Issue 35 / 16 September 2013

WHY do some highly educated, affluent parents decide against vaccinating their children?

Health professionals often scratch their heads over the apparent contradiction of “somebody who should know better” making a decision that is not in the best interests of either their child or the broader community.

I’m not talking about the wacky extremes of the anti-vaccination movement here, but about intelligent people who somehow come to an ill informed conclusion that the risks of vaccines outweigh their benefits.

US anthropologist Dr Kate Clancy casts some light on how this might happen in a Scientific American blog describing her and her husband’s decision not to fully comply with the recommended immunisation schedule for her baby daughter.

“This is a major confession”, she writes.

“I was one of those people who infuriated her doctor with an alternate vaccine schedule. I know I will lose serious science cred by daring to say so. But I think it’s important for me to admit that this was my previous thinking on vaccines, because regardless of what you may think of me, I’m pretty confident I’m not an idiot.”

Why, she goes on to ask, do so many non-idiots get swayed by the anti-vaccination movement?

It’s a good question.

One possible answer Dr Clancy points to is the high level of anxiety experienced by many prospective parents, perhaps especially among those whose educational background encourages them to ask questions and do their own research.

Pregnant women are bombarded with so many warnings, including risks posed by everyday foods, it’s easy to see how they might come to view the world as posing a constant toxic threat to their infant child.

An injection that introduces a foreign substance into their child’s body may be seen by some as just one more such threat — especially now that the far greater threat posed by the diseases immunisation is designed to ward off has become largely abstract for most people.

If you’ve never seen the effects of measles or whooping cough, it’s easier to dismiss the risk they pose and focus instead on the real or imagined risks associated with vaccines.

Dr Clancy writes that many of the educated, affluent parents who reject immunisation are, as she once was, “scared, not really knowing any better, and wanting the right information to make the right choices for [their] child”.

When it comes to vaccines, the internet offers an abundance of information but, unfortunately, a lot of it is not “right”.

Dr Clancy attributes her own shift in views in part to Seth Mnookin’s book on the anti-immunisation movement, A panic virus.

She believes quality information is crucial to changing others’ views, pointing to a new app from the Children’s Hospital of Philadelphia (Vaccines on the Go) designed to answer parents’ questions on vaccine risks and benefits.

These kinds of resources are important, but they won’t do the job on their own.

Somehow, we need to find ways to address the epidemic of parental anxiety — and the distrust of medicine that sometimes accompanies it — if we are to convince those wavering parents of the benefits that immunisation holds for their child.

Jane McCredie is a Sydney-based science and medicine writer.

12 thoughts on “Jane McCredie: Educating the educated

  1. Ian Carr-Boyd says:

    Key words….”should know better”    “wacky extremes”   “ill informed conclusion”   “non-idiots”

    Over thirty years ago, my GP mentor said to me:  “Our role as a GP is to advise.”   Full stop. Not to lecture, ridicule, or coherce.

    Like it or not, free choice remains, and there are only two certainties in life.

    Professors of infectious diseases have long indicated that our most powerful defence against such illness is investing time & effort into our own wellbeing, not a hugely popular concept these days, it seems. 

    I agree with many of Kate Clancy’s sentiments. The nocebo effect may be powerful here.

    Let me add one of my own… I think feelings are more contagious than bugs.

     

     

     

  2. Sue Ieraci says:

    Thanks for the article, Jane. I see a lot of commentary from otherwise rational people who are not prepared to subject their children to the (real but miniscule) risks of vaccination because they haven’t been exposed to the risks of not vaccinating. Like most areas of health care, there is a combination of risk aversion, spectrum bias and rising expectations – much like has occurred in the areas of childbirth and the community’s attitudes to the non-science-based therapies. If one’s poor choices lead to getting the infection, or the homeopathy doesn’t work, or the home birth goes disastrously wrong, the tools of modern medicine come to the rescue. It’s relatively easy to be ”anti-establishment” when the establishment is still there to take you back if something goes wrong.

  3. Greg Freeman says:

    My interpretation is that many well-educated people are very poor at risk assessment. They can have lots of data but don’t have a process for deciding what is relevant to making a good decision for their problem. How else can you explain them losing their money in our thriving gambling industry when the odds are always against them, or that people worry about terrorism in this country when the genuine risk to them is how they drive their car.     Also anxious people decide by failing to act, no matter how severe the consequences.    Anti-vaccinators think they can beat the odds, just like the gamblers. Failure-to-vaccinators are frozen by their anxiety so can’t do what they think they should.

  4. J Heywood says:

    Our medical system is struggling with this phenomenon of intelligent parents who choose not to vaccinate their children.  The reasons are there in our medical journals. Doctors and researchers do NOT agree among themselves.  For example, immunology finds the antibody theory that vaccinations are based on a paradox – inexplicable.  It is this conflict within the medical profession that is undermining its credibility, confusing some parents and alienating others.  

    It is the people who have seen measles, whooping cough, mumps, rotavirus who are bucking the trend. Parents of a boy who got measles soon after his childhood vaccination. Others reporting similar experiences. Parents of a little boy who became paralysed soon after his birth vaccine in 2008, and a little girl who got whooping cough one week after her third vaccination, and did not recover for 6 months.

    Australian medicine is not answering these stories. That is what we need to give. Answers. Our peer-reviewed medical journals, official documents and statistics are fuelling disillusionment because they do not give consistent science. “Benefits outweigh the risks” is not enough.

    We have to acknowledge the risks as other countries have and do something genuine about it. We have never said vaccines are risk-free, so, there is no debate: Australia needs a compensation scheme for the children (and adults), however few they are, who accept vaccinations for the sake of the community but are damaged by them.

  5. Brunhilde (Bruni) Brewin says:

    @ Sue, I can see your point.  But by the same token I can also see the point of those that take the trouble to educate themself where there is an opposition to your  “Real but minisecule risk”, that allows them to decide whether they need to take that risk at all.  I refer you to: 

    http://www.ecomed.org.uk/publications/the-health-hazards-of-disease-prevention

    http://www.issuesinmedicalethics.org/202co114.html

    I could post more – but you might get the general idea that people because they are becoming more informed decide that they do not agree with the people that believe the ‘herd community’ should be vaccinated.

     

     

  6. Jack Verbeek says:

    It’s an issue of trust.

    The pharmaceutical industry has a sorry history of dodgy trials, ghost writing for journals, secret payments to doctors, releasing drugs knowing that they would do more harm than good (ie Vioxx), pushing dangerous psychotic drugs…the list goes on.

    Any intelligent person, knowing that vaccines are produced by a profit driven industry which has not only paid billions over the years in criminal penalties, but spends much money on lobbying governments and influencing doctors, would certainly want to know what their newborn will be injected with soon after birth,

    Why most of them don’t challenge the vaccine ritual, I believe, is that we are taught from an early age to respect and appropriately respond to authority, whether it be the police, government or the medical establishment. The path of least resistance, and least ridicule, is have one’s child vaccinated. Intelligent or not, it’s just easier and avoids the possibility of being labeled an “anti-vaxxer” or “wacky extremist”.

    Many people are now understanding that going along with the herd just for the sake of going along with the herd takes a lot of trust, or perhaps more correctly, faith.

    Many people are now seeking more independent information to assist in making decisions in the best interest of their child and are not liking what they find in many cases.

    Power to the unintelligent!

     

  7. University of Queensland - Central Library says:

    The sins of omission are less than the sins of comission.  The risk benefit for action vs inaction is never more powerful than for vaccination but catastrophe as a result of action (vaccination) is far worse to live with as a parent than catastrophe from an external agent of bad luck (infection).   Nature is responsible for infectious deaths, the establishment and those who go along with it, ie parents, are “responsible” for their children’s vaccination catastrophes.  It is the same for establishment thinking.  Layers of bureaucracy and OH&S rulings stifle theatre proficiency but far better that a 1000 patients die waiting for an operation (acts of omission), than 1 die as a result of iatrogenic mishap (comission).  That is the principle we live with everyday in public hospitals.

  8. Brendan Russ says:

    ” immunology finds the antibody theory that vaccinations are based on a paradox”. How so? As an immunologist, i can tell you that that statement is nonsense. 

  9. Katherine Hyde says:

    The death of ANY child is a tragedy. The idea that many children dying of the “natural disease” is better than a single death “by an act of commission” should be upsetting to parents and professionals alike. This is negligent. In all my years of caring for dying children, and their families, I have never heard a parent express the opinion that their child’s death was a “good death” because they died of natural causes. It was not too long ago (in historical terms) that 1/3 to 1/2 of all children died before their 5th birthday. There are some countries that still have a very high death rate in early childhood. Vaccination has played a significant role in reducing deaths in infants and young children. There is no moral victory in allowing children to die “naturally” in this context.

  10. Sue Ieraci says:

    brunibrewin, you say ”people because they are becoming more informed decide that they do not agree with the people that believe the ‘herd community’ should be vaccinated.” Could you outline what people could be reading that would lead them to that conclusion? It contrasts with a huge mass of scientific evidence.

  11. Derek Mitchell says:

    My grandfather, an ophthalmologist, would have resoundingly pronounced non vaccinators as “fools”.  He lived in the age of certainty, back when if you murdered someone, you hanged for it.  Too much information, and pseudo qualified Netizens have become victims of, in turn, apathy, sensationalist media and group think. When they fall on their swords, their less educated neighbours will call them fools. 

  12. GEORGE QUITTNER says:

    When you leave the realm of reason and enter the world of “belief” and “faith”, the adversary is no longer ignorance.  As stated: Very “intelligent” people suffer inordinate and irrational fear of immunisation.  In my experience as a GP who prides himself on being a good communicator: Changing such people’s minds is mostly hopeless.  It is not very different from the problem that many people believe there is a man with a beard in the sky watching over us.  They cannot be dissuaded either.

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