Tag Archives: vaccination

Vaccination debates: the corona connection

The coronavirus pandemic has intriguing connections with longstanding debates about vaccination.

Background

Vaccination proponents say it’s one of the most important public health measures of the past century, with its benefits in reducing infectious disease vastly outweighing any small risks. Critics say the benefits are overrated and that adverse effects are greater than normally acknowledged.

This was the state of play before the emergence of the new coronavirus, officially known as SARS-CoV-2. How does the coronavirus disease, Covid-19, affect the longstanding claims and counterclaims in the vaccination debate?

 

Quandaries for vaccination proponents

Covid-19 undermines one of the usual arguments for vaccination, namely that unless most people receive routine vaccinations, there is a possibility of a pandemic like the Spanish flu of 1918–1920 linked to the deaths of tens of millions of people. A moment’s reflection, though, should be enough to realise that vaccinating against polio and measles provides little or no protection against a new virus.

Vaccination proponents have tacitly admitted that, when a vaccine is not available, other measures may be necessary, notably contact tracing, quarantine and physical distancing along with hand-washing and other hygienic measures to reduce the risk of transmission. These are relevant for many vaccine-preventable diseases such as measles and whooping cough but are seldom emphasised, perhaps because they might detract from the importance, efficacy and efficiency of vaccination as the first line of defence.

Covid-19 has brought another possibility onto the agenda: the immunity to an infectious disease acquired by having it. This sort of acquired immunity was common before the advent of vaccines.

The entire population, referred to as the herd, is protected if enough people are immune. When, before the measles vaccine, most children had measles, this provided protection for those whose immune systems were impaired. If most people in a community have had Covid-19 then, assuming having had the disease confers immunity, the pandemic will end. However, this is likely to involve much illness and many deaths before herd immunity is attained.

            Critics of vaccines have argued that there are advantages to acquiring immunity by having a disease. Before Covid-19, this argument received very little public attention.

In the vaccination debate, proponents emphasise the importance of herd immunity. This is taken to be vaccine-induced herd immunity. That is, when most people are vaccinated and most gain immunity as a result, the disease agent dies out for lack of individuals to infect.

Some commentators (including scientists) have suggested that widespread immunity acquired from having Covid-19 is an endpoint worth considering. A possible option is to allow or even encourage young and healthy people to be infected while protecting older vulnerable individuals. Few governments have adopted this option, perhaps because it clashes with the vaccination paradigm.

In summary, Covid-19 has undercut the common assumption that vaccines are the only way of dealing with infectious diseases. Claims about unvaccinated children being a health threat, and their parents being irresponsible, have been superseded by worries about contagion from coronavirus-infected individuals.

Quandaries for vaccine critics

For critics of vaccination, Covid-19 raises a possibility that might not be welcome: that an effective vaccine, if developed, might be just what is needed to bring the pandemic under control or to limit its damage. Although all vaccines pose risks, if Covid-19 is as deadly as commonly believed, even a vaccine with significant adverse effects could have more benefits than harms. This is the same sort of assessment used with other vaccine-preventable diseases.

There has been much commentary about how long it will take to test a vaccine and roll it out for the world’s population. There is no guarantee that an effective vaccine can be developed. Just as importantly, vaccines pose risks, especially when introduced for emergency purposes. Mention has been made of the vaccine for the 1976 swine flu, a vaccine that caused more harm than the flu.

Vaccine critics are already warning about the potential dangers of a coronavirus vaccine, especially one that has not received sufficient testing. Some critics see a coronavirus vaccine as a stalking horse for the introduction of mandatory vaccination, including for other vaccines. The social control measures introduced for dealing with Covid-19 might be a precursor for a different control measure: enforced vaccination despite the risks.

Absent viewpoints

The public debate over vaccination is polarised: there are two sides with sharply divergent positions on benefits, risks, ethics and decision-making. This polarisation of the public debate occurs despite both sides having the same ultimate goal: protecting the health of the population, especially children. One of the effects of polarisation is to sideline other perspectives.

Proponents and critics of vaccination agree that immunity to disease is important but differ about the sorts of immunity they emphasise. Proponents focus on the benefits of vaccine-induced immunity whereas critics point to the benefits of natural  immunity.

