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Science of Science Communication 2.0, Session 5.1: the (mis)communication of vaccine-risk perception

It's been a while -- at least 45 mins -- since I've written about vaccine-risk perception and communication.  Well, conveniently, today's session -- #5 -- of  Science of Science Communication course ver 2.0 happens to be on this very topic.  To get the "virtual class" discussion going (real-space class is starting in 60 mins!), consider this case study, which was appended to this week's reading list:

Case Study: Vaccine Risk Communication

1. The Wakefield affair. In 1998, the medical journal the Lancet published a study by a team of researchers led by Andrew Wakefield that purported to establish a connection between the MMR vaccine and autism. Although the study was attacked almost immediately and ultimately was retracted by the journal, the Wakefield paper stoked considerable public anxiety in the U.K., where vaccination rates declined and the incidence of various childhood diseases increased.

2. U.S. Vaccine Risk Anxiety. The U.S. has experienced several pertussis or whooping cough epidemics in recent years as well as recurrent outbreaks of measles, a disease that was deemed eliminated in the U.S. in 2000.  These developments are widely attributed to the growing influence of anti-vaccination groups, high-profile members of which include political figures like Robert Kennedy, Jr. and the Hollywood celebrity Jenny McCarthy, which continue to disseminate the Wakefield study, supplemented with a wide variety of other materials that misrepresent vaccine safety.

Chronicling the misinformation efforts of the activists, public health professionals and journalists warn of a “growing crisis of public confidence” in childhood vaccines. More and more “mainstream parents” are availing themselves of permissive “moral” and “religious” exemptions to universal vaccination, these concerned observers report.  The resulting “erosion in vaccination rates,” a physician who has assumed a high-profile role as an opponent of anti-vaccine activists, national vaccination rates are at risk of dipping below the threshold necessary to preserve herd immunity.

3. The PUAA plan. “Progressives United Against Anti-Science” (PUAA) is a public interest group.  Combatting the anti-vaccine movement is one of its three missions. The other two are correcting the misinformation of climate change deniers and challenging efforts to add the teaching of “creation science” or “intelligent design” to public school curricula.

PUAA has formulated a two-prong plan to counteract the spread of vaccine refusal in the U.S. The first is a multi-million “social marketing campaign” consisting of high-exposure public service announcements, which would variously rebut misinformation about the risks posed by vaccines and seek to excite disapprobation toward parents who decline vaccination for endangering the public health generally.  The second prong of the PUAA plan would involve the promotion of state referenda to repeal “non-medical” exemptions to universal vaccination policies.

To fund its plan, PUAA is seeking a $500 million grant from the General Welfare Foundation (GWF). GWF is among the largest philanthropic NGOs in the U.S.  Promotion of public health is one of its primary interests.

PUAA  has also reached out to both the CDC and the American Medical Association. Because of the CDC’s and AMA’s important institutional roles in the public health establishment, PUAA believes, with good reason, that their communication of support for its plan would significantly increase the prospect of it obtaining funding from GWF.

4.  Issues. Should GWF fund the PUAA plan?  Should the CDC and AMA convey their approval?  Is there enough information to answer these questions?  If not, what additional information would be useful?

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Reader Comments (8)

Is it worth pointing out - ref Lancet - that the journal/science hung on to the paper for ages, and the 'attacks' were mainly from outside of science.. ie a journalist in particular..

ie authority of Lancet to be questioned, more important than dodgy paper retracted (though it was eventually)

also there were 12 co-authors (other scientists) of the paper, and it was only retracted 12 years later, which was 6 years after - The TImes journalist investigated it.. so much for peer review, on a guaranteed to be controversial (ie extra scrutiny required) topic.

February 10, 2015 | Unregistered CommenterBarry Woods


Is very odd how long retraction took.... but weren't there plenty of attacks w/i science community?

In any case, peer review clearly doesn't end w/ publication; on contrary, that's when it truly starts

February 10, 2015 | Registered CommenterDan Kahan

This was my pre-reading response:

The PUAA plan shows several flaws and potential flaws that would need to be resolved before a major philanthropic organization can consider funding.

First of all, if PUAA is creating an information campaign because it is motivated by the information deficit model, it should think again. Studies show that those who hold positions on controversial subjects contrary to the scientific consensus do so not because of a lack of information or a cognitive deficit, but because of a range of social and psychological factors driven primarily by a need to shore up existing beliefs.

However, an information campaign could be effective if it exposed members of the public to scientific information espoused by figures with whom they identified, especially those who share values along the hierarchical-individualist and egalitarian-communitarian spectrums.

Exciting disapprobation seems a risky strategy at best. Already the science communication environment on this issue is fraught with emotion. Emotional expressions about those who don't vaccinate their children often contain polarizing language, which could entrench cultural motivations to identify with one camp or another. Expressions of frustration about those who don't vaccinate are also often polluted with false assumptions, such as that such parents "don't trust science."

As for state referenda, I'm more sympathetic towards this tactic. On a practical level - if we look simply at the outcome of vaccination rates, without examining perceptions and beliefs - it is likely that wherever it is harder to get an exemption, parents will be more likely to vaccinate. There are also suggestions (see NPR’s coverage of work by Doug Opel) that a productive reframing of the vaccine issue would involve diminishing the extent to which it is viewed a "parental choice.” However, it’s one thing to do that in the doctor’s office, and another in the realm of public policy. One should be wary of creating a narrative of suppression, which could backfire if politicians and voters then get a chance to reverse vaccination mandates.

Post-reading, I had some further thoughts, which are here:

February 10, 2015 | Unregistered CommenterTamar Wilner

The PUAA offers quite a different tact than the CCP does in its report you cited (in the conclusion to your post yesterday).

