The following is Part Two of a three-part series on how anti-vaxxers have fed off of science communications mis-steps to become an energised movement. It is based on observations from watching a day of speeches from the anti-vaxx gurus during the Truth About Cancer Live conference. The first part looked at how the anti-vaxx guru emerged from the 1970s-80s style Praise-the-Lord TV preachers and the tools they use in their naturopathic faith healing. Part Two looks at how certain failures in science communications on vaccines has created the monster of the enraged anti-vaxxer. The final part will share some lessons learnt for vaccine communicators.
When you are trying to get parents to inject chemicals and antigens into their newborn, the most precious thing in their lives, you had better take science communications seriously. You need to be compassionate, available, transparent and patient. What I heard from anti-vaxxers during the Truth About Cancer Live event is that the authorities are taking the choice away from parents without explanation, supposedly hiding the facts from them about the dangers of vaccines, calling them names while bullying and ostracising them … if half of this were true, these are hardly good communications skills on an important personal risk decision. But perception matters. This is how the anti-vaxxers are portraying the situation and some clever strategists and consultants have honed their skill of counter-attack.
That’s not the Truth!
Clicking through the pages on the American CDC’s vaccine site, I see everything vaccines don’t do (cause autism, allergies, infertility, Guillain-Barré syndrome, miscarriages, seizures …). This seems to be an organisation under siege.
Sadly science communicators have fallen into the denial trap on vaccines. The more regulatory officials and scientists have had to declare that vaccines were not causing death or diseases and syndromes (or the diseases they were intended to prevent), the less people heard positive messages and the more prone they become to negative, fear-based conspiracy theories. The more I say I don’t do something bad, the less appealing I become (Nixon’s famous “I’m not a crook” line). Part Three of this series will address why the denial trap is the last place a science communicator wants to be ensnared.
It’s Settled, now Shut Up!
One of the more frightening messages science communicators have used is that the science is decided, or that all vaccines, categorically, are safe and they always work. Some vaccines like the flu shot reduce the risks and alleviate the symptoms of many but not all strains. The communicators’ claim of certainty and total efficacy was repeated with derisory scorn many times during the Truth About Cancer conference.
No credible scientist closes a book on any research or declares something as certain and settled. A scientist might say the likelihood of adverse reactions are very low, but should never say “zero risk”. There will always be a surprise or unforeseen event and I feel most reasonable people can understand that. If it is decided, for example, that we may need booster shots for measles, it does not mean the vaccine failed, it just means we continue to learn. And denying the likelihood such cases of weakened immunity might arise is, well, unscientific.
We have to be careful with what is perceived as the public’s need for certainty and its relationship with trust. If we trust a person, we feel safe. When a regulatory spokesperson puts protecting herd immunity and public confidence in vaccines ahead of being honest and transparent, they are setting themselves up for a fall (and the net the anti-vaxxers are holding up is a snare trap). Science is not infallible so your communications have to reflect that.
The term “safety” is an emotional concept, relative to other risks and an individual’s risk tolerance and ability to trust. The individual decides whether something is safe – the perception cannot be imposed on them. I suspect most reasonable people are capable of discerning a low risk from a greater consequence and a clear benefit. Too often though we base our communications strategy on the small minority who will only accept 100% certainty and safety … and they won’t shut up.
Apples and Immune Oranges
OK … here is where I will probably offend most of my tribe (but regular readers of this site know that is not a reason to not share such views).
Not every vaccine is the same or in the same way necessary (but nobody seems to be talking about that). I worry that the vaccine debate has been equally poisoned by marketing opportunists and vaccination zealots. Just because vaccines are effective and beneficial does not mean we shouldn’t discriminate between priority shots and those only recommended in certain circumstances. Vaccines should not be this “all-or-nothing” debate. A few personal anecdotes:
- When our kids were very young, there were many new vaccines coming out, like the one for meningitis B. The first question I asked was the likelihood and consequences of a seven-year-old’s exposure. A decade later, when my daughter travelled to Burkina Faso, we had a different series of vaccines she needed to get. You don’t really need a yellow fever vaccine if you’re staying in Belgium. But what about rotavirus or rabies vaccines? We’ve grouped all vaccines together when immunology is such a wide field. Where is that open conversation?
- When our three kids had chicken pox one after another, a friend asked if he could bring his small children to my place (in hopes he could get this one-time infection “out of the way”). Perhaps it was a different culture and a different time, but I am not sure today that a chicken pox vaccine should be treated as importantly as the MMR vaccine. The anti-vaxxers think all of the diseases are insignificant because, like chicken pox, many had measles when they were children (as a survey of hands in the room indicated).
- In the year 2000, we developed a document on the history of Solvay Pharmaceuticals’ flu vaccine. Less than two decades ago a flu vaccine was recommended for vulnerable populations or those working with them. Now it is expected for everyone older than six months. I feel the flu vaccine should be considered more as an alleviation tool rather than total flu protection as expectations then would be tempered. If I don’t get my flu vaccine, it seems I am deliberately choosing to condemn my sweet Grannie to a painful death. I worry about the zealous marketing and false expectations here. The anti-vaxxers during the conference regularly cited flu vaccine effectiveness rates
When concerned and vulnerable parents hear how many new vaccines are coming out, read news of industry profits and are impacted by the bully-box marketing techniques, is it any wonder some of them are reacting by rejecting all vaccines? Just because the science says the risks are low does not mean every vaccine is necessary or should be mandatory.
Some parents might have been OK with the priority vaccines, but when they perceive schedules being pushed on their children, they may begin to question all of them (and find reassurance on certain social media pages). As much as I respect these scientists in the front lines, sometimes they come across as incomprehensible and scary (no threat – your baby is exposed to “trillions of bacteria”) when reassurance is what vulnerable parents need.
