So, what to say about Trump’s despicable stance on vaccines? Well, how about this:
1. Despite the regularity of empirically uniformed assertions to the contrary, the policy of universal vaccination, carried out by means of school-enrollment mandates, is not a politically contentious policy. On the contrary, the vast majority of the public --including Democrats and Republicans, climate change skeptics and nonskeptics, evolution believers and evolution nonbelievers—all support this policy.
The universal-vaccination pubic consensus can be, and has been, measured by public opinion polls. But the best evidence is just how high vaccination rates are in the U.S. today, and have been for more than a decade.
Yes, this policy is opposed by a fringe, which various narcissistic public figures and a gaggle of professional conflict entrepreneurs jockey to lead. But the fringe is a fringe; “anti-vaxers”—people who really are committed to rolling back universal childhood vaccinations, the most successful public health policy ever devised—are definitely outliers In whatever culturally identifiable group they come from.
2. This doesn’t mean, though, that the policy of universal childhood vaccinations is immune to political polarization. For proof, consider the HPV vaccine. Designed to protect against most of the strains of the human papilloma virus that cause cervical cancer, the proposal to add HVP to the universal-vaccine schedule splintered the American pubic along familiar political and cultural lines. As a result, this vaccine, even some ten years after the political battle abated, continues to bear a stigma that inhibits states from adding it to the mandatory list, and parents from assenting to the administration of it to their sons and daughters (Gollust et al. 2010; Gollust et al. 2015a, 2015b; Kahan et al. 2010).
3. The key to protecting public confidence in and support for universal childhood vaccinations is the quality of the “vaccine science communication environment.” Consider the HBV vaccine. Like the HPV vaccine, the HBV one is designed to confer immunity to a cancer-causing pathogen, hepatitis-b. Only a few years before its recommendation on the HPV vaccine, the CDC identified it, too, as appropriate for inclusion in schedule of mandatory vaccines (for infants now but initially for adolescents). At the time that the HPV vaccine was an object of intense, and intensely politicized, issue (roughly 2007-2010), the rate for HBV vaccines was between 90% and 95% on a national basis.
The difference in public reactions reflected the difference in the science communication environments in which they learned of these respective vaccines (Kahan 2013, 2016).
Unable (understandably, inevitably) to determine on the basis of personal research and experience all the science that they must accept in order for them to flourish in their lives, ordinary members of the public sensibly become experts on identifying who really knows what about what.
When they applied that form of rational perception to the HBV vaccine, all the cues—from the recommendations of their own pediatricians to the actions of their peers—vouched for the good sense of getting the shot.
But when they first encountered the HPV vaccine, the situation was quite different: they were bombarded with information that emphasized partisan division mirroring the divide over already polarized issues, including climate change, evolution, etc.
The reason for the difference was a risky marketing decision by the manufacturer of the HPV vaccine (Kahan 2013). Keen to accelerate the addition of its own HPV vaccination to the universal-childhood vaccination schedules, and to lock up its control of the market for supplying the vaccine for use in the public-school enrollment programs before approval of a rival firm’s competing vaccination was approved, the manufacturer orchestrated a poorly disguised political marketing campaign, one that included adoption of vaccine mandates in state legislatures. The process attracted the usual conflict entrepreneurs—right and left.
In sum, the company recklessly pushed the HPV vaccine into the political arena, which is ripe with cues that attached a partisan brand to the vaccine. Such cues—ones that make a contested science issue a symbolic test of who one is culturally, and whose side one is on—predictably displace and erode the habits of mind that diverse members of the public use to identify who knows what about what.
The HBV vaccine, in contrast, avoided this dynamic. Like other childhood vaccines, it travelled a depoliticized administrative route to adoption, in which public health authorities insulated from politics added the vaccine to the states’ universal-vaccination schedules. As a result, parents learned of the HBV vaccine from their pediatricians, people the trust, in a normal, unpolluted science communication environment that enabled rather than enfeebled their rational power to discern what is known to science (Kahan 2016).