I have all kinds of doubts about the CCP strategy.

The CCP certainly seems to be set on one course of action. But I wonder if the CCP’s strategy, which my most visceral being tells me boils down to appeasement and kowtowing to the anti-vaccination crowd -- meeting them half-way by capitulating on the parental choice issue -- is the best one.

The CCP expressed its concerns as follows:

In striking contrast to responses to the other items in the survey, the ones soliciting participants’ positions on proposals to restrict non-medical exemptions were characterized by disagreement. Not only did these items tend to divide the respondents. They divided them on political and cultural lines....

[T]hese results supply reason for circumspection on the issue of exemptions. The power of these items to divide groups already conspicuously arrayed against each other on contested science issues raises the possibility that real-world proposals to restrict universal immunization exemptions could do the same.

As I noted yesterday, a recent Pew Research poll contradicted the empirical claim made above. The Pew poll doesn’t indicate any glaring division along partisan lines, as respondents from both parties are overwhelmingly in favor of not allowing exemptions.

CCP’s strategy is to attempt to sidestep the cultural, moral and ethical debate altogether, thus avoiding a political imbroglio. “The right response to dynamics productive of excess concern over risk is empirically informed risk communication strategies tailored to those specific dynamics,” the CCP asserts. (emphasis in bold mine)

And maybe the CCP is right. Maybe it’s not the job of scientists and medical experts to engage the cultural debate and to pick between competing moral claims.

In addition the CCP’s strategy smacks of the state-of-the-art computerized mailings conducted by campaign consultants which permit politicians to address narrowly targeted groups without relying on high-visibility media campaigns or public forums. This approach has the great appeal of reducing the risk that controversial, and contradictory, positions will be exposed.

But on the other hand, what are the consequences of dodging the cultural debate? And how has dodging the cultural debate worked on other issues? On this particular issue, is the CCP in a can’t-lose position? Will it win regardless of what it does? And as human beings, is it even possible to dodge the cultural, moral and ethical debate?

Does the CCP suffer from the “fish bowl” effect, being blind to its own moral imperatives? (See Theory of Knowledge Essay 2: "Human beings are not aware of their assumptions and basic beliefs, much as fish are unaware of the water in which they live.") Is the CCP trapped in the framework of Modernity (now being rapidly dismantled) and the Cartesian dichotomy? And what of Habermas’s argument that so-called empirical knowledge, conceived as a body of facts and truths and existing apart from human purpose, is a myth?

Daniel Yankelovich in Coming to Public Judgment speaks of the “enormity of the gap that separates the public from the experts,” and asserts that the public’s side “belongs with the world of values, ethics, politics, and life philosophies rather than with the world of information and technical expertise.”

The public’s side is the side the CCP seems intent upon avoiding. The objectivist outlook – its dogmatic narrowness, its equation of reality with the measurable and quantifiable, its dedication to specialization and expertise, its contempt for modes of knowing that are not information driven -- seems to be the order of the day.

But would it be better, at least when dealing with the public, if the CCP were more explicit and straightforward about setting out what its moral imperatives are? Or is stealth moralism – floating one’s moral agenda under the guise of empirical-analytical science and denying a moral imperative exists – the better tact?

February 10, 2015 | Unregistered CommenterGlenn Stehle

@ Tamar Wilmer

I found your post on your blog to be an eye-opener.

Reading it, I realized how little we really know about why mothers don't vaccinate their children. It seems like step #1 would be to go into those pockets where non-vaccination rates are high and ask mothers who don't vaccinate their children what their reasons for not vaccinating are.

With that knowledge on board, then perhaps an appropriate, and effective, response can be formulated. Any plan without that knowledge seems like a shot in the dark.

Arguments and counseling to get mothers on board the vaccination express should be formulated with their specific concerns in mind. Arguments should address their specific concerns and fears, and seek to ameliorate them. Then, as the CCP report recommends, these arguments should be tested for their effectiveness.

Because non-vaccination apparently occurs in small pockets, a rifle approach, in lieu of the shotgun approach PUAA advocates, seems more appropriate.

All this strikes me as being pretty much run-of-the-mill marketing and political campaigning stuff.

I suppose one could always keep the elimination of exemptions in reserve as 'Plan B' if the above doesn't work. (And that course of action may by now have taken on a life of its own, and be unstoppable.) But the above seems more compassionate and understanding, and less coercive, than reaching out with the long arm of the law to bash people over the head.

P.S.: You're a much better communicator than the people who wrote the CCP report, what with all their high falutin, but extremely arid, technical jargon.

February 10, 2015 | Unregistered CommenterGlenn Stehle

A couple of interesting articles on the vaccination debate:

Measles Is Just the Beginning

We were smart enough to eradicate measles, but arrogant enough to invite it back. Welcome to a four-part series on the precise ways we’re fucking up 50 years of medical progress.

Then there's this:

A lot of Silicon Valley tech employees aren't vaccinating their kids

I loved this comment from below the line:

You have to be smart in the first out-smart yourself.

February 12, 2015 | Unregistered CommenterGlenn Stehle

Oh well. Ain't it great to live in a post-materialist world?

February 12, 2015 | Unregistered CommenterGlenn Stehle

Thanks, Glenn. I'm glad you liked my post.

I'm not sure if there hasn't been enough empirical research on motivations for non-vaccination and under-vaccination; or if the research hasn't reached any kind of consensus; or simply if these findings haven't filtered down to the public conversation. Maybe some of each?

Just with a cursory look on Google Scholar ("vaccine and MMR and motivation") I found this, which looks like it could illuminate motivations slightly:

There are some others that look relevant but are studies of UK parents, which I think might not translate to the US experience.

February 13, 2015 | Unregistered CommenterTamar Wilner

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