Different vaccines need different communications strategies. I have argued for the same for different plant breeding technologies or types of pesticides. This is essential in cases like the potential breast cancer vaccine where results have tended to lag the hype.
Creating a Monster
Now I don’t believe these points are controversial but they are not glowingly positive of vaccine strategy or health science communications. At the moment vaccine rates are dropping in certain affluent areas and this has gained media attention but overall, rates are still fairly steady (although not high enough for public health targets). I worry though that vaccine vigilantes who attack anti-vaxxers are helping amplify their fear campaigns and justify their conspiracy claims of cover-up and fraud. Until now their mouths are big but their numbers are small.
I have spoken out in my social media circles against the ruthless silencing of anti-vaxxers (blocking their speeches, articles, websites and films like Robert De Niro’s planned screening of Bigtree’s “Vaxxed” at Tribeca). This merely fuels their persecution complex, feeds conspiracy theories and generates more media attention. As someone who has had his blog-site shut down by people who disagreed with him, I don’t feel science communicators should ever support censorship? It is something you do when you lack facts or are losing an argument.
Do we really need to poke that bear? Wouldn’t these activists get less media attention if we ignored them. As Del Bigtree said at the beginning of his speech: “Even bad news is good news.” They have more funds and volunteers with Pentecostal outrage moving in to join the fight.
At the moment enraged anti-vaxxers are harassing doctors and outspoken vaccine advocates. These doctors are strong and from my own experience, their resistance to attacks does well to depict the Antis as irrational and dangerous. This is enough to reassure the middle ground. But if vaccine vigilantes keep attacking back, the waters will get muddy. Soon the even-more-enraged zealots may be mobbing around the doors of vaccine centres in the same way pro-lifers picket abortion clinics. We’ll need to ask then who created that monster.
To make matters worse, the anti-vaxx strategists are broadening their campaigns. Some are more cunning than we give them credit (especially when Scientologist tort lawyers smell money). They are moving out of the affluent suburbs and attempting to enrage minorities and alienated communities. This autumn Robert Kennedy Jr’s NGO, Children’s Health Defense, held an event in a New York City to try to radicalise the African American community and encourage them to not trust their doctors. Urban healthcare segregation is the ideal breeding ground to spread conspiracy theories.
Like agroecology and the impoverishment of African smallholders, social justice warriors are the perfect useful idiots for activists seeking pre-packaged communities of outrage. These warrior types put their personal politics above scientific evidence and have no qualms about seeing horrible consequences inflict a system they want to change. Social justice warriors are the well-placed kerosene can to any activist with a torch (a blog on that will be out shortly). I’m frankly surprised it took the anti-vaxxers so long to find them.
These anti-vaxxers are vile and offensive … but some are also smart and, let’s be honest, as long as they’re growing, they’re winning. There is a lot to learn here. Part Three takes my observations of the claims and strategies exhibited in the anti-vaxx speeches and feeds them back into science communications practices to see if there are not a few lessons we can learn.
Cover image: Bigtree Pressie
11 Comments Add yours
“When a regulatory spokesperson puts protecting herd immunity and public confidence in vaccines ahead of being honest and transparent, they are setting themselves up for a fall.” Just curious, can you cite an example? I guess since CDC is not a regulatory agency, you’re not referring to someone from there. Doesn’t matter how honest and transparent CDC is (and their website is certainly that), there will always be those whose cognitive dissonance is stronger than the truth.
I was referring to their need to be categorical on safety and efficacy. They feel the public needs to hear that. I gave the HHS link to https://www.vaccines.gov/basics/work. And if, like the dengue vaccine case in the Philippines, a mistake had been made, then an apology should have followed.
A bit cartoonish, perhaps, but I didn’t see anything categorical, I saw claims like “safe” or “safer”, and “Most people don’t have any serious side effects from vaccines.” which are fair.
I’m sure some sci-comms and vaxx-comms are bad at what they do and should be called out for it, but so far, you seem to have missed the mark with respect to claims made by US public health agencies.
An explanation in simple terms, yes, not necessarily an apology. Do you know of an instance where a vaccine is okay for someone who has had the disease, but not as safe for those who have never been exposed? If that sort of interaction is not uncommon and could have been anticipated, then perhaps it was a mistake, but if it was unexpected, calling it a mistake may not be justified.
“As shown in Table 13, in subjects who had not had a previous dengue infection at baseline, there were more severe dengue cases in subjects who received DENGVAXIA compared to placebo control subjects, yielding an increased Hazard Ratio (HR) for severe/hospitalized dengue for DENGVAXIA vaccinated subjects…” http://bit.ly/2Xb8E1Y
The question in the Philippines is when Sanofi gave the recommendation that it should only be for those having had dengue and whether the authorities or the drug company made a mistake in a school-wide programme. Sanofi claims they weren’t involved in the programme that was launched before their advice. A mistake was definitely made and without further communication, the public has lost trust (hence this year’s measles epidemic).
You have been unfair in the way you have implicated US FDA in all of this. Sanofi and Philippine FDA were at the front-line of the issue.
As far as US FDA is concerned, was it reasonable for them to assume that risk would be different between those who has been previously exposed and those who had not? If the answer is no, then there was no “mistake” on their part. As additional information became available, US FDA adjusted their position and acted appropriately.
Some sources of information about vaccines are better than others, and US FDA and CDC are two of the very best in terms of accuracy and transparency.
I understand George and I don’t think I blamed anyone directly here but when up to 600 children died, we cannot look away. This is a case of fuel for the anti-vaxxers. Dengue has hit my family in the Philippines so perhaps I am too close to this issue. After speaking to a Nigerian on this issue, I can only say that in developing countries in general, vaxx-comm is facing challenges and issues beyond anything conceivable in western countries.