With the HBV vaccine, they never had to make a choice, in sum, between knowing what science knows and being who they are as members of diverse cultural meanings (Fowler et al. 2015).
But with the HPV one, they did. When they are put in that situation, bet consistently that they will choose to “be who they are” (Kahan 2015), and you will become a very rich person (as conflict entrepreneurs well know).
4. Trump as science communication environment polluter. That’s what makes Trump’s actions—his appointment of the crank Robert Kennedy Jr. --to head up an absurd “vaccines & autism” commission so dangerous. From his bully(bull shit) pulpit, he has a unique power to enmesh the facts on the safety childhood vaccines in the toxic memes (Kahan et al. 2016) that transform a science issue into a cultural-identity one.
His actions also create a condition ideal to the flourishing of conflict entrepreneurs, who profit from the anxieties that cultural conflicts over science provoke, and who until now have floundered about without drawing large followings (CCP 2014).
Fighting back w/ true factual information – while certainly appropriate—is unlikely to do be sufficient once positions on vaccine risks have become fused with personal identity (Nyhan et al. 2014; Nyhan, 2016).
5. To public’s confidence in universal vaccination, we—all the people who aren’t part of the existing anti-vax fringe—need to resist Trump’s toxic stratagems. There’s only one effective remedy for Trump’s vile behavior: to refuse to take the bait. Aside from the HPV disaster, politicians on both the right and the left have for the most part refused to make mandatory childhood-vaccination into a partisan issue. They must do the same now. Indeed, they must band together, across party lines, to condemn Trump for the threat to public health that his actions pose.
And the same goes for those outside the government. Media and interest groups must be discouraged from using Trump’s behavior as an occasion to assimilate childhood-vaccines into the set of toxic issues that put ordinary people to the choice of being who they are or knowing what science knows about how to protect their well-being.
Of course, such groups can be expected to do what is in their interest. So citizens, too, must show that polluting the science communication environment around vaccines is something they won’t tolerate from those whose job it is to inform them.
6. This is the biggest test yet of our society’s science communication literacy. I’m aware, of course, about how empty, how naïve an injunction like the one I just propounded can be. We know a lot more about how and why certain issues become entangled in toxic, science-communication-environment degrading memes than we know about how to stifle that process.
But we must use all we know, and seek to add to it through experience as well as research (Pemberton 2013; Mnookin 2011), to block Trump’s effort to pollute the science communication environment on vaccines, and hope we can learn more from the experience.
The alternative to not even trying is to put at risk what is likely the greatest public-health asset—the broad level of U.S. general public confidence in childhood vaccines—that we possess. . . .
Fowler, E.F. & Gollust, S.E. The content and effect of politicized health controversies. The ANNALS of the American Academy of Political and Social Science 658, 155-171 (2015).
Gollust, S.E., Attanasio, L., Dempsey, A., Benson, A.M. & Fowler, E.F. Political and news media factors shaping public awareness of the HPV vaccine. Women's Health Issues 23, e143-e151 (2013).
Gollust, S.E., Dempsey, A.F., Lantz, P.M., Ubel, P.A. & Fowler, E.F. Controversy undermines support for state mandates on the human papillomavirus vaccine. Health Affair 29, 2041-2046 (2010).
Gollust, S.E., LoRusso, S.M., Nagler, R.H. & Fowler, E.F. Understanding the role of the news media in HPV vaccine uptake in the United States: Synthesis and commentary. Human vaccines & immunotherapeutics, 1-5 (2015).
Kahan, D., Braman, D., Cohen, G., Gastil, J. & Slovic, P. Who Fears the HPV Vaccine, Who Doesn’t, and Why? An Experimental Study of the Mechanisms of Cultural Cognition. Law Human Behav 34, 501-516 (2010).
Nyhan, B., Reifler, J., Richey, S. & Freed, G.L. Effective Messages in Vaccine Promotion: A Randomized Trial. Pediatrics (2014).
Mnookin, S. The panic virus : a true story of medicine, science, and fear (Simon & Schuster, New York, 2011).
Pemberton. Jabbed: Love, Fear and Vaccines (2013).