In a previous post I talked about perception of risk and its influence on the vaccine decision-making process. This was an example of a psychological model, a way of explaining a belief by looking at its constituent parts.
In this simple model, I suggested that if we make an active decision about a vaccination we take a risk judgement associated with the disease the vaccine aims to prevent and combine it with a risk judgement associated with the side effects from the vaccine. If our perception of the risk in regards to the vaccine starts to outweigh that of the disease then we are more inclined to refuse to vaccinate.
With this framing in mind, public health programs have often seen a lack of information and education as one of the overriding causes of vaccine refusal.
The key to a high-uptake vaccine campaign therefore is assumed to be good health communication, specifically discovering the misconceptions held by a non-vaccinating population and debunking them by effectively communicating the correct information.
The 20-year long myth that still plagues UK vaccine communication
If there is one specific misconception and outright wrong vaccine belief that warrants debunking, it is that of a theory put forward by a British researcher and medical practitioner named Andrew Wakefield.
In his 1998 paper 1 published in The Lancet (a very well respected medical journal), Wakefield and his co-authors reported the medical findings of 12 children under the care of the hospital that Wakefield worked at. The paper reported a correlation between a range of fairly common developmental disorders exhibited by the 12 children to the measles, mumps and rubella (MMR) vaccine, a vaccine received by the vast majority of British children at the time.
Often in science, a study on this scale and quality will either not be publishable or will be published, read by a few academics with a specific interest in the subject area and then maybe form part of the basis for later more rigorous work.
However, instead of the common muted response for this study, a televised news conference instigated by Wakefield propelled the lacklustre findings to the front pages of The Guardian and The Independent newspapers. The news story lasted for a couple of weeks, however it quickly burnt itself out with relatively little effect on the overall uptake of the vaccine.
This was the case until around 2000/1 when Wakefield published two further papers related to his theory. Little in the way of additional findings were reported within these papers; they were in essence restating his previous results and his strong concerns related to the vaccine 2. At this point, journalists in the UK felt the story had new legs to it. It was seen as one of those lone voices, fighting the good fight against an out of touch and negligent system stories, so they pushed it much further this time. They found emotional narratives from parents who thought that their child had been damaged by the vaccine and reported them as fact. They found other health care professionals who were sympathetic to Wakefield’s cause and sought comments from them, further legitimising his claim.
The story hit its peak in late 2001 when the then prime minister Tony Blair was asked whether their son Leo had been vaccinated with the MMR vaccine. The prime minister’s immediate response was that they refused to comment on private family issues. Although they were to later clarify that he had been vaccinated 3, the damage had already been done.
Doubt had set in.
Side note: Measles causes death in around one out of every 1000 cases and has a basic reproduction number (Ro) of 14-18. If you know the story of rice doubling on the chess board each square (see a post by @flyyingkiwi for the full explanation of the concept of exponential growth) then you understand how quickly an Ro of 2 can get out of hand, the Ro of measles is therefore disease-based wildfire. Very scary stuff even if protection drops just a little.
None of the reporting of the crisis at the time was wrong, per se. It was often misguided and highly ignorant to the scientific process, however all reporters reporting on the story and those being interviewed were doing so in apparent good faith.
All, however, apart from Wakefield himself.
Wakefield committed fraud
There is a cruel irony for those of us who work in vaccine confidence. In that, we are often accused of being shills by people defending a man who knowingly conducted fraudulent work, putting children at risk for his own financial gain.
In 1997 Wakefield filed a patent 5,6 for a vaccination procedure that was to be used in the place of the triple MMR vaccine, a patent that if the country were to turn against the MMR vaccine would benefit the owner financially to the sum of millions of pounds 7. This behaviour on its own would be classified as a conflict of interest that, if disclosed, would not necessarily entail a rejection of Wakefield’s theory (but would look suspicious to say the least). What, however, did constitute fraud in this case was the falsification of data and questionable research practices conducted to form the findings that Wakefield would later use to discredit the existing vaccine program.
Yes, even though the original study was a poor example of rigorous scientific research (that somehow made it past the peer-review process), the results of the paper itself were highly questionable. Participants in Wakefield’s study were specifically selected and standard results were reported with such systematic incompetence that even the earliest of career researchers would have spotted the mistakes 5.