The immune system can also be boosted through various means, including exercise, diet, vitamin D, sleep and mindfulness. (For references, see my book Vaccination Panic in Australia, pages 352-355.) One of the contradictory features of the response to Covid-19 is that control measures, especially quarantine, distancing and closure of businesses, may have negative effects on an individual’s immune system.

When gyms and pools are closed and exercise classes banned, people get less exercise. In principle, people can exercise by themselves at home, and indeed are encouraged to, but for many individuals the control measures will reduce their level of physical activity. Exercise has many health benefits aside from immune system improvement.

            How control measures are affecting diet is hard to determine. Closure of fast-food outlets might improve some people’s diets. On the other hand, staying at home and worrying can lead to less healthy eating.

            The body manufactures vitamin D when the skin is exposed to sunlight. Staying inside reduces vitamin D production.

Ample sleep benefits people’s immune systems and general health. Staying home more of the time may be enabling people to get more sleep, though worries and physical inactivity can impair sleep quantity and quality.

Mindfulness refers to a state of mind that is calm and focused; meditation is one way to be mindful. Worrying about Covid-19, and obsessively seeking information about risks, is contrary to mindfulness. So are losing one’s job and worrying about finances.

Research shows that personal relationships are crucially important to happiness. Distancing measures have disrupted many relationships, especially physical contact, and thus have adversely impacted wellbeing. There are also other adverse impacts, including increases in domestic violence.

            It is difficult to quantify the impacts of control measures on exercise, diet, vitamin D, sleep, mindfulness and relationships and hence difficult to take them into account in policy-making. Probably the impacts are more negative than positive.

One thing is certain: the vaccination debate will continue. Covid-19 may be causing some shifts in public discussions about immunity and vaccination but is incapable of ending the overall controversy.

Brian Martin
bmartin@uow.edu.au

Thanks to Tonya Agostini, Kevin Dew, Meryl Dorey, John Potterat, Jennifer Reich, Samantha Vanderslott and Jody Watts for valuable feedback on drafts. None of them necessarily agrees with any of the views in this post.

An orchestrated attack on a PhD thesis

Judy Wilyman, an outspoken critic of the Australian government’s vaccination policy, undertook a PhD at the University of Wollongong. She graduated in December 2015.

On 11 January, her PhD thesis was posted on the university’s digital repository, Research Online. On the same day, anticipating an attack on Judy and the thesis, I posted a document titled “Judy Wilyman, PhD: how to understand attacks on a research student“, which turned out to be remarkably accurate in characterising the nature of the attack, which commenced within 24 hours.

The attack included a series of biased articles in The Australian by journalist Kylar Loussikian, numerous hostile blogs and tweets, a one-sided Wikipedia page, and a petition. Never before have I heard of such an outpouring of rage over the award of a PhD in Australia.

Loussikian-story

As a sociologist, this phenomenon is fascinating in its assumptions and motivations. I am hardly a neutral observer: I was Judy’s principal supervisor at the University of Wollongong, and quite a bit of the outrage has been directed at me, my supervision and my research. On the other hand, I have considerable inside knowledge, enabling insight about the claims being made.

Given the volume of hostile commentary about Judy’s thesis, it is not possible for me to undertake a comprehensive analysis of it in a short time. Therefore my observations here are preliminary. Rather than try to provide detailed evidence to document my generalisations, I merely illustrate them with a few comments made by signers of the petition against the university and the PhD. Down the track, I hope to provide a more detailed response, including to some of the treatments that address matters of substance.

SAVN attacks

The outrage over Judy becoming Dr Wilyman can best be understood by studying the operations of the group now calling itself Stop the Australian (Anti)Vaccination Network or SAVN. Since 2009, SAVN has been attempting to censor and discredit any public criticism of vaccination, using misrepresentation, ridicule, complaints and harassment, as I have documented in a series of articles. SAVN’s agenda has been to cleanse public discourse of dissent about vaccination. Judy Wilyman has been one of SAVN’s many targets.

savn

Judy had been under attack by SAVNers for several years. Therefore, I and others at the University of Wollongong correctly assumed there would be a hostile response to her graduation. Consider two hypotheses for how I and university officials would behave in this situation.

