Dec 28 2011

What Is an Antivaxer?

(Cross-posted at Science-Based Medicine.)

Labels are a cognitive double-edged sword. We need to categorize the world in order to mentally capture it – labels help us organize our mental maps of the overwhelming complexity of things and to communicate with each other. But labels can also be mental prisons, when they substitute for a thorough, nuanced, or individualized assessment – when categorization becomes pigeon-holing.

We use many labels in our writings here, out of necessity, and we try to be consistent and thoughtful in how we define the labels that we use, recognizing that any sufficiently complex category will be necessarily fuzzy around the edges. We have certainly used a great deal of electrons discussing what exactly is science-based medicine, and that the label of so-called alternative medicine is really a false category, used mainly for marketing and lobbying (hence the caveat of “so-called”).

We get accused of using some labels for propaganda purposes, particularly “antivaccinationist” (often shortened to “antivaxer”). Also “denier” or “denialist”, as in germ-theory denier. Even though we often apply labels to ourselves, no one likes having an unflattering label applied to them, and so we have frequent push-back against our use of the above terms.

As with many such terms, it is really defining one end of a continuum and we recognize that there is a broad range of attitudes and opinions regarding vaccines. Not all doubts about the safety of vaccines, nor skepticism toward the motives and ethics of corporations or the effectiveness of regulatory bodies, is necessarily “antivaccine”. We are, however, frequently accused of implying exactly that, especially by those who are ironically far to the anti-vaccine end of the spectrum.

A recent e-mail to me is very typical:

I have a few questions for you. Would you give a vaccine using a formula that was a hundred years old to your children? Or if you could go into the future a hundred years, would you use today’s vaccines? If you had three children, and two died soon after being vaccinated, would you give the third the same vaccine? I’m sure some of you would not, which means you are in the same boat as the anti-vaccers. I have a problem with the way you lump everyone who disagrees with you into one hated group. Though I believe in taking the natural approach to health, the reason I avoid vaccines is because of some it’s contents, mercury, for example. I don’t believe all vaccines are bad, and I don’t blindly accept that all vaccines are safe.

I will first define what I think are some useful subcategories to the anti-vaccine landscape. The first sub-category is not truly anti-vaccine, but can be made to feel as if they are being lumped in with extremists – and that is well-meaning parents who are simply misinformed or confused.

To be absolutely clear, we are not critical of this group. They are the victims of misinformation and propaganda. For example, the e-mailer above claims that they avoid vaccines because they contain mercury. However, mercury was removed from the routine childhood vaccine schedule in the US by 2002. Tiny doses of mercury (in thimerosal) is still present in some, but not all, flu vaccines. You can get all the vaccines you need without any mercury (except for insignificant trace amounts). I should also mention that the doses of mercury in vaccines prior to 2002 was tiny, that it is in the form of ethylmercury, which is much less toxic than methylmercury (the form that is more likely to be encountered in the environment), and that the evidence does not show any link between mercury in vaccines and any adverse outcome.

So why are we still talking about mercury in vaccines? Because those who are genuinely anti-vaccine keep using this canard as a scare tactic. I use the term antivaxer not to refer to the victims of propaganda but to those who spread misinformation and propaganda about vaccines because their agenda is to oppose vaccines.

As my colleague David Gorski has written many times – with an antivaxer it’s always about the vaccine. Not safety, not autism, not any one ingredient in vaccines – it’s about the vaccines themselves. This is the “true antivaxer” category – an anti-vaccine activist.

This subgroup (not really a subgroup, it is, rather, what we actually mean by antivaxer) can be divided into several subgroups by how they got to their anti-vaccine ideology. Some in the antivaxer camp are part of what has been called for years the “mercury militia.” They are convinced that mercury toxicity is responsible for a long list of human ills, and they jumped on the anti-vaccine bandwagon because of the mercury (thimerosal) issue.

Another antivaccine subgroup are the alternative medicine proponents and practitioners. They generally do not take a science-based approach to health care, and may endorse one or more specific unscientific, mystical, or spiritual approaches. They often oppose vaccines simply because vaccines are in the science-based camp, and conveniently they have their own alternatives to sell you.

The e-mailer above may be affected by this CAM subgroup also, given her endorsement of the naturalistic fallacy. The idea that “natural” (never well defined) is inherently more safe and effective than anything “artificial” (also not clearly defined) is perhaps the most common and most effective bit of CAM propaganda, and in fact goes back much farther than the modern CAM movement. Ironically it is a label that is used to “greenwash” over the real issues – evidence for safety and effectiveness and scientific plausibility.

A third category in the antivaxer camp are those who have a specific ideology that opposes the use of medical interventions in general, or specific interventions that include vaccines (such as Christian Scientists). In this case the anti-vaccine stance is a literal religious belief. They are often happy, however, to endorse the propaganda of the previous groups in order to bolster and justify the antivaccine position they take for primarily religious reasons.

