SkepticblogSkepticblog logo banner

top navigation:

Anti-Vaxers and the Need for Clarity

by Steven Novella, Jun 06 2011

Humans are not entirely rational creatures. We all know this from daily experience, although we happily assume that we are more rational than other people (which is just one of our irrationalities). We are motivated by the need for meaning, and for esteem. We tend to pick sides, and then invest our egos in that side, defending it at all costs.

We are also motivated by the need for simplicity and control. The world is a very complex place, overwhelmingly so. Therefore we need to simplify it in our minds, so that we can deal with it. We use schematics, and categories, and rules of thumb to impose a manageable order on the chaos of reality. These devices are quite adaptive, as long as we realize that they are just that – human devices to approximate reality in a way we can handle.

But too often we confuse our simplistic models of reality with reality. Further, we like our morality plays to be black and white. The villains are villains, without redeeming qualities. The good guys wear white and have no major flaws (nothing beyond an endearing quirk). The ambiguities and gray of the world make us feel uncomfortable. This tendency, by the way, leads to certain logical fallacies, such as poisoning the well. If Hitler believed something, and everything Hitler did was bad, then that belief must also be bad.

We can see this need for moral clarity and scientific simplicity at work in the anti-vaccine movement. Their core belief is that vaccines are not safe, that they are causing harm to our children. They are incorrect in this belief, but that is the bedrock of their movement.

They are not satisfied with this notion that vaccines are not safe, however. Every other belief about vaccines must also be in line with their core belief. They are particularly intolerant of complexity or moral ambiguity. Therefore they have convinced themselves that not only are vaccines not safe, they don’t work. Further, the diseases they treat are not that bad. They believe those who promote vaccines are also selfish and evil, morally compromised liars (they happily portray us as baby-eaters). They cannot wrap their heads around the notion that perhaps well-informed people who mean well disagree with them.

The anti-vaccine echo-chamber exists in a cartoon world of cardboard villains, dark conspiracies, and white-hatted heroes (a role they reserve for themselves), where the science all lines up in their favor, without the slightest compromise or ambiguity.

Before someone tries to turn this back on the scientific community, I do not think the same applies to the defenders of science-based vaccines. We admit that vaccines have risks, and harm does rarely occur. But the benefits outweigh the risks. We acknowledge that pharmaceutical companies care mainly about their own profit (they are corporations, and that’s what they do), and they need to be carefully regulated to protect the public interest. We acknowledge that, while vaccines work, they are not perfect. The flu vaccine in particular is very problematic, particularly matching the strains each year with the ones that are likely to hit in flu season. But still, we eke out more benefit than harm.

We also acknowledge that the anti-vaccine community is a diverse group. And while I suspect there are some charlatans and con artists thriving in their midst, most anti-vaccinationists appear to be sincere parents who are just trying to do their best for their children. They are simply misinformed, by a well-funded campaign of scientifically complicated misinformation. Many are caught up in the anti-vaccine echo-chamber, subject to group dynamics and all that implies.

Just take a look at the Age of Autism blog – a sociologist could make a career out of studying the comments alone. A recent article at AoA is the perfect example of the need for simplicity. David Burd writes Death by Flu, The Big Lie Crumbles. The title itself reveals much – flu is not that bad, and those who say it is are lying. Nice moral clarity.

Burd is shocked (shocked!) to discover that the number of flu deaths each year is estimated by the CDC. He writes:

“CDC makes it abundantly clear these 3K to 49K “flu-associated” deaths are not actually counted, but are instead estimates generated from computer models that hypothetically link such as pneumonia deaths to those theoretically having a prior case of influenza (with the influenza long gone).


Subtracting 105 from 311 we see a documented count of 206 adult flu-associated deaths. It will be interesting to see what CDC’s computer-model finally conjures up as the final 2010-2011 “flu-associated” death tally.