To make his behaviour even more reprehensible, Wakefield’s data collection processes often involved a blatant disregard for ethical practice in scientific research. At a 1999 press conference Wakefield even admitted taking blood samples from children at his son’s 10th birthday party 8.
Vaccine rarely cause blank
Needless to say, this whole mess was damaging to the MMR vaccine program. Since the above came to light, Wakefield’s co-authors have removed their names from the original study as they became aware of their lead author’s conduct, the Lancet has fully retracted the paper 9, and the media have reported extensively on Wakefield being stripped of his medical licence and the subsequent epidemiological research that refutes his theory.
It has taken nearly 20 years but in England we are now at the point where uptake of the vaccine has reached, and as of this year possibly surpassed10, previous levels.
The story I’ve told here is an example of what happen when a vaccine causes blank claim enters public discourse before the appropriate scientific process has determined validity. France has their own vaccine causes blank story 11 and so does Japan 12. Each rumour different and each rumour locked within their language of origin, spreading through networks like the viruses that their subject matter attempts to prevent.
Sadly, vaccine causes blank is often a far more intuitive explanation for a developmental disorder than the complexities of epigenetics that is often at the root of occurrence.
I believe that some part of our the MMR vaccine causes blank thinking still remains dormant within the UK. The seeds of doubt have a habit of burying themselves deep in our brains. I’ve had many hour-long conversations with parents on this topic and it always comes down to one thing; feelings. Some people just feel that the theory that Wakefield put forward was right and no amount of evidence will convince them otherwise. Especially from a shill like me (joke, obviously. If you’d like to read about my funding I mention it, along with my personal views on vaccination, here).
So, I’ve decided that one of the best things I can do when communicating about vaccination is to not repeat the previous myth, even when my effort is to debunk it. I answer the question on the topic when asked but repeating the myth without prompting grows seed of doubt, it makes it more familiar, and familiarity has a habit of making a statement feel more true to us 13</sup).
But it’s still there though, isn’t it?
I’ve not mentioned [blank] anywhere in this post but for some of you it’s there, fighting its way to the front of your mind, demanding to be paid attention to.
About me
My name is Richard, I blog under the name of @nonzerosum. I’m a PhD student at the London School of Hygiene and Tropical Medicine. I write mostly on Global Health, Effective Altruism and The Psychology of Vaccine Hesitancy. If you’d like to read more on these topics in the future follow me here on steemit or on twitter @RichClarkePsy.
Also I’m in the process of building up my Steem basic income shares so I’ve decide to sponsor a share a week to someone that engages in the comments below. I’ve no real system for this but get stuck in and I'll likely sponsor you in at some point.
References:
[1] Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A. RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
[2] Ben Goldacre: Bad science blog, The medias MMR hoax
[3] The Guardian: Blair baby ‘has had’ MMR jab
[4] UK Parliament: Measles and MMR statistics
[5] Deer B. How the case against the MMR vaccine was fixed. Bmj. 2011 Jan 6;342:c5347.
[6] Brian Deer: Andrew Wakefield vaccine patent
[7] Deer B. How the vaccine crisis was meant to make money. Bmj. 2011 Jan 11;342:c5258.
[8] Dyer O. Wakefield admits fabricating events when he took children's blood samples. BMJ: British Medical Journal. 2008 Apr 17;336(7649):850.
[9] Dyer C. Lancet retracts Wakefield's MMR paper. BMJ: British Medical Journal (Online). 2010 Feb 2;340.
[10] BBC News: MMR vaccine first-dose target met in England
[11] World Health organisation: The Global Advisory Committee on Vaccine Safety rejects association between Hepatitis B vaccination and multiple sclerosis (MS)
[12]Vox: Why Japan’s HPV vaccine rates dropped from 70% to near zero
[13] Lewandowsky S, Ecker UK, Seifert CM, Schwarz N, Cook J. Misinformation and its correction: Continued influence and successful debiasing. Psychological Science in the Public Interest. 2012 Dec;13(3):106-31.
Is it okay to just be agnostic and not claim to be 100% sure, and lean towards not wanting to put [manmade injection] into your body?
I wish less people tried to act like experts and pressure people into using these things, when they don't actually have any idea one way or the other.