Hypothesis 1. We would push through a sub-standard thesis.

Hypothesis 2. We would take extra care to ensure that the thesis was of requisite quality and that all university processes were followed carefully. This would include sending the thesis to technical experts and choosing external examiners of high standing.

To me, it beggars belief that anyone would believe hypothesis 1, especially given that outsiders lack information about the operation of university processes. Yet in practice it seems that many outsiders, based on limited knowledge, assume that the thesis must be no good, my supervision was inadequate and the university was derelict.

The rush to condemn the thesis and the university can be understood this way: opponents assume it is impossible to undertake a scholarly critique of vaccination policy (or at least impossible for Judy to do so). Therefore, they condemn everyone involved in the process.

Furthermore, opponents do not acknowledge that scholars can differ in their evaluation of evidence and arguments. Instead, in various scientific controversies, including the vaccination debate, dissident experts are subject to attack.

Agenda-setting

Within media studies, there is a well known and widely discussed view that mass media do not tell people what to think, but are quite influential in determining what people think about. The articles by Kylar Loussikian in The Australian apparently were highly influential in getting a lot of readers to think about Judy Wilyman’s PhD. Their agenda was set by the mass media yet, as noted within agenda-setting research, few readers realised their focus of attention had been so influenced.

UoWooWoo

Associated with media agenda-setting is the significance of framing, which is about the perspective from which people see an issue. Loussikian’s articles framed the issue as about shortcomings of a PhD thesis and the credibility of the student, the supervisor, the examiners and the university. This frame was adopted by most (though far from all) commentators.

It is an interesting thought experiment to consider the likely response to a differently framed set of articles about the thesis, in which the central issue was an attack on academic freedom by SAVN over a number of years. However, The Australian was unlikely to adopt this frame. Indeed, a couple of years earlier, an Australian journalist had adopted SAVN’s agenda against Judy.

Assumptions about scholarship

Many of the attackers seem to have assumed that scholarship and criticism of vaccination are incompatible. How else could they justify condemning the university? An alternative view is to support current Australian government vaccination policy while accepting that it can be subject to a scholarly critique.

Respectful-Insolence

SAVNers for years have proclaimed that there is no debate about vaccination, by which they mean that there are no valid objections to the dominant view. To acknowledge that a scholarly critique is possible is to accept there is something to debate. Apparently this possibility is so threatening that it must be met by denigration and abuse.

Looking at the thesis

In “Judy Wilyman, PhD” I anticipated the sorts of attacks that would be made. This was not difficult: I simply listed the methods that had been used previously. Here’s what I wrote in a section titled “What to look for in criticism”:

When people criticise a research student’s work, it is worth checking for tell-tale signs indicating when these are not genuine concerns about quality and probity but instead part of a campaign to denigrate viewpoints they oppose.

  1. They attack the person, not just their work.
  2. They concentrate on alleged flaws in the work, focusing on small details and ignoring the central points.
  3. They make no comparisons with other students or theses or with standard practice, but rather make criticisms in isolation or according to their own assumed standards.
  4. They assume that findings contrary to what they believe is correct must be wrong or dangerous or both.

The attacks on Judy’s research exhibit every one of these signs. Her opponents attack her as a person, repeatedly express outrage over certain statements she has made while ignoring the central themes in her work, make no reference to academic freedom or standard practice in university procedures, and simply assume that she must be wrong.

My preliminary observation is that most of the hostile commentary about the thesis exhibits one or more of these signs.

petition

There have been numerous derogatory comments made about Judy, me and the university, most without providing any evidence and many based on misrepresentations of the thesis. Proponents of evidence-based medicine might ponder whether it is legitimate to condemn a thesis without reading it, condemn a supervisor without knowing anything about what happened during the supervision process, and condemn a university without having any information about the operation of university procedures. (Tell-tale sign 1)

Some of the opponents of the thesis have referred to comments made by Judy in other contexts. Likewise, questions have been raised about some of my other research. This is the technique of attacking the person in order to discredit their work. (Tell-tale sign 1)

When raising concerns about a piece of research, the normal scholarly route is to send them to the author, inviting a reply, not to immediately publicise them via journalists. An alternative is to submit them to a scholarly journal for publication, in which case many editors would invite the author to reply.