Interestingly, Burd glosses over an important fact that he relates – the CDC does make it abundantly clear what methods they use. They have complete transparency. Using various methods they, and other researchers, estimate the number of flu-associated deaths in the US as between 3 thousand and 49 thousand each year. They estimate the number for a very good reason – the surveillance mechanisms in place do not allow for a direct counting. Most people who come down with the flu do not undergo laboratory testing to confirm that they actually have the flu. The diagnosis is often made based upon clinical symptoms. We also know from case histories that some people will develop complications from the flu, like a secondary pneumonia, which will be the ultimate cause of death.

The goal of the CDC estimate is to figure out, as closely as possible, how many excess deaths are due to the flu – how many people died who otherwise would not have if not for the flu.

Burd makes no substantive analysis of the methods used by the CDC and other researchers. Nor does he attempt to make an alternate estimate. He simply counts the laboratory-confirmed cases as if this is the “true” number. He makes no mention of the fact that most cases of flu are not examined with a laboratory test, and therefore this number is likely to be a gross underestimate – by orders of magnitude.

He takes this pseudoscience further by comparing US and Canada laboratory-confirmed cases:

Summing up, while Americans are coerced, cajoled, or required in school and health institutions to undergo the dangers of flu shots, our Canadian neighbors overwhelmingly reject them, and the last five years Canada has averaged but a single (non-comorbidity) flu-associated pediatric death, while the U.S. toll rises ever higher.

He neglects to mention that the US has a higher population than Canada, and that differences in surveillance methods would also need to be taken into consideration. The comparison, in other words, is absurdly useless. While decrying the methods used by the CDC to estimate flu deaths, Burd abuses completely inaccurate numbers for his propaganda purposes.

But he has fed the echo-chamber another round of reassuring simplicity and moral clarity – not only is the flu vaccine unsafe, the flu is not that bad a disease anyway, and those who are pushing the vaccine are liars.

Burd makes no attempt at due diligence or respectable scholarship. He does not try to understand the CDC methods. It’s enough that he has hit upon a fable that suits the propaganda agenda of AoA.

Nor is AoA an isolated example – it is more the rule than the exception (although it is an extreme example). We see the same thing at the DiscoTute with respect to evolution, or on any news outlet with a political skew (which essentially means all of them, although to varying degrees). This phenomenon is widespread (as you would expect for anything that derives from basic human nature), which is why it is important not to rely on any single source of information. It is helpful to look for the other side to the story, assume that there is probably more complexity to an issue than is at first apparent, and to be vigilant about the need for simplicity and clarity in our own thinking.

25 Responses to “Anti-Vaxers and the Need for Clarity”

  1. Before someone tries to turn this back on the scientific community, I do not think the same applies to the defenders of science-based vaccines.

    I agree that there’s a lopsidedness to this debate (certainly in the scientific evidence, and I personally believe in the moral dimension as well), but I would note that the lay skeptical community sometimes distills it into our own black and white caricature — portraying vaccines as risk-free (this is a rare slip-up, but it happens), feeling that most anti-vaccination activists are terrible people, or leaping to the assumption that a given outbreak must be tied to the anti-vaccine movement. (Some demonstrably are, but the demonstration should come before the finger-pointing.)

    It’s easy for us to forget the kind of nuance you underline here:

    We also acknowledge that the anti-vaccine community is a diverse group. And while I suspect there are some charlatans and con artists thriving in their midst, most anti-vaccinationists appear to be sincere parents who are just trying to do their best for their children.

    For most skeptics, these are the “anti-vaxxers” we most often encounter: loving, involved parents trying to resolve a bewildering rhetorical firefight with a “first, do no harm” strategy of their own.

    Skeptics who are qualified medical experts have won important victories in this area, and I think grassroots skeptics have as well. I’d just like to underline again that in a public health battle with such life-and death stakes, we should continue to strive for the highest standards of responsibility.

  2. Max says:

    Mr. Andrew Wakefield isn’t against all vaccines. I’m sure he wasn’t against the measles vaccine he tried to patent.

