As we were reminded during California's recent measles outbreak, a surprising number of well-educated people decide each year not to have their children immunized against an array of communicable diseases. Trying to discern why they make this dangerous decision is a priority for public health officials, and a perplexing puzzle to the rest of us.
Newly published research shows that cultural anthropology can both help us understand their thinking, and suggest ways of productively communicating the importance of vaccination.
San Diego State University anthropologist Elisa Sobo spent time with a community of parents whose children attended a California Waldorf School. It's part of a large, international network of alternative schools that emphasize independent thinking and creative expression.
These schools are often criticized for having high rates of non-immunized children, and that was clearly true of the campus Sobo visited: Just over half of the parents filed "personal belief exemptions" indicating their child was un- or under-vaccinated.
The desire to "fit in" with a group of self-defined free-thinkers in fact leads to a kind of groupthink, in which dissent is effectively silenced.
Tellingly, she found the percentage of kids who are vaccinated goes down the longer they have been at the school. This suggests that, while parents who choose such schools may be skeptical of vaccines, there's something about the culture of the institution that bolsters this skepticism and effectively discourages the otherwise-common practice.
That's exactly what Sabo found when she interviewed 24 parents and conducted a focus group with a dozen of them. She discovered they were "highly educated, and took seriously their perceived responsibility for child health."
They also prided themselves on being "independent thinkers" who are deeply skeptical of both big government and big corporations. This shared sense of identity, she writes in the journal Medical Anthropology Quarterly, reinforces anti-vaccination attitudes, which gradually coalesce into a cultural norm parents are reluctant to deviate from.
Opposition to vaccination becomes, for many, intertwined with their perception of themselves as intelligently skeptical parents.
One potential source of this skepticism is "anthroposophy," which Sobo describes as "a holistic philosophy promoted by Waldorf education's founder, Rudolf Steiner." Among other things, this school of thought argues that the fevers and inflammation that accompany common childhood diseases "contribute to cell renewal and growth, as well as to overall immune-system strength."
Sabo reports this philosophy is not specifically taught as part of the Waldorf curriculum, and none of the parents she interviewed mentioned it in relation to immunization. But previous research has linked the belief to low levels of immunization among children enrolled at Waldorf schools in Europe.
Besides the purported "benefits of getting a disease naturally," anti-vaccine parents frequently mentioned "the profit motives of those who make, sell, and distribute them."
Other stated concerns included side effects and perceived toxicity of vaccines. This information largely came from alternative-medicine publications and websites, which were widely shared among the Waldorf parents.
"Such sources—which supported talk of vaccine toxicity, ineffectiveness, needlessness, and developmental inappropriateness for small bodies—were more likely to be publicized within the school community via social networks than were mainstream scientific materials," Sabo writes. "This was because of (unwritten) community rules favoring alternative perspectives and stigmatizing conventional ones."
Sabo's research identifies two important ironies. First, she writes, "Although Waldorf education has a social mission, participants (in this study) overlooked the plight of disease-vulnerable people."
Second, "the equation between non-vaccination, the independence of mind that it is taken to signify, and Waldorfian identity make it harder and harder to contravene the norm without threatening one's sense of group membership."
In other words, the desire to "fit in" with a group of self-defined free-thinkers in fact leads to a kind of groupthink, in which dissent is effectively silenced.
How can this be countered? "Vaccine promotions should leverage parents' favored ideas and address community concerns," Sabo writes. "Pro-vaccine messages aimed at Waldorf parents should emphasize how vaccination, booster shots included, help children's immune systems naturally (vs. working synthetically)."
In addition, she writes, "Publicizing that about half of Waldorf students are fully vaccinated ... will also be helpful," as it will demonstrate "that vaccinating one's children is not inimical to being free-thinking" or a member of the school community in good standing.
"Because such actions have the potential to dislodge vaccination's social stigma," Sabo writes, '"these could be the most important practical steps of all."
Findings is a daily column by Pacific Standard staff writer Tom Jacobs, who scours the psychological-research journals to discover new insights into human behavior, ranging from the origins of our political beliefs to the cultivation of creativity.