This is the transcript of my TEDx Oslo talk, for those wanting to read instead of watch or who are unable to watch. Anyone is welcome to translate this talk into other languages as long as it appears with my name and the fact that it is a TEDx Oslo talk. (Ex: A TEDx Oslo talk by Tara Haelle.) I have also included three of the graphics I used in the talk, designed according to my requests by the graphic artist Hannah Henry, and which I paid for. Please check out her website here if you are interested in hiring her. If you include the graphics with your translation, you must also include credit to Hannah Henry and link to her website. You can find the Slideshare of the talk here.
“It was just over a half century ago that every summer gripped parents across the world, especially the Western world, with fear. In its heyday of the 1940s and 1950s, polio killed or paralyzed over half a million people across the world. Outbreaks led to public closures. People avoided friends and neighbors out of sheer terror that they would be struck by the disease or their children would. The unpredictable and invisible threat of polio made familiar places like playgrounds and swimming pools suddenly terrifying.
So the arrival of the polio vaccine was like a liberation. The enemy, previously lurking behind every corner, had been vanquished. It was the tremendous relief that earlier generations felt when they no longer lost children to tetanus or diphtheria or yellow fever.
More vaccines have since followed: against rubella, hepatitis A and B, pneumococcal and meningococcal diseases, and more … even the Holy Grail – a vaccine that prevents cancer by preventing the human papillomavirus vaccine.
We completely eradicated smallpox, a horrifying disease that left those who didn’t die scarred for life. Every one of you survived this. Most of you because you never had it… because of this.
And yet we now find ourselves in a century when we can beat back more than two dozen diseases that once killed millions … and the biggest threat to public health, or one of them, is not the diseases themselves but vaccine hesitancy — the fear that holds parents back from vaccinating their children. What happened? How did we get to this point?
Well, when my first son was born, I turned down a vaccine. I didn’t think was necessary. I didn’t understand it. I wasn’t dumb or stupid — I was actually in grad school — but I was scared, just like hundreds of other parents I’ve spoken to in the six years I’ve been reporting on this issue.
Now to be clear: I am talking about vaccine hesitancy and refusal, but I’m not talking about that very tiny percentage of people who spout conspiracy theories or show up at government meetings spreading misinformation about vaccines.
I’m talking about the fence sitters, and those parents are utterly terrified of doing the wrong thing, of harming their child when all they want to do is protect them.
Consider this quote: “In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”
That quote comes from a kind of unexpected source, a Founding Father of the United States, an inventor and a writer — Benjamin Franklin.
If such an intelligent, worldly man as Benjamin Franklin all those years ago could fear vaccinating his own son, vaccine hesitancy isn’t new. And those it afflicts are not “ignorant” or “stupid.” In fact, vaccine refusal rates frequently correlate with higher education.
So something else is at work here.
That something is what has kept us alive since we have been living in caves and hunting mammoths. It’s a cognitive framework that helps us make decisions. It dictates what we pay attention to and how we assess the relative risks and benefits of different choices. It affects how we translate our beliefs and values into actions and behaviors.
If we’re going to address vaccine hesitancy, we have to address the underlying processes that lead people to believe in fears lacking any scientific basis.
But first, let me back up. Why is vaccine hesitancy such a problem? Why, if I, you know, if my children are vaccinated, why should I care if my neighbor’s kids are vaccinated– aside from humanitarian reasons?
Well, vaccines work in two ways. In an individual, the body makes antibodies in response to the vaccine against the disease. That standing army of antibodies then waits. If the pathogen they’re trained to fight arrives, they attack it off before infection takes hold.
But the second mechanism is just as important: widespread vaccination reduces the ability of a disease to circulate. With fewer infected people walking around, fewer infected people are passing the disease along. No vaccine can prevent 100% of disease in 100% of people, so this “herd immunity” is essential to preventing outbreaks and protecting vulnerable individuals.
But as people lose faith in vaccines, herd immunity starts breaking down. Polio returned to Syria when civil unrest interrupted polio vaccinations there. And in my home country, just last year, Mickey Mouse got measles! An outbreak of measles at Disneyland — in a country that eliminated measles 16 years ago — spread to a half dozen states and two other countries.
That outbreak showed the power of a disease to return when vaccination rates drop. Southern California has some vaccination rates lower than those of Sudan. So that risk is clearly real.
Of course, vaccines are not risk-free either — nothing in life is. Mountains of research, however, have shown us that the risk of a very serious vaccine reaction is extremely, extremely rare.