  3. CountryGirl says:

    Literally hundreds of thousands and perhaps millions of illegal 3rd world immigrants enter the U.S. every year. They are not tested for health problems or vaccinated. This is a ticking time bomb. Sooner or later one of these “conquered” diseases will go pandemic in the U.S. and other 1st world countries that attract illegal immigration. When that happens it will be too late for most parents to see the light and correct their mistake. Vaccinate!!

    • Max says:

      “Measles — a disease that was declared eliminated in the USA in 2000 — is again breaking out across the country, in the largest outbreak in 15 years, spread largely by unvaccinated travelers who bring home the disease.
      Doctors have reported 118 measles cases in the USA since January — nearly twice as many as the total for all of last year, according to a report released Tuesday by the CDC. About 90% of this year’s patients were unvaccinated, and 40% had to be hospitalized for complications.
      Most of the patients brought the disease with them from Europe, which is in the throes of a major epidemic, with more than 10,000 cases and six deaths in France alone, according to the CDC. Thousands of additional measles cases have been reported across Europe, affecting 38 countries, the WHO says.”

      • CountryGirl says:

        I assume the bold part of your comments was intended to refute the issue of illegal immigrants bringing diseases into this country. I am sure that you were able to show sources for that statement. But one has to wonder why. If we do not know who brought in a disease why would it be likely to be an unvaccinated “traveler” vs one of the 2 million illegal aliens. Is this just another example of PC writing their own history?

      • Max says:

        Says right there, “Most of the patients brought the disease with them from Europe.”
        Herd immunity prevented it from spreading and causing a big outbreak.

        Apparently, Mexico has better Measles vaccine coverage than the UK.

      • gdave says:


        “If we do not know who brought in a disease…”

        But in this case we DO know. Read Max’s post again. The CDC really does try to determine the origin of an outbreak, “patient zero”, and they are often successful. In this case they were able to trace the origin to travelers, mostly unvaccinated, who had been in Europe, which is suffering an even greater measles outbreak.

        But if the CDC hadn’t specifically tracked this outbreak back to U.S. nationals who had traveled overseas, “…why would it be likely to be an unvaccinated “traveler” vs one of the 2 million illegal aliens?” Well, why would it likely be one of the 2 million illegal aliens vs. one of the U.S. travelers who made 60+ million trips abroad in 2009 (“Why More Americans Don’t Travel Abroad”, CNN website, February 04, 2011)? Especially keeping in mind that, as Max pointed out in his reply, Mexico (major source of illegal immigration) actually has better measles vaccination coverage than the UK (major overseas destination for U.S. travelers).

        For that matter, do you have any actual evidence that illegal aliens are more likely to carry contagious diseases than legal immigrants? It seems logical, given the lack of health screening, but is there any actual evidence? Have there been any outbreaks of diseases that have been tracked back to illegal aliens? That’s not rhetorical. I don’t actually know, and I’m genuinely curious.

        I’m not saying that illegal aliens couldn’t be carrying dangerous communicable diseases (odds are, some of them must be), but how high is the risk level from this particular vector?

  4. Craig Blackley says:

    The article quoted Burg saying :” our Canadian neighbors overwhelmingly reject them” in reference to flu vaxccines.
    Thats nonsense- in Ontario, Canda’s most populous province, the flu vaccine is given, free, to anyone who wants it. I don’t know the correct numbers, but I understand that apx. 30 to 40% get it each year- enough to strengthen the “herd immunity” effect.
    In case anyone mis-understands, I’m mentioning to this in agreement with the Mr. Novella’s posting.

  5. CountryGirl says:

    Do you really believe Mexico has a better vaccination program then the U.S.?

    The reason I suspect illegals bring diseases into this country is because it is reported as fact in the papers all the time. The recent cases of whooping cough is a great example and there are numerous examples of TB being spread by illegals.

