Will a measles outbreak persuade more parents to vaccinate their children?
That’s the question people are asking as concern grows about the outbreak linked to Disneyland that has spread to 67 cases across seven states.
Some doctors have expressed hope that parents will be more likely to get their children immunized. I hope they’re right, but research suggests that the long-term effects of the outbreak could be worse, not better. The social and political conflicts we’ve seen emerge over the outbreak threaten to polarize the issue along political lines and weaken the social consensus in favor of vaccination.
Measles was declared eradicated in the United States in 2000, but vaccination is still crucial to protect against a resurgence due to cases imported from overseas. The Disneyland outbreak, which was probably caused by just one infected person, highlights just how explosively contagious the disease can be.
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Despite the anxiety that some parents are feeling after the outbreak, it’s not clear that even such a vivid reminder of a vaccine-preventable disease will change many people’s minds given the resistance we continue to see from hesitant parents. In a previous study, my co-authors and I found that a series of messages used by public health officials to convey the dangers of measles, mumps and rubella had no effect on parents’ intention to vaccinate. Even events as high profile as the massacre at Sandy Hook Elementary School tend to have only a brief effect on public opinion toward the issue in question — as was observed in Washington State, where a recent pertussis outbreak did not change vaccination rates.
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Keon Lockhart, 12 months old, getting a measles vaccination in Miami last June. Credit Joe Raedle/Getty Images
Moreover, the outbreak has fueled a backlash against the anti-vaccine movement that is likely to be counterproductive. Dr. James Cherry, an infectious disease specialist at U.C.L.A., for instance, labeled parents of unvaccinated children “selfish†and “dumb,†while a Los Angeles Times columnist, Michael Hiltzik, called for treating “the anti-vaccination crowd†as “public enemies.†If we’ve learned anything in politics over the last few decades, it’s that this kind of language is likely to be polarizing, driving people away rather than persuading them.
What’s even more dangerous is politicizing the debate over vaccines. Comments by Gov. Chris Christie of New Jersey calling for “balance†in the vaccine debate after President Obama said Americans should “get your kids vaccinated†could have a similarly perverse effect, turning a public health issue into a matter of partisan allegiance.
The extensive coverage we’ve seen of the Disneyland outbreak could also confuse parents by exaggerating the size of the anti-vaccination movement and the prevalence of unvaccinated children. I share the concern of many public health officials about rising vaccine exemption levels in some states, patterns of school- and community-level clustering and widespread misinformation about the safety of vaccines. High levels of vaccination are needed to maintain herd immunity.
However, news articles focusing on an extreme and unrepresentative group of anti-vaccine parents and celebrities may cause others to wrongly infer that their views are mainstream. Dan Kahan, a professor at Yale Law School, finds that exposure to news media coverage attributing disease outbreaks to declining vaccination rates or to commentary attacking vaccine opponents as “anti-science†causes people to significantly underestimate current rates of vaccination. Research on social norms campaigns has likewise found a risk of boomerang effects if messages inadvertently normalize undesirable behavior like binge drinking.
In fact, the social consensus in favor of vaccination is overwhelming. Even after recent increases, for instance, only 3 percent of kindergartners in California had an exemption from vaccination. The evidence suggests we should strengthen and reinforce this norm, not create an uproar that calls it into question.
A more proven approach is to work in a more targeted fashion to help health care providers identify at-risk patients and communicate with them more effectively. Likewise, we could support community, business, educational and health groups in areas at greater risk of outbreaks and help them promote the importance of vaccination within their communities. Trusted friends and neighbors can be more effective advocates than government health agencies.
Continue reading the main story Video
Play Video|12:12
Vaccines: An Unhealthy Skepticism
Vaccines: An Unhealthy Skepticism
An outbreak of measles that started at Disneyland has turned a spotlight on those who choose not to vaccinate their children. How did we get to a point where personal beliefs can triumph over science?
Video by RetroReport on Publish Date February 1, 2015. Photo by Joe Raedle/Getty Images.
Finally, it may be time to reconsider overly lenient state exemption policies that fail to strike an appropriate balance between public health and personal autonomy. The Disneyland outbreak may not change most people’s minds about vaccines, but if it causes policy makers to re-evaluate the status quo, this episode might do some good after all.
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