Most side effects, like fever and soreness, are mild and temporary, and protection against life-threatening diseases, meanwhile, is usually lifelong.
And there’s the rub: Vaccines have been so effective at reducing so much disease that we don’t fear it anymore. Who fears smallpox anymore? No one. Who fears polio? Very, very few. Fear of what a disease, excuse me, fear of what a vaccine might otherwise do to a child has replaced fear of the disease. The psychology term for this is availability bias, part of that cognitive framework I mentioned.
You see, our brains use heuristics – mental shortcuts – to help us make sense of the world.
With all the sights and sounds and sensations and smells surrounding us at any given time, we need to know what to pay attention to, and what to dismiss. We need a lightning-fast, subconscious strategy for assessing our environment so we can make decisions. Heuristics gives us that.
One of these is availability bias: the information that’s most available, or accessible, to us stays at the forefront of our minds. We hear about a shark attack; we fear sharks the next time we go the beach instead of riptides or drowning. We also fear sharks because they’re predators. The same primal urge to protect ourselves — and our children — from predators can lead many parents to fear injecting their tiny baby’s body with mysterious concoctions.
Heartbreaking stories about vaccine injury – true or not – are more available to parents online and through the grapevine. They haven’t seen measles or polio in their communities, so why fear them? Better not to take the risk of vaccines, right?
That’s what Ben Franklin thought, and he was wrong. That’s omission bias: fearfully avoiding an action with a tiny risk of harm in lieu of inaction with a greater risk of harm. Those parents don’t realize – unless they have Franklin’s experience– that NOT acting is a form of action, too.
And if they do vaccinate and something does happen, then it’s all too easy to confuse correlation with causation.
The measles-mumps-rubella vaccine is given to children around the same time that autism becomes easier to diagnose. If parents notice autistic symptoms not long after their children are vaccinated, it feels natural to blame the vaccine, despite all scientific evidence to the contrary. Our brains seek patterns, and cause-and-effect makes the world make sense. It’s incredibly difficult to deprogram that, especially when emotion is involved.
Dozens of these thinking biases and errors lead parents astray. Parents think that something “natural” is better. But dying from disease is natural too.
Most nefarious of all is confirmation bias. Our brains are incredibly protective of what we believe and we seek out information to confirm those beliefs. We also engage in “motivated reasoning” to deflect threats those beliefs at every turn, and we’re simultaneously really, really lousy at assessing risk. Risk assessment requires engaging the intellect, and these automatic cognitive biases are often much stronger.
That means that giving parents facts is not going to change their mind. Scientists learned long ago that our brains just aren’t wired that way. Instead of a neatly arranged filing cabinet, our brains are more like overgrown mangroves, with fears and facts and feelings all knotted together.
As scientists are learning in on-going research, there will be no single strategy to fostering “vaccine confidence.” A complex problem requires complex solutions.
Sometimes harnessing those biases can work: when the norm is to vaccinate, and everyone around us is vaccinating, people are more likely to follow suit. Sometimes also fear can work, for better or for worse. Unflinchingly showing people what’s at stake can persuade some parents.
And of course, research into genuine vaccines risks, which do exist, needs to continue. Ongoing, all the time. People must be reassured that scientists are constantly looking for any kind of risks associated with vaccines, assessing their safety, and ensuring that their risks are outweighed by the benefits.
Public health messages: sometimes they can target specific fears of particular communities. For those who fear “unnatural” ingredients and value what’s “natural,” it may help to learn that the residual formaldehyde, the tiny amounts left in some vaccines, it’s no different chemically than the formaldehyde that’s in a pear, and there’s a lot more of it. It’s in our bloodstreams. Our bodies make formaldehyde.
But more than anything, confronting vaccine hesitancy requires engagement. Instead of dismissing or mocking or fearing or laughing at, mocking those who fear vaccines, we need to listen to them — genuinely listen. A person who feels heard relaxes, lets their guard down. Their cognitive biases are less engaged when the threat of being attacked goes away.
There will always be a tiny percentage of people that we can’t reach— there always has been — that’s okay. We don’t need to reach 100% of people — just enough to keep herd immunity up.
When we come across someone who fears vaccines we won’t get very far by laughing, mocking, accusing, but we might get somewhere, bit by bit, with some thoughtful communication, and some empathy and compassion.
Special thanks to Holly Scheer for her help with the transcription.
Watch the talk below.