Let me describe a public health scenario: An infectious disease is spreading widely throughout the community. A method of immunization is readily available and very effective, but public resistance to it is high, especially in urban areas and among wealthier and more educated social classes. Fears over the safety of the available technique run rampant, spearheaded by a very small but real risk that vaccination may cause serious harm, especially in children. Differing opinions about whether or not immunization should be compulsory or voluntary, or whether the rights of the few should trump the rights of the many, are at the center of public debate.
Sound familiar? It should. Only this is not a description of the recent measles outbreak and safety of vaccines in the United States. It's a description of the public response in the U.S. and Europe to the smallpox vaccine in the late 1700s to early 1800s.
At that time, public resistance to vaccination was overcome not though an appeal to public reason, awareness campaigns, dissemination of scientific facts, or evidence that the method was effective in protecting disease, but through the efforts of a single man: George Washington. In 1776, Washington ordered that his entire army be inoculated against the disease. It was this action, and not the obvious benefit of immunization itself, that turned the tide in favor of inoculation throughout the rest of society. Something similar happened in France after Napoleon ordered compulsory vaccination for all his troops using Jenner's new method. The initial success of vaccinations is due more to political authority during wars, not to science or "reason" alone.
But the historical triumph of vaccines was also never fully complete. Resistance to vaccination is as old as vaccines themselves. As a case in point, the Anti-Vaccination Society of America was founded in 1879. Their main point of contention? That vaccines were not "natural" and unsafe, causing disease as much as they cured it. The anti-vaccinationists of the 1800s were also concerned that mandatory vaccinations would violate their hard-won rights to individual liberty.
In light of this long history, it should be less shocking that our current debates over vaccination are being fought along uncannily similar lines. Politicians are weighing in on whether or not vaccinations for common childhood diseases should be voluntary or mandatory, and whether or not enforced vaccinations - say ones required to attend public schools or daycares - are in violation of basic liberties. Overt public resistance to vaccination has been growing for the better part of the past two decades, with little satisfactory explanation as to why. Indeed, the popularity of the anti-vaxxer movement is perplexing to many working within public health and medicine. Why aren't the scientific facts about the effectiveness and safety of current vaccines for dangerous diseases like whooping cough and measles enough to change anti-vaccinationists' minds?
Recent research has merely highlighted what those of us who work in the field of public health or medicine have known for decades: Facts alone are almost never effective in changing people's beliefs or behaviors. A study released last year showed that giving more facts to anti-vaxxers may only entrench their negative views about vaccines. So if doling out more scientific information isn't working, then what can we do to stem the tide of parents who choose not to vaccinate their children?
As a medical anthropologist, I think the solution lies within our basic approach to the problem. First, we need to stop trying to use bare facts to battle ingrained beliefs. It didn't work in 1776 or 1805 and it won't work in 2015. Those who see vaccines as unsafe, ineffective, or unnatural do not see their views as based on beliefs at all; they see them as based upon facts. They do not trust the "facts" being given to them because governmental - and scientific - authority has eroded over the years. Second, the decision not to vaccinate is not based on facts or information alone, but relies upon emotional, cultural, and social components. Fears over adverse effects are very real, whether or not they are scientifically valid. What we need is more social scientific studies on parents' decision-making process itself. What type of thinking goes into the choice not to vaccinate? What factors are important to parents as they weigh their choices?
Only by grasping the logic involved in the decision not to vaccinate can we shift the balance of this issue. Instead of focusing on "facts" versus "ignorance", or trying to shame people into the socially responsible choice, we should focus on the context of everyday decision-making. It's a better alternative than rehashing the same arguments we've been having for 200 years. If the facts won't work, maybe a different approach - one focused on a better understanding of how people think about science, medicine, and their health - will offer us some effective solutions.