019. <http://skeptoid.com/episodes/4662>
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created: May
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