Alleging there are errors in a piece of work does not on its own challenge the central arguments in the work. For this, addressing those arguments directly is necessary. Very few of the critics of Judy’s thesis have addressed any of its central themes. (Tell-tale sign 2)

The intensive scrutiny of Judy’s thesis on its own does not enable a judgement of its quality, because it is necessary to benchmark against other comparable theses. None of her critics has attempted a similarly intensive scrutiny of any other thesis, much less a set of theses large enough to enable a fair assessment of her work. Experienced examiners have assessed many theses, as supervisors and/or examiners, and are well placed to make the required judgements about quality. This is in stark contrast to outside critics, many of whom lack any experience of thesis supervision or examination. (Tell-tale sign 3)

Why is there such a hue and cry over Judy’s thesis? Many theses tackling controversial topics or taking non-standard positions are published every year. Many of the critics of the thesis apparently believe no thesis proposal critical of vaccination should be accepted at an Australian university, and that for such a thesis to be passed necessarily reflects adversely on the university. The thinking behind this seems to be based on the assumption that criticism of Australian government vaccination policy is dangerous and should be censored. (Tell-tale sign 4)

I care. I believe in freedom of thought and speech, however this unscientific bullshit has to stop. It’s endangering lives — Kate Hillard, Broome, Australia

The net effect of these techniques is striking. A group of campaigners, with a well-established agenda of attacking critics of vaccination, sets out to discredit a thesis. Disdaining accepted scholarly means of critique, they feed material to a journalist. They take sentences from the thesis out of context and assert they are wrong, going public before offering the author an opportunity to reply. They ignore the central themes of the thesis. They show no awareness of scholarly expectations in the field, instead asserting the superiority of their own judgements over those of the examiners. Based on this charade of intellectual critique, they then condemn the thesis, the student, the supervisor and the university in an orchestrated campaign.

The role of expertise

SAVNers and quite a few other commentators state or assume that vaccination policy is a scientific issue, rather than one including a complex mixture of science, ethics and politics. These commentators then jump to the conclusion that only scientific experts are qualified to make judgements about vaccination policy. There is a contradiction in their discourse, though, because few of these commentators themselves have relevant scientific expertise, yet they feel entitled to make pronouncements in support of vaccination. So their assumption is that anyone, with relevant credentials or not, can legitimately support vaccination policy but no one without relevant scientific expertise is entitled to criticise it. They ignore the significance of policy expertise.

Wikipedia-Judy-Wilyman

This is a familiar theme within scientific controversies: critics of the epistemologically dominant view are dismissed because they are not suitably qualified. There is another way to look at policy issues: all citizens should be able to have an input, especially those with a stake in the outcomes. This participatory view about science policy has been well articulated over several decades, but few of those commenting about Australian vaccination policy even seem to recognise it exists.

Many opponents of the thesis and critics of the university have declared this issue is not about academic freedom but about academic standards. This claim would be more convincing if these opponents had ever made scholarly contributions about academic freedom or if they were not making self-interested judgements about their own behaviour. Their actions show their agenda is suppression of dissent.

The SAVN message

What is the implication of SAVN’s campaign against Judy Wilyman? And why do SAVNers and others continue to attack the University of Wollongong despite lacking any concrete evidence of any shortcomings in the university’s processes? There is one underlying message and two audiences. The message is that no university should consider allowing a research student (or at least an outspoken research student) to undertake a study critical of vaccination.

The first audience is the University of Wollongong. The second audience is other universities, which are being warned off critical studies of vaccination, or indeed of any other medical orthodoxy, by the example being set by the attack on the University of Wollongong.

There is also another message, which is along the lines of “Don’t mess with SAVN. We will launch a barrage of abuse, ridicule and complaints, and use our connections with the media and the medical profession, to assail anyone who crosses us.”

The original reason I became involved in the Australian vaccination debate is that I saw SAVN’s agenda as dangerous to free speech. If adopted more widely, SAVN’s approach would stifle discussion on a range of issues.