The final category (at least on my list – acknowledging that no such list can be all-encompassing) are environmentalists. I am not saying that environmentalists are antivaccine, but rather that some individuals’ journey to the antivaccine camp passes through their somewhat extreme environmentalism. In this world view corporations are evil until proven otherwise, and environmental toxins are a massive cause of human disease and suffering. They see vaccines as one more environmental toxin (and here there is large overlap with the “mercury militia”), and readily accept that there are no limits to the malfeasance of large corporations in pursuit of profits. Robert Kennedy Jr. most famously fits into this category, in my opinion.

The e-mailer hints at the conspiracy attitude with the comment that they do not blindly accept that all vaccines are safe. This is a straw man argument, since neither do vaccine supporters. There is a copious amount of evidence for vaccine safety. It is perhaps the safest medical intervention we have devised – millions of doses given with few serious adverse outcomes. But we always want more data, and so we endorse monitoring vaccine safety and performing more studies as vaccines evolve and new vaccines are developed.

Like all such categories, they are not clean. There is a great deal of overlap and ideological contamination. These are peaks in a complex landscape, but not completely discrete groups. But the one thing they all have in common is that they oppose vaccines, they engage in the abuse of science in order to engage in an antivaccine agenda, and they spread misinformation and scaremongering about vaccines.

Many people, however, have questions and concerns about vaccines. This does not make one an antivaxer. It is reasonable and healthy to have questions about any health intervention, especially when a parent is making such decisions for their children. We encourage questioning. The antivaxers (ironically while crying for informed consent) have made making an informed decision more difficult by muddying the waters. It is difficult to counter a dedicated campaign of misinformation, as it is a lot easier to sow doubt and confusion than to correct every piece of bad information.

I also want to emphasize that I encourage a doubting and questioning attitude. It is good to be skeptical of all claims, but healthy skepticism can easily slide into cynicism or denial. It is important to question all sides and see who has the better and more authoritative answers to questions.

With regard to vaccines, the data is there, published in the peer-reviewed literature. Many professional groups have thoroughly analyzed the literature and independently concluded that vaccines are safe and effective. On the other side are those promoting bad science, bad logic, conspiracy theories, and unwarranted fears that always find their way back to vaccines. That is not a healthy approach to the evidence, no matter what you label it.

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10 responses so far

10 Responses to “What Is an Antivaxer?”

  1. locutusbrgon 28 Dec 2011 at 1:40 pm

    Steve you are wonderfully even handed.
    I am frustrated by the modern attempt to defeat, arguably, the single greatest win in medical history. If people just could see, in a real way, the disaster of childhood death and disfigurement in the pre vaccine era. Public sentiment would beat this down to the background where it belongs.

  2. addisontreeon 28 Dec 2011 at 10:43 pm

    Excellent post.

    What about the group of “well-meaning parents who are simply misinformed or confused” who are also promoting an antivax agenda or antivax organization? They may not be beyond changing their views if presented with the real information but they are also not actively seeking out the true facts about vaccines.

    My instinct is to use the “antivax” label when referring to this group. Isn’t a line is crossed when one becomes an activist for a cause?

    Am I thinking poorly here? Could everyone who regularly sends money to NVIC, Generation Rescue or any of that ilk justly be referred to as “antivax”? And would referring to them that way be more or less likely to make them look up the truth about vaccines on their own? (For example calling someone a cultist who is not a member of a cult but is often seen with cult members might be enough of a shock to get that person to reexamine their social circle before completely “drinking the Kool-Aid”.)

  3. VRAlbanyon 29 Dec 2011 at 9:33 am

    In my last encounter with anti-vaxers and parents who have been misinformed, we went through gambit of usual issues and I tried to address them

    - thimerosal contains ethylmercury, not methylmercury
    - thimerosal has been removed since the early 2000s anyway, and the rate of diagnosis of autism has NOT decreased in correlation
    - there have been many studies showing a positive correlation between increased diagnoses of autism and the expansion of diagnostic criteria for autism spectrum disorders
    - etc…

    … but after we go through all those points (or they are ignored), I have seen some antivaxers and misinformed parents fall back to, “Well, there has never been a study done directly comparing autism rates between vaccinated children and non-vaccinated children”.

    The only counters I had to that were
    1) In an expermental set-up, it would be highly unethical to with hold vaccinations from a control group of children
    2) An observational study might be difficult because the population of non-vaxed kids is much smaller than vaxed kids and their data might be difficult to track down. And there might be data skewing if parents of nonvaxed kids with autsim are less likely to come forward, or if nonvaxed kids with autism are sought out specifically. It would be difficult to get an accurate rate of diagnosis in that group.
    3) Though not directly comparing vaxed kids to non-vaxed kids, there have been many experiments done already that were specifically designed to find a link between autism and vaccines, but none has ever been found.

