Sounding a note of alarm, the World Health Organisation (WHO) has just revealed there was a four-fold increase in measles in Europe last year. More than 20,000 people have been affected with 15 European countries reporting large outbreaks. Measles cases are highest in Romania, Italy and Ukraine and there have been 35 deaths from the viral illness.
There is a current measles outbreak in Limerick, which public health experts say will continue to spread due to lower than optimal immunisation rates. How is it that an infectious disease, which the WHO not long ago spoke of as a potential target for eradication, is on the march again?
The genesis of the current wave of anti-vaccination rhetoric can be traced back to 1998 research alleging a link between the MMR vaccine and autism. Disgraced gastroenterologist Andrew Wakefield was found guilty of research fraud and struck off the British medical register. But the false news about MMR safety caused immunisation rates to plummet; they have yet to fully recover.
Lack of trust
And the loss of trust in vaccines is not confined to measles and the MMR. More recently, the HPV vaccine to prevent cancer of the cervix in women has been a target. Understandable parental anxiety and the unfortunate conflation of minor side-effects into complex syndromes that remain scientifically unproven have caused HPV immunisation rates to drop precipitously.
But not everywhere: Ireland, Denmark and Japan are among the countries worst affected. Do selective pockets of vocal anti-HPV vaccination groups (so-called anti-vaxxers) offer any clues as to why some people have lost faith in one of modern medicine’s greatest breakthroughs?
Anti-vaccination campaigns are not new. Opposition to childhood vaccination dates back to 1796 when it was introduced in England to protect against smallpox. Many of the themes played out more than 200 years ago still resonate today.
However, the drivers of false health news have changed. More than 60 per cent of adults source their news online. In a study published last month, the Rand Corporation said a combination of the 24-hour news cycle and social media was one of the principal drivers of what it called “Truth Decay”. This phenomenon has seen a blurring of the line between opinion and fact, with personal experience seen as more influential than fact, leading to less trust in usually respected sources of factual information.
With a background of geopolitical turmoil, a collective increase in anxiety fuels the rapid online dissemination of false news. The alt-right movement has directly influenced anti-vaxxers, who have successfully copied it’s modus operandi which is centred on the clever use of visual memes. Subversive and designed to provoke a reaction, these memes press all the right buttons to ensure disproportionate impact.
Loss of faith in expertise
Allied to this is a collective loss of faith in expertise. Experts are increasingly seen as part of a global elite; combined with easier access to online information, a dilution of informed voices is inevitable. Naturally this makes some experts nervous, with a real risk they will double down with vehemence on their authority and risk sounding even more remote from their audience.
So what can medicine and science do to tackle the targeting of vaccines with fake news? Adopting a more humble tone is vital: the days of listening to and trusting an all-knowing expert are gone. Dismissing people’s worries as baseless is one of the least effective ways of communicating public health risks. Trying to directly debunk “alt-facts” (lies or misleading statements claimed as fact) like those circulating among anti-vaccination groups doesn’t work. And it seems well-meaning efforts to re-emphasise evidence for the safety of vaccines is equally unhelpful.
Dr Claire Hooker, senior lecturer in medical and health humanities at the University of Sydney has suggested some strategies for dealing with low-risk threats such as vaccine hesitation.
The first is to “hose down your own outrage first”. Our own outrage stops us listening well to what’s driving public concern. Respecting people’s fears about vaccines comes next. A fearful parent needs to know we care about their concerns and that we have heard and understood their worries.
Hooker says one of the strongest predictors of whether someone believes or acts on a public health message is trust; if we can’t trust the communicator, we won’t believe the message. Competence and openness are key aspects of trust and are best served by being upfront about uncertainty and complexity. And learning to tolerate an initial over reaction allows the communicator to remain a trusted source.
Overall, those of us who respond to anti-vaccine scares must focus on maintaining relationships and dialogue, and not to correct all people’s false beliefs. This is the best way to protect against polarisation and “alt-facts” and to bolster our capacity as a society to confront the risks we collectively face.
Dr Muiris Houston is The Irish Times health analyst