Motivation to offer up this opinion piece comes thanks to Education Minister Chris Hipkins suggesting parents of unvaccinated children in Northland are ‘pro-plague’. My supposition is those responsible for the vaccination status of some 200 children in the upper north of our country are not some crazy bunch of ‘anti-vaxers’ seeking to rain the pestilence that is measles down on the rest of the population. Rather, they are at a point where deciding to vaccinate their children with the MMR vaccine has quite simply eluded them.
Hipkins’ assertion took me back to similar motivation to conduct my doctoral research as to why parents don’t have their children vaccinated with MMR. In this instance British Secretary State for Health (akin to our David Clark) John Reid had intimated that when provided with accurate information and professional support people should be able to make the rational choice to vaccinate. Unpicking this, rationality as used here is an economic term suggesting we always act in our best interests to get the most out of a circumstance – to maximise our utility in fact. Yet we know in reality, that when it comes to health, choices are more complex than this. For example, it is unlikely anyone who smokes is not aware of the deleterious affect on their health and wellbeing, but they continue. Likewise, we hear every day of the negative impact of sugary soft drinks, but hundreds of litres continue to be consumed adding to the obesity problem in our youth. People don’t necessarily make the optimum choice when presented with accurate information, especially when that choice involves their child.
Our education Minister was right to assume the so-called ‘anti-vax’ movement is alive and well here in NZ, but it really isn’t them we should be focussing on right now. Just as otherwise sensible people are adamant the earth is flat, so folks will continue to spread the lie the vaccine industry and governments are in cahoots to poison children with dangerous chemical concoctions otherwise known as vaccines. Whilst their message is fallacious, the anti-vaxers have become sophisticated and used social media to great effect in spreading their mythology. Our government, DHBs, and massed ranks of health professionals are not so well equipped to use the channels of disinformation appropriated by these groups and perhaps do not command public trust and confidence to the extent they may think. When MMR uptake plummeted in the UK following publication in the Lancet of Andrew Wakefield’s errant ‘research’ postulating a link between the vaccine, autism and Crohn’s disease, the government there were coming out of the trauma of ‘mad cow disease’ characterised by Agriculture Minister John Selwyn Gummer practically force-feeding a beefburger to his daughter on national TV to demonstrate what a good job had been done to eradicate the disease. The media had none of it and public mistrust of official sources of information readily moved over to the issue of MMR.
So why are Northland parents, or parents elsewhere in NZ for that matter, not vaccinating their children against measles? The simple answer is they are not behaving rationally but allowing a range of inputs to affect their decision making.
A truly rational person must in effect act like some form of supercomputer – absorbing every detail of information about the decision they are trying to make. This is pretty impossible in reality though and the harder the decision is to make the more likely we are to simply rely on ‘gut feeling’. Imagine for instance a fielder in a game of cricket who starts running to the spot where they think the ball will land before the batsman has even struck the ball. Their behaviour could be based on instant computation of the likely angle of the bat strike, weather conditions, speed of impact, potential velocity of travel, and what have you. However, the fielder likely starts running because they have an innate sense of where that ball is likely to go based on practice and previous observations, they employ heuristics – rules of thumb.
When it comes down to vaccinating our child, heuristics are in play, not retrieval of supercomputational algorithms linked to a summation of every article ever published on the efficacy of MMR versus perceived risk to their loved one balanced against a utilitarian desire to do one’s bit for the community by enhancing the ‘herd immunity effect’. With that in mind we need to know how those rules of thumb were derived.
At the simplest level we haven’t seen children dying from Measles for some time, not witnessed brain damage or whatever. Even with the many local outrbreaks we are facing and talk of plague and epidemic, today’s parents haven’t seen the real ill-effects of the MMR triad, but caution and suspicion around the vaccine is still there. The term ‘vaccine-hesitancy’ is in vogue now as a descriptor of someone who is not able to make up their mind to vaccinate. And that is the nub of the issue. Hesitancy is based on heuristics – our not being able to make a rational decision as we are overwhelmed with information for and against vaccination combined with the anxiety and fear of putting my child at risk from a jab – something I have heard a lot about, for the sake of combatting potentially serious infections – something I have never witnessed.
The Northland parents are likely ‘vaccine hesitant’ not plague mongerers, and if so, they need to be helped in their decision making rather being castigated as such. Conducting my research in the UK a decade ago I was intent on being a good, impartial researcher, yet the focus groups forming part of my study rapidly became a forum for discussion and debate in which parents and care givers could exercise their misgivings and challenge each other’s heuristics – basically bounce ideas off each other. Being able to interact in this way actually tipped the balance toward vaccination.
I talked about this effect at a national immunisation conference a year or so back and remain pretty adamant that trying to convince someone to vaccinate their child on a one to one basis with a healthcare professional is not going to be as successful as facilitating community leaders to head up group discussion with input from those professionals when requested. The sense of whānau and hapu likely prevalent in Te Tai Tokerau, and community mindedness across the country makes it something of a no-brainer to adopt this model. Sure, information leaflets and government pronouncements are useful, but at the end of the day if we are to shift heuristic intent toward increasing the vaccination rate, helping people talk through the issues themselves on their own terms is the only rational solution.