(I don't mean you. Clearly you have a lot of knowledge.)
It reminds me of shooting down a bad 9-11 conspiracy theory or something. That particular theory can be wrong, but it doesn't mean you should have confidence that it happened like the official line says.
I feel like it's hard to be really sure that's there's nothing at all problematic. Whereas trusting nature's design and that it didn't leave us to scramble to make special potions.. seems intuitive to me
@lesshorrible beat me to most of this, and has put it wonderfully. I will add that yes it is absolutely okay to be unsure about vaccination. In fact a healthy skepticism and holding a healthcare system accountable is essential to its workings.
I never see the healthcare systems job as forcing people to do something that they don't want to do, if people lose trust in the system, or any of its interventions, then I want to look at what the system can change to make it better. I criticise the system a lot, there's so much we could do better.
Always do what feels right for you, but also make sure to get a a full range of the opinions out there.
Thank you for such an honest comment! :-)
There are side effects but they are rare. It is very unlikely that you will be reminded that you ever got an injection, but you will be immune (in absolutely most cases). In most cases I would suggest you trust nature’s design, our bodies are amazingly complex and still function better than most lawn mowers. However, nature also made bacteria who are great at infecting and overcoming immune systems. Vaccines are effective against many bacterial, and some viruses. A vaccine is not abolishing nature’s design by the way. Vaccination gives our body’s immune system a “clue” so that it can detect pathogenic markers (certain proteins, surface-sugar markers, cell membrane fragments) as soon as they managed to get across the primary barrier. These vaccines are great and scientifically shown to be effective. However, vaccines are being improved, making them safer and more effective. There is a vaccination concept using harmless bacteria that could be used to vaccinate against HIV. Vaccines could even stop bacteria in our nose by using bacteria that are already present. This is no magic, but using nature’s design.
Cheers!
HIV vaccination sounds great and makes a lot of sense.
It kind of feels like it shouldn't be an aspect of life that being sexually actively comes with a risk and needing to put on latex and all this annoying stuff :p
Like, we should be able to just play around like rabbits do.
I had never thought about the idea of a vaccination for that kind of thing, but it certainly seems intuitive to me.
Thanks for your answer.
Where people lose me and what doesn't seem intuitive to me is in the realm of "your baby is doomed (you're a bad parent etc) if you don't give them this"
Using vaccines when you choose to to make things better makes a lot of sense.
Well that HIV vaccine is still very far in the future, still very interesting.
No I got you! There’s a lot of weird tips out there, for health, wellbeing, etc. The problem is that most of these are private decisions, while refusing to get a vaccination could put others at risk. You can decide to do whatever you want as long as you are not harming others with that decision. That’s my stance.
Thank you for your reply and the kind upvote on my previous reply. Cheers!
This is a wonderful response, thank you!
Really late reply but I am 100% in the line of thinking that being critical of anything really is the best way for any individual to make any decision about anything.
Look at the data, look at the interpretations, look at both sides of the coin and then decide for ourselves...
After doing so, if any individual comes to a conclusion, they can sleep soundly knowing they are comfortable with it and looked at the possibilities.
Cheers!
better late than never! I agree with that.
I'm not of the mind to tell people that they're wrong, if they look at the data and decide for themselves or for their kids what they should do.
And, I want the same in return.
Hahaha, exactly...
Good philosophy (on telling people they are wrong), we are mostly all adults here so respect is important! I like your post from yesterday too!
Cheers!
Ya. Sometimes I get the vibe from the pro-vaccine people that they actually want the government to force people to use vaccines, whether or not they want to. Or a softer version, they say it's child endangerment and that you're a bad parent.
Not allowed to disagree and make your own choice, basically.
But it's nice to see there are others, like in this thread, who are trying to educate and persuade and not force their view.
I don't like anyone being forced to do anything! Hahaha. But that being said, as mentioned before, doing research and coming to our own conclusions is a good thing.
Maybe polio is really bad news and should be considered for most people, but a flu shot is not really necessary? Not sure!
I have seen people with polio in Africa and it is pretty scary. Clearly these people are still living but with a difficult condition. But I have also had the flu and I am still here... thus do I need a flu shot every year?
right! I agree with all that. Being skeptical or not wanting to use them doesn't mean you reject all possibility of them being useful in certain scenarios.
and being useful in those scenarios doesn't mean flu vaccine etc is necessarily needed
No thanks, I ain't injecting that shit into my body.
