Jun 05 2012

Education and Vaccine Uptake

A new study, not published but to be presented at a meeting, purports to show that after the infamous Andrew Wakefield 1998 Lancet article alleging a connection between the MMR vaccine and autism, vaccination rates in the US declined by about two percent. This may seem like a small amount but has an effect on public health, and vaccine refusal typically occurs in pockets that bring vaccination rates below the level needed for “herd” immunity, allowing for outbreaks.

This, however, is all old news. There are two other pieces of information in the study that are interesting. The first is that the decrease in vaccination rates did not rebound after Wakefield and his Lancet study were thoroughly refuted. That genie was out of the bottle, and correcting the misinformation did not have the desired effect of putting it back in. This too is in line with other research and experience. It is easier to spread fear than reassurance. Once rumors are spread the damage cannot be undone.

The study also purports to find that the there was an inverse relationship between education level and vaccine use – college-educated mothers were less likely to vaccinate their children. Further, in the 8 years after the Lancet study this gap increased. This education-gap is also in line with previous research, but needs some explanation. We need to distinguish unvaccinated from undervaccinated, and vaccine non-compliance from vaccine refusal. When looking at the undervaccinated, and specifically those who missed scheduled vaccines, this correlates with lower socioeconomic status and less education. This is in line with a more general pattern – the fewer resources a family has the less likely they are to avail themselves of available health care.

However, if you look at those who refuse or delay vaccines as a deliberate choice, there is a positive correlation with the education level of the parents, especially the mother. This may seem paradoxical at first – higher education leading to bad health care decision making, but actually it makes perfect sense. First, let me say that I am taking as a premise that refusing vaccines is a bad decision. For reference just plug in “vaccine” into the search box on this blog and you can read dozens of articles explaining my position. ┬áIn short, the evidence overwhelmingly supports the conclusion that vaccines are safe and effective and a net health benefit for the vaccinated. Fears over vaccines causing autism or other neurological damage are based upon soundly refuted pseudoscience. So why, then, the reverse correlation with education?

The typical hypothesis, which is plausible but untested (as far as I know), is that higher education levels leads to greater access to information, specifically on the internet, where vaccine fears have largely been spread. If you are not exposed to misinformation about vaccines then you cannot act on that misinformation.

I also think, however, that this is part of a larger phenomenon – a direct relationship between education level and general acceptance of pseudoscience. Prior surveys have found a correlation between higher levels of education and belief in ghosts, ESP, and alien visitations. Education superficially seems to make us more gullible. However, the interpretation of this result, in light of other psychological research, is different than just gullibility. Access to information is likely part of the reason for the correlation between education and belief. Another factor is likely that as we get smarter we get better at justifying our own beliefs. Having an education can make someone more confident in defending their offbeat beliefs, and better able to defend those beliefs from the skeptics.

This is a sobering realization. It is partly the result of human psychology, but also partly an indictment of our educational system. We cannot change human nature, but we can transcend it by understanding that nature and developing methods to compensate for it. We would call these methods critical thinking, or perhaps metacognition. We need to teach students not only how to access information, but how to think about it critically, and how to examine their own thought processes for flaws and pitfalls.

The relationship between education and paranormal belief is more complex than the study I linked to above would suggest. A Finnish study found that the areas of study made a difference. University students and those studying psychology and medicine had less belief in the paranormal while vocational students and those studying education and theology had higher beliefs. The authors interpreted this as those having a more analytical style of thinking had less belief in the paranormal than those with an more intuitive style of thinking.

This all goes along with one of the major premises of the skeptical movement – that education alone is not enough, you have to teach students how to think critically and be more skeptical. This is increasingly true in the internet age. We are exposed to all sorts of information, which appears to be counterproductive and lead to greater misinformation than accurate information, unless we also have the scientific literacy, critical thinking and metacognitive tools to properly assess that information.

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