I am therefore buoyed by the support I’ve received from my colleagues, including senior figures, at the University of Wollongong, who believe in the importance of open debate and of scholarship that challenges conventional wisdom.

It is apparent that academics and universities need to do more to explain what they do and to explain the meaning and significance of academic freedom.

Postscript

See also my other writings about attacks on Judy and her thesis.

The story-editing solution

The way people think about their lives can have profound effects on the way they behave. Timothy Wilson explains how to reap the benefits of story-editing.

Stereotype-threat

Two groups of US students sit down to take a maths test. The groups are similar and the questions they are asked are identical, but there is one difference between the groups. At the top of the test, students in one group are asked to indicate their sex, male or female; the students in the other group are not.

It seems like a trivial difference, but it’s not. Boys aren’t affected, but girls are: the girls who are asked to indicate their sex before the test do worse. This is an example of a stereotype threat: bringing to consciousness a stereotype, in this case that girls aren’t good at maths, harms their performance.

What is going on? Being reminded of being female stimulates mental effort to deal with the stereotype, and this is mental energy that can’t be used to focus on the maths problems.

This is one of numerous examples of how beliefs about ourselves can affect how we behave and perform. There’s a large amount of social and psychological research about this phenomenon. A really valuable overview of the research and its implications for policy and practice is Timothy D. Wilson’s book Redirect.

Redirect

Wilson makes two main points. The first is that social interventions need to be carefully tested, preferably with a design in which individuals are randomly assigned to a control group and an experimental group. It is not good enough to undertake interventions that seem like they should work because they are obvious and sensible.

Wilson’s second main point is that the story-editing approach, namely getting people to change the narratives they use to understand themselves, can be far more powerful than other methods.

Scaring kids

There is a popular programme in the US to discourage teenage delinquency. At-risk youngsters are brought together to hear lectures from prisoners, who tell them about what is in store for them should they make the wrong decisions about their lives. This programme is well-meaning and seems plausible: scare these kids with warnings about their possible fate and they’ll be more likely to go straight. There’s one major problem: it doesn’t work.

scared-straight-kenan1

Wilson uses this example as one of many in which a well-meaning intervention was rolled out across the US before it had been adequately tested. When controlled trials were finally undertaken, it turned out that the lectures intended to scare the kids out of trouble were actually making things worse. These kids were more likely to drop out of school, be arrested and go to prison. Wilson provides example after example of plausible interventions that have no benefit or even make things worse. He assigns the “bloodletting” award to counterproductive interventions: doctors used to treat many illnesses by drawing blood, thereby making the patient more likely to die.

What was wrong with the scaring-kids intervention? Thinking in terms of stories people tell about themselves, an explanation goes like this. Some supposedly at-risk kids previously thought of themselves as regular, honest and well-intentioned. They did the right thing because that is how they thought of themselves. But then they were put into a group labelled “at risk” and given lectures about the dangers of crime. Some of them started thinking their reason for avoiding crime was to avoid the consequences: their motivation, previously internal, became external, and this is not as effective a deterrent when the circumstances are less favourable. Furthermore, these kids were put in a group of others considered at risk, and this is truly a risk, because they are influenced by peers setting a bad example.

Timothy-D-Wilson
Timothy D Wilson

            Wilson’s main attention is on interventions to address social problems in the US including poverty, low education, crime, sexism and racism. The bottom line is that all interventions should be tested before being used on a wide scale, and that story-editing approaches are often extremely effective.

It’s possible to use the insights from the story-editing approach to look at some other sorts of issues, including ones where interventions cannot be readily tested.

Whistleblowing

When a worker speaks out about a problem in their workplace, such as corruption or hazards to the public, they often suffer reprisals such as ostracism, petty harassment, reprimands, referral to psychiatrists, demotion and dismissal. This seems a harsh response to someone who is concerned about problems. What are the stories told about this common scenario?

From the employer’s point of view, the worker is out of line, challenging management and threatening the viability of the enterprise (not to mention seeking to expose management involvement in unethical and criminal activities). The worker is labelled a traitor, malcontent, snitch or dobber. The story provided is that the worker is in the wrong, due to personal failings. Rumours may be spread that the worker is a poor performer, has a mental illness or is involved in unsavoury sexual practices. Quite separately from the labels applied, the actions taken against the worker suggest their own meanings. Being referred to a psychiatrist is demeaning and signals to others that the worker is mentally unstable.