    So… my question is, are all the above points correct?
    Is there anything that can be added that would be more convincing to concerned parents?
    Because I don’t think my points swayed many antivaxers (in the general sense), especially those who are of the grand conspiracy mindset (though I do realize that conspiracy theorists are tough nuts to crack anyway).

  4. Rikki-Tikki-Tavion 29 Dec 2011 at 11:20 am

    Great post. Thank you!

    I had a conversation with a young father recently which went downhill when he said: “I’m not an Anti-Vaxer, but my child isn’t vaccinated”. I thought he shouldn’t have guardianship over a little person. Especially since the person in question has a habit of licking everything in reach, including (but not limited to) old beer bottle caps from under a couch.

    His point was appearently the “his little immune system can’t handle that much at once”-gambit. He added annother argument that the child was protected by herd immunity, that vaccinating was altruistic by protecting herd immunity, that he couldn’t force his child to do such an altruistic act, because the child was unable to consent. Of course, that only worked in conjunction with playing down the risks of an infection.

    At that point I could only challenge his assumptions, but it didn’t do me any good.

  5. jreon 29 Dec 2011 at 1:16 pm

    So… my question is, are all the above points correct?

    Happily, no. There has been a direct comparison of autism rates between vaccinated and unvaccinated children. See Lack of association between measles-mumps-rubella vaccination and autism in children: a case-control study.
    Interestingly, in this study the rate of autism was highest among the unvaccinated, lower among those receiving a monovalent vaccine, and lowest among those receiving the MMR vaccine. Not to the point of significance, though. What the study shows, for the nth time, and to the surprise of (almost) no one, is that there is no correlation between vaccination and autism.

    Your points are generally valid, however. It is difficult to conduct a large-scale comparison such as is demanded by antivaxers, because it is unethical to withhold a preventive measure for a serious disease once it is known to be safe and effective (see, e.g., Tuskegee, Guatemala). The study cited above was possible only because of Poland’s unique history: having come late to the European community, Poland went through several different vaccination schedules in a short period, and so populations with distinct immunization histories were already available for comparison.

  6. VRAlbanyon 29 Dec 2011 at 10:01 pm

    jre, that is fantastic!
    My simple internet searches in the past were not successful, so thank you. That SHOULD be the silver bullet in the “There’s never been a direct comparison study” argument for most reasonable people.

  7. VRAlbanyon 29 Dec 2011 at 10:04 pm

    link to the full study, for good measure

    http://journals.lww.com/pidj/Documents/Lack_of_Association_Between_Measles_Mumps_Rubella.pdf

  8. VRAlbanyon 29 Dec 2011 at 10:23 pm

    Oh boy, Rikki…
    If you see this dude again, maybe you could get in some digs about, “Did your baby consent to wearing that outfit today? I don’t think you should be dressing him until he can.” or, “You shouldn’t force your son to eat those vegetables! He’s not capable of consenting to what you are serving him for dinner!” The point being that parents are supposed to make decisions for their children until they are capable of responsibly doing so themselves.
    But questioning his parenting skills would probably just make the guy mad…
    From your description, the whole consent premise seems like BS anyway, since this guy has apparently been convinced some anti-vax tenets, though proclaiming not to be anti-vax himself.

  9. krobinson 30 Dec 2011 at 1:14 am

    I’m not quite sure if this would work, but if there are any lawyers that could chime in on this issue it would be appreciated. As Steve mentioned above it is very difficult to combat doubt and confusion by spreading factual information. But why not stifle the movement by causing doubt and confusion in McCarthy and Carrey? Would it be possible for any of the vaccine producers to win a libel or slander case against those two? I’m sure it would be highly publicized and it would force followers to look at the facts in the case rather than taking everything those two say at face value. Just a thought, there should be some form of litigation for such a detrimental form of misinformation.

  10. PharmD28on 30 Dec 2011 at 5:30 pm

    ““I’m not an Anti-Vaxer, but my child isn’t vaccinated”. ”

    These “non-antivaxer” parents, or sub-category, or whatever….they need talking to…if they will not listent to the science, then I say pound them – I once told a pharmacy tech at lunch with folks when she defended her position on not vaccinating her children….she would not hear me out in the slightest…so I told her that while she is acting in what she thinks is in good conscience, she is terrorizing the health of those children and of others who are unable to get vaccinated and I told her that she deserves significant shame for this baseless misguided position. I said this in a very calm manner, it shocked her, shocked a few of my colleagues too, but they had a hard time arguing with the point.

    Not sure if she will have changed her mind after I was such a dick, but 15 onlookers got the take home message and a number of people later were grateful for it….not sure if that is the right thing but damn it felt good.

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