Sharon Kaufman, PhD, is chair of the Department of Anthropology, History and Social Medicine at the University of California, San Francisco. Her work explores topics at the intersection of medical knowledge and society’s expectations for health. One area of particular interest is individuals' trust—and mistrust—in the findings of scientific studies.
Given the recent measles outbreak in California and other states,we turned to Dr. Kaufman for insight into today's anti-vaccination movement.The following are her responses to questions posed by John Swartzberg, MD, chair of the Berkeley Wellness editorial board, and Cecilie Bisgaard-Frantzen, a graduate student in public health at UC Berkeley. To read more from Dr. Kaufman on this topic, you can also check out this recent article she wrote for the website of the journal Health Affairs.
Q. What do you think accounts for the anti-vaccination movement?
A. Anti-vaccination movements have existed since the smallpox vaccine was discovered in the 1700s, and anti-vaccination activism certainly is in play today. However, most parents are not anti-vaccination per se. Rather, they live in a time, as we all do, of heightened risk awareness, mistrust of government institutions and the pharmaceutical industry and a great many opportunities for "seeing" doubt. They feel responsible for shielding their children from the potential health risks and environmental toxins that exist (or seem to) in so many consumer goods, foods, etc. And they are well aware that scientific discoveries are subject to change.
This constellation of socio-cultural features in American life was well established by the late 1980s and early 1990s. Then two events, occurring close together in the late 1990s, served to strengthen the doubt and fear already brewing. First, the now discredited Wakefield article in The Lancet (1998) appeared, suggesting a causal connection between the MMR vaccine and autism. Second, the FDA announced in 1999 that infants who received the recommended number of vaccines might be exposed to cumulative amounts of ethylmercury (contained in the vaccine preservative thimerosal) that exceeded federal safety guidelines.
The re-emergence of measles in the U.S. after a 15-year period of occasional cases is one outcome of parental doubt that became more deeply entrenched during that period. Many parents seek out pediatricians who will modify the recommended vaccination schedule, so they are not against giving all vaccines to their children. Rather they are wary of perceived problems that may arise if they give their children what they consider to be too many vaccines at once. Serious vaccine-related adverse events, though very rare, do occur, and parents today are well aware of this.
Q. How do social networks and news media foster skepticism towards vaccines?
A. Social networks and the media play a large role in stoking skepticism about vaccines. Stories from parents who are convinced their children’s problems are caused by vaccines are everywhere, impossible to avoid. Social science research demonstrates that dramatic stories of individual lives are more powerful than scientific facts, statistics, and reassurance from the medical community in determining doubt, mistrust, and skepticism. Talk about vaccine safety is inescapable among new parents today and an overwhelming barrage of "information" about vaccine safety circulates widely among them.
Q. When Jimmy Kimmel did a spoof on the anti-vaccination movement, he received harsh emails from a lot of people. Several academics who have spoken out against the anti-vaccination movement have had their lives threatened. Why does this topic make some people so angry?
A. Violence (verbal and physical), bullying and hate speech are deeply entrenched elements of our contemporary society, visible in many arenas of civic life. The anonymity of the Internet enables those forms of communication to exist and proliferate. The small minority who threaten and rage against scientists and physicians are representative of the strong libertarian stance that has always characterized some elements of anti-vaccination movements. The escalated violence they espouse is one way ethical choice is given free expression today. And unfortunately their loud claims that the science of vaccine safety is wrong indicate the tenacity of mistrust.
Q. If parents don’t trust the vaccine science, how can we talk with them?
A. The measles outbreak, following previous outbreaks of pertussis and mumps, is a reminder that dialogue with doctors and greater education from the medical community can only go so far. Those efforts should continue. But maintaining our society’s immunity to these dangerous childhood illnesses will require broader, systemic changes that are not easy for health practitioners or scientists to shape.
Public concerns about the market-driven priorities of Big Pharma need to be addressed. A greater understanding of the causes of autism and developmental problems would help sever the connection made between vaccines and those problems. State administrative rules that make personal exemptions more difficult to obtain would lead to higher vaccination rates. In sum, parents of young children are perhaps the most visible citizens of our modern predicament—highly risk aware, skeptical, and burdened by the responsibility of finding their own ethical compass within the many means for the maintenance of doubt.