In some cases, the worker starts believing what is said about them, thinking “There must be something wrong with me.” The late Jean Lennane, former president of Whistleblowers Australia, worked as a psychiatrist, and treated quite a few such workers. After hearing their stories, she would say, “You’re not insane. You’re a whistleblower.” This is a story-editing intervention. Jean changed her patient’s script from “There’s something wrong with me” to “There’s something wrong with the organisation.” She changed the label from “dobber” to “whistleblower.”

Edward Snowden
Edward Snowden: hero or traitor?

Back in the 1990s, the NSW branch of Whistleblowers Australia held weekly meetings. Some people who attended for the first time said, “I’m not a whistleblower, but …” and went on to describe experiences that perfectly fitted the usual idea of a whistleblower. At that time, the term “whistleblower” had a negative connotation and many workers were reluctant to accept the label.

In the following years, the label “whistleblower” gained in status in Australia, in part through media stories that used the term in stories portraying gallant individuals challenging abuses of power. Workers were less likely to acquiesce in labels applied by bosses and more likely to take pride in calling themselves whistleblowers. Employers are more often losing the story-editing struggle, though reprisals against whistleblowers remain all too common.

War

Another arena for story-editing struggles is war. A familiar example is what to call a fighter challenging a repressive government: a terrorist or a freedom fighter. Governments have far more power to label than do their opponents, as shown by the ubiquity of the label “terrorism” applied solely to challengers, not to governments themselves, even though many government actions fit standard definitions of terrorism.

terrorist-or-freedom-fighter

By labelling opponents as terrorists, governments might in some cases actually be assisting their enemies in recruitment, especially when entire groups are stigmatised. It is useful to remember that the South African apartheid government called its armed opponents “terrorists,” that the US government, during the Vietnam war, called the National Liberation Front “terrorists,” and the Philippines government calls armed opponents “terrorists.” Commentators in the US have called some environmentalists “eco-terrorists.” The aim in such labelling is to stigmatise, but is this effective? It is possible that it may cause some activists — even ones who had not considered the use of violence in resistance — to identify with the government’s opponents.

A related story-editing struggle concerns what to call those who refuse to fight, by refusing conscription or by deserting from the army. Military leaders typically call them “traitors” or “cowards.” Within the peace movement, they might be called conscientious objectors or war resisters and be seen courageous or even as true patriots.

Vaccination

What should a parent be called who has reservations about vaccination, or who declines some or all vaccinations for their children? They can be called conscientious objectors or, more pejoratively, vaccination refusers or deniers. Some campaigners who raise concerns about vaccination are called baby-killers.

Does this sort of labelling help promote vaccination? From a story-editing perspective, derogatory labelling of people with concerns about vaccination could be ineffective or even counterproductive, by alienating some parents who had cautiously expressed concerns and found themselves grouped with more vociferous critics. In addition, hostile labelling may drive some parents towards vaccine-critical groups as a source of identity.

vaccine-cover-detail

A different approach to vaccination critics is to label them concerned parents and to provide information about how their concerns relate to vaccination. The story promoted with this sort of intervention is that it is legitimate for parents to have concerns about their children’s health and that choosing to vaccinate is one possible resolution for their concerns.

In this case, the story-editing struggle occurs mainly between advocates of vaccination, namely between those who stigmatise parents reluctant to vaccinate and those who respond to their concerns with sensitivity and sympathy. From a story-editing perspective, the latter approach is more likely to be effective, though designing a way to rigorously compare the two approaches would be extremely difficult.

Conclusion

Redirect provides a powerful summary of a body of research showing that the way people think about themselves makes an enormous difference to their behaviour. Seemingly trivial interventions that change self-perspectives can have long-lasting impacts.

Wilson has two main aims in Redirect. The first is to show the power of story-editing and the second is to emphasise the importance of careful studies of social interventions. Research shows that all too many well-intentioned interventions appear to be ineffective or, even worse, counterproductive.

