Vaccine Denial: Failure Mode Analysis

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 become preventable, 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.

By Brian Dunning
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