Great article Sir. I will be pasting the link every timeI see the wailing banshees screaming conspiracy and putting kids at risk with their rhetoric and fake evidence.
Nice to see someone having the guts to speak out.
Ha, thanks, I look forward to them directing their wailing towards me instead!
followed...!!
but it is a zero sum game !!
Wow. I just finished writing a post about the importance of STEM communication.
I use the vaccine-autism false hypothesis as an example.
Did not know about this particular individual and his data fraud though. Still it underscores the importance of STEM communication.
I saw, excellent post, I highly agree!
Yes, sorry, this rumour is one of the UK major exports I'm afraid. Such a hard one to debunk as we don't have a clear understanding about the causes of autism, we just know that it isn't the vaccine.
Seems like Wakefield is patient one. I once read a paper that stated that if somebody heard a rumor about vaccination they were highly unlikely to change their opinion when given the facts.
Something that I have heard (feel free to debunk this if you know better): people in “educated” states in the US have a lower percentage of vaccinated population compared to more “rural” states. Is there a link between education and stance on vaccination? I feel people in non-science degrees for some reason believe that they now understand science, even though they cannot tell the difference between a mole and a mol.
You are doing interesting work. I hope that people will realize that vaccination has far more scientifically proven benefits that side effects, whether real or imaginary.
Cheers!
I've not seen it broken down by state before (but will check it out at some point). From what I've seen it's more that education doesn't stop people from holding false beliefs about vaccination. It's like intelligence in that respect you can have a high IQ but that doesn't make you better able to spot bullshit. Also yes, rumours are sticky, people do like to double down if they don't like/respect the source that is debunking it .
It was lab talk. A friend who I’ve done research with said that NE states have low vaccination levels while Alabama and Mississippi are among the most vaccinated states. I just thought that might be interesting. Cheers!
Very possible, will look into it for sure
I guess there will always be a few con artists like Wakefield, and a certain percentage of the public that makes decisions based on faith/feelings over science. Really negligent reporting by the media here, I think they are the party that we should expect a lot more of. Would be great if we had some kind of panel of scientists to check the accuracy of scientific reporting, but then maybe that would lead to less science stories in general in the media .... very difficult issue.
Con artist is precisely the term, yes. I think the media, in the UK at least, got their figures burnt for this event. Reporting has got a lot better since. Our role out of the HPV vaccine has been a huge success here, that would almost certainly not have been the case if the media had gone for the hyperbolic reporting of rumours again.
Great to hear that the media has changed its ways a bit. Also in New Zealand there has been some coverage about how the anti-VAXers increase the overall incidence of the disease.
great article
Thanks! 😀
Ah, yes. The Wakefield story once again. I once edited a book for a client who believed that vaccines cause [blank], and his proof was the Wakefield study.
As much as I told him that the paper was retracted, Wakefield was charged with fraud, and got his medical licence revoked, this bloke refused to correct his content. Stubborn old man.
Well, I don't know if he published his book yet, but I stood by the facts. Even after him counter-arguing so many times, I did not change my mind. I just kept telling him that he's using false "facts" for his book. After a few exchanges, he never talked to me again.
Goes to show how utterly stubborn some people can be even when presented with sound science facts right in front of their noses. Which is why we as science communicators must continue to reiterate these things over and over, no matter how tired we are of talking/writing about it. Three cheers to you @nonzerosum 😎
Ah then you know the struggle well! How interesting, that must have put you in an awkward position, I'm guessing you didn't get paid in the end?
Hopefully it will die out in time, it seems to be moving this way in the UK. That said we seemed to have exported it all over the world in the time being.
Thanks for the comment, and I saw you resteemed the post as well, awesome thank you so much!
Thankfully I did get paid. But i still can't help worrying that the book was published with that false information within :(
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Emotional responses certainly drive the anti vaccine movement. Its important we balance and in fact swamp this, with facts. It's amazing how much traction it gained, possibly because media, too, is inclined to publish emotive stories over scientific rationale.
Good post to my brother, Very helpful, always successful and happy forever, happy to be protected by God.
greetings from me @fauzan19