Let me say this at the outset: I am an infectious disease epidemiologist. I believe vaccines represent arguably the most astonishing advance in health that we have yet developed. The lives they have saved are probably literally countless, and the cost at which they have done it is negligible. Vaccines in general are very cheap, very effective, and very safe. I hope, fervently, for a new vaccine for tuberculosis and any vaccine at all for hepatitis C virus. Without them, eliminating either of these diseases will be an uphill battle.
And I have very little time or patience for the endless ridicule and hatred that is heaped upon people who don’t want to vaccinate their children.
I understand that many parents of children who cannot be vaccinated would be furious at the people putting their children at risk, but they would seem to be in a minority among people who pillory anti-vaxxers. It seems to me that anti-vaxxers have now taken the place of young-earth creationists in the New Atheist pantheon of demons to be vanquished.
Vaccination is complex. When it is contentious it involves conflicts between the rights, values and safety of a number of parties; the child eligible for vaccination, its parents, other children, their parents, and the state. These are not simple conflicts to resolve, because the issues are not simply empirical, as many critics appear to believe. Being vaccinated is a medical procedure. It carries risks, although not the ones Andrew Wakefield would have us believe. It requires the consent of someone responsible, and our societies have vested parents, rather than the state, with this responsibility. In communities with low vaccination coverage, vaccinating your child is (in most cases) accepting a small personal risk in exchange for a large potential benefit, but in communities with high coverage, this balance shifts. Risk perception matters, and it is not entirely amenable to rational persuasion.
To take an example relevant to adults: the risk of transmission of HIV during heterosexual sex with somebody whose viral load is suppressed by anti-retrovirals, and with whom one is using condoms, is negligible (and in fact, the per act transmission for heterosexual sex even with somebody who is not on treatment is only around 1 in 1,000). An argument could be made that, depending on one’s social circles, picking up a random stranger of unknown status at a bar actually carries a higher risk than sleeping with someone whose status is known, but whose viral load is confirmed to be low. I could demonstrate this to you. And yet many people would have to think very, very seriously about having sex with someone they knew to be HIV+, if they didn’t simply dismiss it out of hand. I know the odds, and even I don’t know that I could get over my fear. There is more to the question than the facts.
The expectation that people who are afraid of vaccinating their children simply need to read the research and come around fundamentally misunderstands how people change their minds about things they fear. And the idea that anybody – anybody – could be convinced of anything by being vilified as a dangerous lunatic or a complete moron is simply breath-taking. Deciding what constitutes tinfoil-hattery in a world in which Thalidomide and Vioxx happened is not straightforward, and the sad fact is that a lot people who don’t study science after high school find it really, really difficult to assess the credibility of different sources and understand their content. I have two medical science degrees and I can’t manage most Wikipedia chemistry pages. We need to cut people some slack.
It’s easy to say “vaccines work”. Overwhelmingly, they do. But the people who question this are not trying to kill kids. Some of them are afraid. Some of them are paranoid. And yes, some of them are shameless liars. I suspect, although I don’t know, that the former are at least as numerous, if not far more numerous than the latter. They need to be convinced, and they will not be convinced by vilification. Some of them, tragically, will be convinced by whooping cough.
I have no idea how to resolve the conflict between the state, children and public health on one hand, and the adults who will not be convinced on the other. For measles vaccines, in particular, to be effective, coverage needs to be over 95%. But pushing people who are already on the fringe even further out of society cannot be the answer. Even from an epidemiological perspective, if the welfare of children is paramount, creating the conditions under which unvaccinated children can only attend Steiner schools in Byron Bay is the worst possible idea. The Royal Children’s Hospital runs an advisory service for parents who are concerned about vaccination, where they can sit down and talk to a nurse about their fears. Some will be convinced. Some won’t. But I’m alright at statistics, and I know who I’d bet on out of those nurses vs. Penn and fucking Teller.