Yet in some areas it can be difficult or almost impossible to carry out controlled tests. I’ve outlined three areas where story-editing struggles take place: whistleblowing, war and vaccination. Based on the evidence provided in Redirect, the preliminary hypothesis in each case is that a key in such struggles is changing the way people think about themselves. It might even be possible that derogatory labelling is ineffective or counterproductive. Read Redirect and decide for yourself.

 ***

Timothy D. Wilson, Redirect: changing the stories we live by (Penguin, 2013)

Brian Martin
bmartin@uow.edu.au

Thanks to Jørgen Johansen and Cynthia Kardell for useful comments on a draft.

Vaccination passions

200490829-002

Vaccination seems to arouse stronger emotions than most other controversial issues. Jonathan Haidt’s research on the foundations of morality can help explain why.

When I started studying the Australian vaccination controversy several years ago, I was struck by the incredible passions aroused by the issue.

It is not a surprise that campaigners are committed and emotional – that was to be expected. I have studied other controversies, such as nuclear power and fluoridation, in which leading campaigners are personally invested in the issues. In the 1980s, the movement against nuclear war stimulated some fierce emotions: the future of humanity was at stake! (And still is.)

Vaccination is not as earth-shattering as nuclear war, but nonetheless evokes incredibly strong emotions. When acquaintances learn about my studies, many of them have asked me why this is so. I usually say I don’t really know, commenting that maybe it has to do with children’s health.

Both sides in the debate about vaccination put children’s health as their number one priority. They just draw different conclusions.

Supporters of vaccination say it is vital that every child be vaccinated (except for those for whom this is medically unwise) to create “herd immunity”, the protection for the population created when levels of immunity are high enough that an infectious agent cannot easily spread.

Critics of vaccination point to the risks of vaccination itself – it causes adverse reactions in a small percentage of children – and discount the importance of herd immunity, instead citing the importance of good nutrition, a healthy lifestyle and natural immunity acquired by contracting diseases.

There are other potential threats to children’s health, such as pesticides, x-rays, junk food, backyard swimming pools and parental violence. Nuclear war would harm children, to be sure, and continued global warming would be a major threat to the lives of future generations. However, vaccination is more personal: it involves a tangible intervention. Proponents can point to horror stories of deaths and disabilities from whooping cough, meningococcal and other infectious diseases, while critics can point to horror stories of adverse reactions to vaccines.

hiroshima7
War – bad for children

The rider and the elephant

Jonathan Haidt’s book The Righteous Mind offers additional insights into why the vaccination issue can be so polarising. Haidt doesn’t address vaccination, nor indeed any other such controversial public issue, but his ideas are relevant. (See also my previous comments about Haidt’s work, as applied to whistleblowing and deliberative democracy.)

Haidt, like many other psychologists, subscribes to the picture of the human mind as having two aspects or components. One is slow, logical, contemplative and careful. This rational component of the mind Haidt calls the “rider”. The other component of the mind is fast, intuitive and judgemental. Haidt calls this component the “elephant”. He argues, provocatively, that humans are largely driven by their elephants, namely the intuitive sides to their minds. The primary function of the rider, namely the rational side of the mind, is to come up with logical-sounding explanations for the judgements made by the elephant.

Elephant and Rider

This certainly fits what I’ve observed in the vaccination debate. Most people have made up their minds, and it doesn’t matter what evidence is provided. They just ignore what is unwelcome and come up with arguments to justify their positions. This helps explain why the debate never seems to progress: the elephants hold sway and the riders are active in justifying the paths chosen by their elephants.

Only rarely do I meet someone who is undecided and who wants to hear both sides of the argument and ponder the issue before making a judgement.

The foundations of morality

Haidt’s special contribution concerns the biological foundations of morality. Citing a wide variety of research and ingenious experiments, he identifies six values that seem fundamental to people’s views of right and wrong: care, liberty, fairness, authority, loyalty and sanctity.

Righteous_Mind

Haidt is especially interested in how these foundations of morality affect debates over politics and religion in the US. He discovered that libertarians, who oppose government regulations and support a free market, rely mostly on the value of liberty. He says that US liberals (who might be called progressives elsewhere), who support government interventions to assist the poor and disadvantaged, rely especially on the value of care, with liberty and fairness as additional influential values. He finds that US conservatives rely more equally on all six foundations.

