“It will take off like wildfire”
Within the last few weeks it has become apparent not only that a major measles outbreak is occurring in multiple locations (reports here and here), but that the cases are continuing to increase in numbers. The outbreaks are all associated with regions of strong resistance to having children vaccinated.
The outbreak north of Portland, OR, has increased from 23 cases to over 50 with a public health emergency declared. Other outbreaks are in Brooklyn, the lower Hudson River Valley, Atlanta, while in Europe over 41,000 cases were reported last year, resulting in 37 deaths.
In spite of attempts to correct a widely held belief that vaccinations contribute to autism, the “belief” continues to circulate especially in some enclaves.
Most attempts have proven less than effective in part because of incorrect assumptions about parent’s underlying motivations.
The current outbreaks have once again focused wide attention on “vaccination hesitancy” and “vaccination refusal” and the consequences to children and communities.
A key paper that helps to understanding parent’s motivations actually appeared in Nature in December 2017, but remains obscure not only because of its academic nature but because it seeks to identify a correlation with the little known and underappreciated Moral Foundations Theory (MFT). Even a very recent article in Slate, People’s Fears About Vaccines Aren’t Just About Vaccines, fails to garner the attention it should in the public’s eyes.
The typical (and rational) assumption in the medical and health community (and the media, politics, and public) is that parents are primarily relying on personal values of not wanting to cause potential harm to their children. Fears of side effects, of actually inducing the disease or causing other health consequences (autism) are assumed to be the predominant reasons. While not widely recognized, these fears correlate strongly with the Care/Harm values foundation identified in MFT.
It is this limited assumption, while rational, that leads to the creation of “appeals to reason” using valid medical evidence that seem logical but are actually ineffective in bringing results. Still other appeals, peppered with scolding charges of “irrationality,” “science denial,” and “madness” result in even less success and even greater frustration on behalf of both sides.
The article in Nature sheds light on understanding parents’ anti-vaccination motivations, but also surprisingly presents an opportunity to address an even greater “conundrum” in a much broader arena: economics. I’ll return to that connection at the end of the post after a summary of the results of the study and MFT, and the enlightening conclusions.
First is a broad and important phenomenon also applicable here and that is how little we recognize that bright and well-informed people can see the same set of facts, here regarding childhood vaccination, and draw such radically different conclusions. This should not come a surprise, as most of us experience this on a daily basis. However, understanding why this happens just might be a surprise, because it is also consistent with what I shall paraphrase1 as
The Four Very Comfortable Bad Habits of Everyone:
- Our not recognizing and accepting that we live in Bubbles,2 the limited social environments in which we subconsciously operate by
- Unconsciously depending upon our Confirmation Bias (which emphasizes that information which adds further validity to our preexisting values, beliefs, and hypotheses), which is
- Reinforced by our Availability Heuristic (a mental shortcut which limits what knowledge we organize and use based on how easily an example, instance, or case comes to mind), resulting in the ongoing condition
- That We Don’t Know That We Don’t Know What We Don’t Know
– yet we consistently ignore them.
Second, the heart of this specific issue of vaccinations involves underlying values, emotions and individual psychology, and in particular the foundations for these values and emotions. The failure of other approaches suggests looking and seeing if the different value foundations proposed by Moral Foundations Theory can explain the behaviors that are seen.
The study in Nature looked at some of the fundamental motivations behind various parental “attitudes” towards vaccination. Parents were grouped as being in one of three categories: as having low hesitancy (meaning they were willing to vaccinate even if they had questions), medium hesitancy (there were significant questions and discussion but eventual vaccination), or high hesitancy (refusal to vaccinate). They then completed a standard MFT survey to identify how their personal values were distributed among the six value foundations of MFT.
MFT focuses on the basic moral codes by which we each judge right and wrong (the balance or emphasis among them is not the same for everyone). These then provide a fundamental sense of how we should behave and how society should operate. These are the “lenses” through which we view the world or its immediate proximity, our behavior as well as the behavior of others, and the issues of the day. These “lenses” vary from person to person but tend to be similar for the social groups with which we associate (think Bubbles).
The MFT six foundations, as positive/negative pairs (with examples), are: Care/Harm (caring for others, or not); Fairness/Cheating (eliminating corruption); Loyalty/Betrayal (to personal, tribal or group values); Authority/Subversion (e.g., patriotism); Sanctity (or Purity)/Degradation (holiness, cleanliness vs. pollution); and Liberty/Oppression (personal freedom) (all of these are discussed more in depth here).
The reported results are extremely informative. One study (of multiple ones in the paper, all consistent) revealed the following for 1007 subjects:
- Low Hesitancy parents (73% of the group) provided the reference or “control” distribution over the six MFT foundations;
- Moderate Hesitancy parents (11% of the group) were twice as concerned with Purity/Degradation values as the Low Hesitancy group (i.e., to protect the purity of their children and not degrade their bodies); and
- High Hesitancy parents (16% of the group) were twice as concerned with both the Purity/Degradation and Liberty/Oppression values as were the Low Hesitancy group (i.e., both to protect the purity of their children and not degrade their bodies, as well as protect the parents’ liberty to make this decision and not be oppressed by governing officials to vaccinate).
Critically, as opposed to the assumptions made in formulating “arguments” to convince parents to vaccinate, neither the Moderate Hesitancy parents nor the High Hesitancy parents were motivated by Care/Harm values at all. In other words, on this issue, vaccination hesitant parents were not motivated by any care-for-others value (i.e., the greater community). This explains why the (moral) argument used to appeal to parents’ sense of a greater civic responsibility, that their unvaccinated child might infect some other children sick, doesn’t work. It’s an appeal to a less important moral value and thus less effective.
It does explain why vaccine hesitancy tends to be found in small enclaves, the Bubbles in which people find community with others of the same primary values, even though overall childhood vaccination rates remain high both in the US as well as in most of these communities (but not high enough).
In other words, vaccine hesitant parents are not acting “irrationally.” They are actually acting very rationally with respect to their moral value system, which happens to have different priorities for different value foundations within Moral Foundation Theory than do other larger groups.
For all of us, not just the vaccine hesitant, these priorities are heavily determined by the information we already received (via the Availability Heuristic) that is consistent with what is already comfortable (affected by the Confirmation Bias) that is typically fed by like-minded people in our individual Dunbar Bubble (our social environment).
In other words, we don’t know that we don’t know what we don’t know, and we’d prefer to keep it that way.
It is true that some resistance to vaccinations is so entrenched (see above) that only higher hurdles for opting children out of vaccinating as a requirement for public school enrollment will do any good. Economists would call this “nudging.” (As I am writing this, protests have occurred in the state of Washington over plans to change the law limiting the permissible reasons for “opting out” of vaccinations (in an article from the Huffington Post curiously titled, Parents Protest For Kids’ Right To Suffer From Preventable Illness). This further highlights the strength of the Liberty/Oppression value foundation among this group.)
Speaking of economics and economists, I mentioned I would return to them. As a group economists have been criticized for long assuming that what they call homo economics (we, the human species that engages in economic transactions) will make rational decisions with regard to spending, saving, and investing. Over the last century this has proven to be an assumption that does not work. To date they have not figured out that what they call irrational economic behavior might actually be very rational economic behavior, just based on a differently prioritized set of values. Worth coming back to in a later post.
1With apologies to Stephen Covey.
2I chose to call these Bubbles, but various other names have been used to describe the concept: echo chamber, fortress, stronghold, worldview, etc. The description chosen might bear some relationship to how many people would actually fit into it…