Parents who refuse to vaccinate their children have been called selfish and stupid. They were even accused of child abuse. But what if they actually act logically?
That’s the conclusion of Jennifer Reich, a sociologist at the University of Colorado who has spent the better part of two decades studying these families’ vaccination decisions. Reich is not anti-vaccine; her children received vaccines according to the Centers for Disease Control and Prevention schedule. But she sees parents’ decisions to take a different path as a logical consequence of the desire to be wise consumers in an increasingly complex world, to make informed decisions about everything. it could affect the health of their children.
Vaccine skepticism is also, in some ways, a consequence of our modern wellness culture. Although well-intentioned, messages that people can prevent illness through individual choices — like setting a step goal or counting calories — have sown in some parents the belief that they can prepare their children to resist an infectious disease should one arise, Reich says.
STAT spoke with Reich ahead of his appearance at the upcoming STAT Summit and in light of the ongoing measles outbreak in Pennsylvania.
The questions and answers below, which were compiled from two interviews, have been edited for length and clarity.
You’ve spent a lot of time talking to parents who reject vaccines, and I’m curious what you learned from that.
At the time I started thinking about this, the narrative was really that parents were selfish or anti-science. They were stupid… And I found that to be wrong. In talking with parents, I found that they were making very sophisticated decisions focused on their child and weighing scientific information to assess whether they thought their own child would benefit most from a vaccine.
The more I spoke to families, pediatricians, and experts, the more I began to recognize that vaccine hesitancy, in many ways, is a logical consequence of the cultural pressures we have placed on families. We ask parents every day to make perfect decisions about their health, schooling, shopping, grocery shopping, eating, and tutoring… We never ask parents to worry about other people’s children, and from that perspective, rejecting vaccines that don’t seem particularly relevant to you or your children actually seems quite logical.
What do you mean when you say that parents who are skeptical of vaccines are acting rationally?
In talking with families, I heard mothers in particular spend a lot of time trying to understand the science behind each vaccine, trying to understand the risks and benefits as they understood them, but also questioning the benefits of all vaccines for all children. And I would say that many times the answers they arrived at were not anti-scientific. They weren’t even anti-scientific. They were simply using logic that asked whether their own child would benefit most from this vaccine, not what kind of impact it would have on others.
I ask because I imagine some will say, “If people don’t act on the best peer-reviewed science, there’s no way they can act rationally.”
I can give you an example from some of the parents I spoke with. What I often heard was that parents accepted that there was demographic data that spoke to collective patterns of infectious disease, and most of them had no doubt that this data was real. But they couldn’t really understand how this data was useful in predicting the experience of their family and their children. And in the context of a cultural message that says if you work really hard and have high-quality food, breastfeed your children, and take care of their health, everything will be fine, the logic that demographics would speak to their individual situation seemed illogical to them…
I have also heard from parents that in evaluating each vaccine for each of their children, they sometimes arrive at different decisions for each child. And so I asked a mother to explain to me that she did not see the use of a rubella vaccine for her son, who will never be pregnant, understanding that rubella is a fairly benign disease for the infected person, but that it is a devastating disease if a pregnant woman encounters it… And so she accepts this science, but she simply points out that her son will never be pregnant and therefore does not benefit from this vaccine. And it’s not unscientific, but it ignores the fact that his son is likely to live in a community with pregnant women… So he has some responsibility to avoid a bad outcome, but it’s not untrue that he won’t personally benefit from this vaccine.
Is it fair for me to assume that by viewing these people as logical, it doesn’t necessarily mean you agree with their conclusions?
I think if we can recognize the kind of logic that people bring to these conversations, it creates the possibility of having better conversations. If we dismiss what they say without recognizing that they have read a lot, understood the information, and come to different conclusions, it becomes very difficult to create a shared sense of understanding from which to move forward.
Parents all want healthy children. They all want healthy communities and largely consider themselves good people. So the idea that they are intentionally harming other children doesn’t ring true, but we also don’t recognize how many things parents fear every day when it comes to their children, and vaccines are one of the few things we ask parents to actively consent to…It’s often the only (thing) parents identify and can control in a world of things that often seem out of control. And there is an opportunity for public health experts and health care providers to take their concerns seriously and think about how to engage where they are, rather than dismissing it all as misinformation.
When you talk about these cultural pressures, what are the roots? When did it start?
I think most people attribute the rise of the modern anti-vaccine movement to the 1980s, when parents began organizing to ask questions about the whole-cell pertussis vaccine. … But I think there’s really no way to think about individual pressures to make health care decisions and take responsibility for one’s own health, independent of a lot of things that happened at the same time.
So I think a lot about the women’s health movement, for example, in the late 1960s and early 1970s… We can also think about groups like ACT UP that opposed the FDA process and testing of drugs to treat AIDS and how that really changed conversations about science and created a notion of the lay expert – that individuals who had first-hand knowledge had a valuable perspective. And I would say that these two examples illustrate how health care has improved through patient input. So we have, outside of the field of vaccines, a context in which we can see similar cultural shifts.
What do you think about how people end up here? All the factors you expose This makes sense, but obviously some parents internalize these responsibilities, leading them to simply follow their doctor’s advice.
In the same way that I really don’t think health literacy is the only problem, I’m also a little skeptical of claims that this is all misinformation. I really believe that people are experts in their own lives. They know each other. They know their families best, and we must take this experience and knowledge very seriously. And so, from that perspective, we can then say: how does this happen?
In my research, I’ve often heard stories from mothers who were initially very supportive of vaccines and then had negative health care experiences that started with their birth experience or their prenatal care experience, or who felt like they wanted to have a conversation with a pediatrician and the pediatrician didn’t have enough time to have the conversation they wanted to have.
In many ways, they began to feel alienated from the systems they thought were there to support them, and they found support elsewhere, whether it was a new moms group that had many people critical of vaccinations, looking for alternative health care providers and ways for them to feel like their concerns were being taken very seriously, or whether it was an online community that validated their concerns.
I think we can take this very seriously, not as the failure of a pediatrician or a parent, but we can ask questions like, “How come doctors’ appointments have become shorter and shorter over the last decade?” “How come the average pediatric appointment lasts between 11 and 16 minutes? And we know that health care providers are also very unhappy.
If we accept the principle that parents are in fact acting logically, how does that change the way public defenders address this problem?
I don’t think it sacrifices much ground based on the assumption that parents are behaving rationally and want the best for their children…
Gn Health