This analysis helps explain why US people with different political orientations often seem to be talking past each other. What drives them is different. Their elephants are taking different paths, based on different intuitive moral judgements, and their riders give rational reasons to justify their choices. In this circumstance, rational analysis is, for most people, a sideshow that affects little.

Vaccination and morality

The six foundations of morality have obvious relevance to the vaccination issue. First consider care, something important for both liberals and conservatives. The morality of care derives, in evolutionary terms, from parents caring for their children. Groups of early humans with an innate commitment to protect and care for their own children were more likely to survive. In this sense, care is a fundamental aspect of most people’s sense of right and wrong: it is right to protect children and wrong to allow any harm come to them.

caring-for-child

Wanting to protect children is intuitive and doesn’t need to be taught. So it is easy to see why vaccination can arouse such passions: it is about care for children.

But the limitation of Haidt’s analysis, at least when applied to vaccination, is that it doesn’t say how the value of care can come to be applied in different ways. It is straightforward to feed a hungry child or to protect a child from a threatening animal. However, vaccination is not such a simple matter.

Supporters of vaccination see children as the prime beneficiaries. Critics see vaccination as a possible danger. They both appeal to care, but have come to different conclusions about how to achieve it.

Supporters point to the dangers of infectious diseases such as measles and chickenpox. Critics point to the dangers of adverse reactions to vaccines. Pointing to the role of the morality of care helps explain why the passions around vaccination are so strong, but does not explain differences in attitudes towards it.

In part this can be due to personal experience. Some children contract infectious diseases and suffer seriously from them, or even die. Parents, other relatives and friends see this and may be influenced to support vaccination. Other children suffer adverse reactions to vaccines; their parents, other relatives and friends may be influenced to oppose vaccination.

Other aspects of morality are also relevant. Liberty is a value based around personal autonomy and resistance to overbearing rule. In evolutionary terms, according to Haidt, it derives from the value to groups of subordinates ganging up on any individual who assumes too much power. When vaccination is pushed on people, for example through mandatory vaccination of soldiers or health workers or through financial penalties for not vaccinating, this may trigger resistance in those for whom liberty is a key moral foundation.

Authority, as a moral value, means accepting the prevailing systems of hierarchy and leadership. When governments, health departments and doctors support vaccination, this invokes the moral foundation of authority.

doctor-as-authority

Haidt says that conservatives are more likely to have authority as a key moral driver. However, this does not seem to fit the pattern for vaccination policy, given that many of the doctors and researchers promoting vaccination are “liberal” in Haidt’s sense. Still, it makes sense to say that vaccination gains support through the authority response in those for whom this moral foundation is salient.

Another moral foundation is sanctity. Disgust is one emotional response to a violation of the sense of sanctity or purity. Many people feel intuitively that certain practices are disgusting, for example incest or eating food that has fallen on the floor – even when the floor is perfectly clean. If that doesn’t disgust you, consider eating food that has fallen into a just-cleaned toilet. Sanctity, like the other foundations, is driven by the elephant, and people sometimes cannot give a logical justification for their reactions.

Some critics of vaccination may see the body as a sacred object that, when healthy, should not be assaulted by any medical intervention. If so, this can help explain their conscientious objection to vaccination. However, sanctity has declining relevance in societies like the US and Australia, where attitudes to personal behaviour have changed dramatically over recent decades.

Conclusion

To more fully understand how emotional reactions shape people’s views on vaccination would require research. Examining the role of the six foundations for morality elucidated by Jonathan Haidt is a promising basis for investigation. Each of the six foundations – care, liberty, fairness, authority, loyalty and sanctity – could play a role. However, the way that each of these values actually maps onto a person’s position on vaccination is not automatic, and may be influenced by personal experiences as well as the views of family and friends. This may be a fruitful area for study precisely because the passions are so great.

Brian Martin
bmartin@uow.edu.au

Thanks to Don Eldridge for helpful comments on a draft.

PS I’ve applied moral foundations ideas to several other topics: