Thursday, February 05, 2015

Is the Measles Vaccination Discussion a Teachable Moment?

by Gary Berg-Cross

Fifteen years ago, the CDC was proud to announce victory over measles. More recently there is has been a creeping increase in measles outbreaks attributed in park to the growing number of parents have opted to not to have their children vaccinated. Fear is involved backed by an old claim that there is a link between vaccines and autism. I guess the small success of the flu shot this year also lowers the confidence that they work. And so we have this, according to the CDC, 1 in 12 children born in the United States is not being vaccinated as recommended. That's a huge percent for something the best science seems to say is effective and safe.

The measles vaccine dust up is what Adam Frank called a "teachable moment" for everyone as the anti-vax movement is suddenly thrown into the spotlight. Collectively, we can see the Disneyland outbreak and the various responses for what it could be — a wake up call for informed decisions and rational discussion about science denial and the relation of parental rights (freedom) and responsibility to the public at least.

Below is a portion of what Frank wrote on what he called living in "a strange moment of human history" :

We have this thing called science. Through its fruits (medicines, technology, etc.), many of us live lives fundamentally different from the tens of thousands of generations preceding us. At the same time, through science's unintended consequences, we have also changed the "natural" world in ways likely to pose daunting challenges to our ongoing "project of civilization." But strangest of all, in the midst of these profound changes, one growing response to the tough questions science raises in our lives has been to act as if it didn't exist.

I am, of course, talking about denial. The anti-vax movement, like climate change denialism, rests on the assumption that if you disagree with certain established scientific results you can just ignore them. You call the science lies — or claim the scientists have a political bias."

Indeed people ignore or trump science based on emotional feelings (fight or flight) vague values of freedom and such. So parent's get to chose is proclaimed as an absolute.  It has an ideological-religious fever to it. But on this issue of parent’s choice there is also the question of what is behind the choice and what is a good choice.Recently, NPR's Morning Edition had a 4 minute segment called The Psychology Behind Why Some Kids Go Unvaccinated. We could use some of what was said there as part of this teachable moment.

We can start by asking why do some people believe that these particular vaccinations are dangerous? Can’t they understand the facts?

It turns out that (some) telling parents that are afraid to vaccinate kids the facts makes them less likely to vaccinate them. It’s a general belief phenomena of the emotional brain we can demonstrate and understand to some degree.

Some of it is the near term pain vs. more distant or less obvious gain.  But also Dartmouth research by Brendan Nyhan was cited on the belief dynamics which challenge the teachable moment opportunity for some.

The frame of the research is the idea hat beliefs are shaped by pre-existing views, filtered by motivated reasoning (energized by Worry ) through loyalty to our group allegiance (tribe’s) belief.  For example, take groups and give them facts to show that Obama was born in the US. Some are not persuaded by that facts and believe that Obama was born in Africa. Who? Those who didn't like him to begin with. Not everyone is open to the facts, your ideology filters things and indeed can motivate people to use their thinking in a defensive way.

Once you believe in something strongly with emotions it is hard to debunk. And this theory of child vaccinations leading to autism has that rigidity. It came from a 1998 article in a good Journal, Lancet,

suggesting such a link, but the study was later retracted and has been widely discredited. It was, for example only an 11 kid sample and later couldn't be replicated and then the author was shown to have mad up the data. But it is hard to stop the meme. Especially when it is promoted by tribes with a megaphone.

The Morning Edition talked about the collective action dilemma – We can get a free ride sometimes when others do the hard work like with vaccinations. It means that I don’t have to deal with the risk and this is also called the tragedy of the commons. I’d say it is a general problem we face. Letting everybody act in their own self-interest isn't optimal although some believe that.

How to solve the dilemma?

Some cultures force or apply public-social pressure (e.g. You are a moron–if your child is not vaccinated I won’t invite her over for a play date.)

Social scientists think these (force and shame) are not the best ways. While a little social pressure is good, experts who have studied the psychology of the vaccine doubters say it's counterproductive to be accusatory — or even to try provide a little well-meaning education.

Below is some discussion of this from researchers as part of a different article:

"When you attack somebody's values, they get defensive," said risk communication expert David Ropeik. "It triggers an instinctive defensiveness that certainly doesn't change the mind of the vaccine-hesistant person."

And some of the criticism on cable television, social media and in mainstream newspapers and magazines is starting to look like bullying, Ropeik and other experts said.

"There are millions of people who are ambivalent to some degree. When they hear the people being picked on defend their views, that has the real prospect of turning some of those people against vaccines."

The anti-vaccine movement is nothing new. People have been questioning the safety and efficacy of vaccines for decades, especially once the illnesses the vaccines protect against started to disappear, and the risks of the vaccine began to loom larger when there was no backdrop of death and disease.

But simply telling people their views are stupid, or even not fully informed, will not work, said Dr. Brendan Nyhan of Dartmouth University (also cited in the NPR story).

"It could make the problem worse. Imagine what calling people selfish and dumb can do," Nyhan said. "If people call me selfish and dumb, it doesn't make me more open-minded, and I don't know why anyone would think otherwise in this case. I think it's really short-sighted. People enjoy lashing out at anti-vaccine folks, (but) it turns into an 'us versus them' thing."

Nyhan conducted a study last year with Freed that found that when they gave ambivalent parents facts that show vaccines do not cause autism, they were even less likely to vaccinate their kids than they were before.

"They are committed to that point of view. You can provoke a kind of backlash reaction if you are not careful," Nyhan said. "That is why it is important to test the messages that we use and avoid the counterproductive type of messaging seen in the wake of Disney."

Telling people they are wrong will just make them dig in their heels, said Nyhan.

"There is a psychological tendency called disconfirmation bias. Information we don't want to hear, we try very hard to reject it. That is especially true for beliefs that are central to our identity," he said.

Most Americans support vaccination. A survey from the Pew Research Center published last week found that 68 percent of American adults believe that vaccinations of children should be required, while 30 percent say that parents should be able to decide not to vaccinate their kids.

But groups such as the National Vaccine Information Center view and position themselves as courageous visionaries who challenge a flawed, mainstream point of view. Libertarian leaders such as Sen. Rand Paul, R-Ky., are taking on the issue of vaccination as a question of personal freedom.

Bottom line, how might we get people to vaccinate their kids?

Build relations and trust – acknowledge the fear and discuss it without force or shame.

And, of course, a similar approach may be useful for the secular and intellectual community on other issues.

Note- Adam Frank is a co-founder of the 13.7 blog, an astrophysics professor at the University of Rochester, a book author and a self-described "evangelist of science."

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