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Medical Anthropologist Explores 'Vaccine Hesitancy'

12 hours ago
Originally published on February 13, 2019 6:21 pm

Distrust of vaccines may be almost as contagious as measles, according to medical anthropologist Elisa Sobo.

More than 100 people have been infected with measles this year, according to the Centers for Disease Control. Over 50 of those cases have occurred in southwest Washington state and northwest Oregon in an outbreak that led Washington Gov. Jay Inslee to declare a state of emergency on Jan. 25.

Some public health officials blame the surge of cases on low vaccination rates for this highly infectious disease.

Clark County, Wash. — the center of the current spate of cases — has an overall vaccination rate of 78 percent, but some schools in the county have rates lower than 40 percent.

Washington is one of 17 states that allows a parent to send his or her child to public school not completely vaccinated because of a "philosophical or personal objection to the immunization of the child."

What makes some families reluctant to vaccinate their children? Sobo, a professor at San Diego State University, says it may be driven in part by the desire to conform in a community where many parents are skeptical of vaccines.

To better understand how parents decide not to vaccinate, Sobo interviewed families at a school with low vaccination rates in California. She found that skepticism of vaccines was "socially cultivated."

Parents who believe that vaccines are dangerous persuaded other parents to believe the same thing by citing fears of "mainstream medicine" harming their children. Enrolling in the school even seemed to change the beliefs of some parents who had previously followed the state-mandated vaccine schedule: They started to refuse vaccines.

NPR's Audie Cornish spoke with Sobo on All Things Considered. These interview highlights have been edited for clarity and length.

What are the common ideas that we have about families that don't believe in vaccination?

One common idea would be that they're all absolutely looney-tunes, crazy people wearing tinfoil hats and reading all these conspiracy theories on crazy blogs on the Internet. And that is absolutely not the case. What I found was that most of the people who are hesitating to vaccinate ... They're really smart people, and they're highly, highly educated.

Back in 2012, you actually spoke to some parents in California, in a community where parents had their kids at a fairly progressive school. Half of kindergarteners had gotten exemptions from vaccines. What was going on in this community?

Often, the parents, the family didn't arrive at the school having any hesitancy about vaccinations ... As they acculturated or became part of the community, that's when these kinds of beliefs and practices would take hold.

The longer the family had been in the community, ... this practice of being hesitant about vaccinations evolved and it became part of that family's medical practice.

[In areas where there are low vaccination rates], there tends to be a more open norm, where not vaccinating is accepted or sometimes even encouraged. When you have people surrounding you that move in that direction, to go in a different direction has social costs.

It's not just the facts and the information that you're going by. It's: "What are the norms? What are people around me doing? And they seem to be OK, and everything's working out for them."

Think about yourself and the clothes that you wear to work. I'm guessing that you probably don't have a formal dress code, but you kind of look around, and you see: "Oh, OK, this is what we're expected to wear to work." And you just do it.

Are you talking about a formal kind of peer pressure?

The peer pressure is not formal.

Informally, there becomes a sort of feeling in the community. It becomes known for not vaccinating.

There are parts of the country where there's the opposite expectation, where someone who didn't want to vaccinate their kids might be socially isolated for that decision.

And then their behaviors would be pushed underground. They might not feel comfortable telling other people.

When you see what's going on in Washington State, what came to mind for you?

What is the media coverage going to do? Are they going to vilify these parents?

That witch hunt aspect is not helpful to have a good discussion about vaccination. It needs to be much more open and much less polarizing.

Are people ready to listen? Can there be convincing?

I think people are very ready to listen — if they're heard. If you listen to them, and you allow them to say what they think without feeling judged, without pushing them into a corner, they're absolutely ready.

Mara Gordon is a family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.

Copyright 2019 NPR. To see more, visit https://www.npr.org.

AUDIE CORNISH, HOST:

Why do people decide not to vaccinate their kids? The question is on a lot of people's minds as an outbreak of measles continues in Washington state. Dozens of young people have been diagnosed. Most of them were not immunized. Medical anthropologist Elisa Sobo of San Diego State University has studied communities with low vaccination rates. She found that common assumptions about the reasoning behind this decision are wrong.

Welcome to the program.

ELISA SOBO: Thank you.

CORNISH: What are the sort of stereotypes or the common ideas we have about families that don't believe in vaccination?

SOBO: So one common idea would be that they're all absolutely "Looney Tunes," crazy people wearing, you know, tin-foil hats and reading all these conspiracy theories on crazy blogs on the Internet. And that is absolutely not the case. What I found was that most of the people who are hesitating to vaccinate or skipping a few - they're really smart people, and they're highly, highly educated. They're well-educated, and they're very well-read. And they were super concerned about their children's health, too. They really did care.

And because they cared, they read a lot. They studied a lot. And they knew, it turned out - subsequent research that I did in the larger community showed they knew a lot more about vaccination than your general public that just goes to the doctor and just gets a vaccine out of routine.

CORNISH: To help us understand some of the research you've done in this area, at one point back in 2012, you actually spoke to some parents in California. And this was in a community where these parents were - had their kids at a fairly progressive school. And yet there was a good half of the kindergartners who had gotten exemptions from vaccines. So what was going on in this community that led to that kind of decision-making?

SOBO: Yeah. What was interesting about that statistic was that often the parents, the family didn't arrive at the school having any hesitance about vaccinations. They came in at maybe age 3 or what have you because it's a preschool there. And as they acculturated or became part of the community, that's when these kinds of beliefs and practices would take hold.

So you could see, for example, looking at family structure and looking at the ages of the children, the younger the children were in a family, the fewer vaccinations that child had. This practice of being hesitant about vaccinations evolved, and it became part of that family's medical practice.

CORNISH: So when you see what's going on in Washington State - right? - the measles outbreak there, what does that make you think about having done this research?

SOBO: I guess I worry a little bit about the media coverage. I worry about the vilification of the parents. I worry about us stereotyping these people into a corner that they're - we're trapping them in this corner and making it very hard for them to get out of that corner by taking what's really a small behavior and turning it into an identity. And that can be really dangerous.

CORNISH: Why? What's dangerous about it?

SOBO: When something becomes part of your identity, it can be really hard to let go of it. It can be really hard to say, oh, I'm going to change my mind because it's so much part of what's been defined as the core value of your community.

CORNISH: Going forward, especially given the public health ramifications of this conversation, what advice would you give to the public health community?

SOBO: I would advise the public health community to think more deeply about the needs of the vaccine-hesitant parent and to actually create materials or protocols or what have you that speak to their needs and speak to their questions. When you slap me down for being an informed consumer, you're pushing me away from the system. You're not welcoming me in and saying, hey, good job; I'm glad you're interested in your child's health; let's talk.

CORNISH: Elisa Sobo is a medical anthropologist at San Diego State University. Thank you so much for speaking with us.

SOBO: Oh, it was my pleasure. Transcript provided by NPR, Copyright NPR.