The World Health Organization recently named a reluctance or refusal to vaccinate one's children as one of the 10 most pressing health issues of 2019. Solving the vaccination gap—and thus preventing problems like the current measles outbreak in Washington State—will require a better understanding of what drives loving mothers and fathers to make the dangerous decision not to inoculate their children.
New research from Australia provides valuable insights regarding these parents' underlying motivations. It finds that both hardcore anti-vaxxers and those who are reluctant or hesitant to vaccinate their children tend to occupy specific moral universes. Intriguingly, the elements that make up their ethical codes are a mix of those usually seen on the political right, and others more prevalent on the political left.
Identifying these ethical codes could help shape persuasion campaigns more successfully—and stop authorities from pursuing counterproductive campaigns that could drive more people into the anti-vaccination camp.
"Public confidence in vaccination is waning, driven in part by the manufacture of doubt by anti-vaccination activists and websites," writes a research team led by Isabel Rossen and Mark Hurlstone of the University of Western Australia. Their study aimed to determine who is vulnerable to anti-vaccination persuasion, and why.
These are defined as harm (ensuring others' well-being); fairness (belief in justice and individual rights); loyalty to one's group (be it nation, religion, or some other body that is integral to your identity); authority (respect for the social hierarchy); purity (the belief that certain aspects of life are holy and should remain unsullied); and one that Haidt and his colleagues are considering adding to the list, liberty/oppression (belief in personal freedom and fighting oppression).
These foundations align quite well with the dominant values on each side of the left-right divide. Liberals emphasize harm and fairness, while conservatives place a higher value on loyalty, purity, and respect for authority.
But the Australian researchers, whose study is published in the journal Social Science and Medicine, found that anti-vaxxers don't fall squarely along these traditional lines.
The participants were Australians who visited parenting websites and who described themselves as a parent or guardian; for the study, these participants filled out a detailed questionnaire designed to determine which of the moral foundations most resonated with them. They also indicated their political ideology, and answered a series of questions regarding their feelings abut vaccines' safety and effectiveness, and the likelihood that they would vaccinate a future child against 12 different diseases.
The respondents fell into one of three categories: vaccine accepters, fence-sitters, and vaccine rejecters. Fence-sitters were skeptical of the science and/or motives of the drug companies that provide vaccines, but in the end they were likely to vaccinate their kids.
Each of the groups "demonstrated a unique pattern of moral foundation endorsements," the researchers write. Vaccine rejecters were significantly less likely than members of the other two groups to endorse respect for authority—and significantly more likely to score high on purity.
That's an unusual mix. Lower respect for authority is typically a hallmark of people on the political left, while endorsement of purity is almost always associated with social conservatives (particularly those who are highly religious).
Rejecters and fence-sitters both scored high on the liberty foundation, meaning that both groups consist of people who really dislike being told what to do. "This group seems to believe that although vaccines are effective and beneficial for society, it is important to allow individuals to make their own decisions," the researchers write.
The findings largely confirm those of a 2017 study in Nature Human Behavior, which found that parents who were very wary of vaccination were twice as likely to endorse the moral foundations of purity and liberty than those who accepted the practice.
The Australian researchers argue these insights can be used to improve communication strategies aimed at increasing vaccination rates. For example, it may be possible to capitalize on fence-sitters' emphasis on liberty "by framing vaccination as an opportunity to keep their child's immune system fit and healthy, enabling it to live a life free and unrestricted by disease."
In addition, their results suggest that coercive measures aimed at forcing parents to allow vaccinations will likely backfire, given their vehement belief in parents' rights. Punishing them will only "undermine trust among this group of parents, thereby potentially pushing fence-sitters toward vaccine rejection," the researchers write.
So the most effective approach may be to emphasize why vaccines are so crucial, to your child and to society as a whole—while conceding that parents have the final choice. So long as their authority is acknowledged, a whole lot of hesitant moms and dads can probably be persuaded to do the right thing.