    • Max says:

      Ken August, a spokesman for the California Department of Public Health, said state officials do not believe there is any connection between immigration and the whooping cough outbreak.
      Public health officials, he said, have a number of reasons for reaching this conclusion. His response, edited for clarity, continues below:

      *Pertussis did not need to be imported into California. It’s always been here.
      *Mexico does a great job vaccinating for pertussis. Until just a few years ago, Mexico was using the whole-cell vaccine, which is probably more effective than the acellular vaccine that has been used in the U.S. since the 1990s.
      *There is no pertussis outbreak/epidemic in Mexico.
      *Immunization rates in Hispanic children are high.
      *All adults, whether they are from the U.S. or Mexico, are likely to be susceptible to pertussis. A 2008 survey found that about 6% of U.S. adults stated they had received Tdap, a whooping cough inoculation for adolescents and adults that was approved by the FDA in 2005. The number is actually likely to be lower since the responses were not verified.
      *Hispanic infants are overrepresented among pertussis cases, but this discrepancy disappears after six months of age when most infants have received three doses of Dtap — the vaccine for infants — and are much less vulnerable to pertussis.
      *Overall rates of pertussis disease are highest in whites. We think Hispanic infants are overrepresented among young infants because they are more likely to live in larger households, per census data, and have more contacts. More contacts means more opportunities to be exposed to someone with pertussis.

      Sounds like Mexicans should worry about Americans bringing whooping cough into their country.

    • Max says:

      TB is a better example.

      “More than 25 percent of TB patients reported in the United States originate from Mexico, which make the control, prevention, and treatment of this highly infectious disease a question of important to U.S. national interest and policy.”

      • Max says:

        Also, Americans aren’t generally vaccinated against TB.

      • Somite says:

        Although in decline, TB can be found worldwide in many countries and is endemic in some US states (Hawaii, Alaska). If TB is a concern to you, and statistically it shouldn’t, you would have to adopt a completely xenophobic travel and immigration policy rather than just immigration from Mexico. It is not immigration control but public health programs that are useful in controlling communicable diseases.

        I’m sorry but we just have to get used to living with evyone else in the world,

        For a more complete discussion of worldwide tuberculosis see:

  6. CountryGirl says:

    “There is no pertussis outbreak/epidemic in Mexico.”

    Would you know? Mexico has two classes of people, the rich and the very poor. Millions of the very poor die every year with no attention to the cause and no report in their news media. As far as we know there could be thousands of cases of whooping cough in Mexico’s barios and we would be none the wiser.

    It is politically correct to coverup anything bad associated with illegal immigration. Illegal immigrants kill about 3500 people in this country every year. They commit tens of thousands of rapes and sexual attacks. In some states they are responsible for over half the drunk driving crimes. They are major players in selling drugs to our children. They cost state and federal governments in excess of $200 billion every year. Perhaps the reason you are so uninformed is because politicians want you to be uninformed.

  7. Kenneth Polit says:

    Sorry, but I’ll get my information from people that actually got a university education in their respective fields, and conducted scientific studies, not someone who made her living showing us her naughty bits.

  8. CountryGirl says:

    Sadly it is the experts, those with scientific degrees in their respective fields that most often feel pressured to be politically correct and not truthful. I prefer to get my information from many sources and evaluate it myself rather then just sign on to a belief system.

    What are naughty bits?

    • “What are naughty bits?”

      Naked genitalia. Kenneth Polit is refering to Jenny McCarthy’s stint as a Playboy model (which in no way qualifies her to dispense any advice or opinions on medical issues).

  9. Sheila says:

    Country Girl, I think the experts in their respective fields feel pressured to be truthful, and not to fall into anyone’s political agenda. Whereas politicians feel pressurized into saying whatever will get them elected, and these days journalists feel pressurized into meeting deadlines, even if that means not checking anything. Some feel pressurized to say whatever the owner of the newspaper or TV channel wants.

    For example, Jan Brewer claimed that immigrants had beheaded people in the Arizona desert, and this was widely repeated,especially by Fox news. However, the medical examiners and sheriff’s offices all say they haven’t seen a single beheading. Not one. Jan Brewer made it up.

    The criminal gangs who run illegal immigrants across the boarder are very bad people indeed, but they’re Mexican residents, not illegal immigrants. The immigrants themselves have every incentive to NOT ATTRACT POLICE ATTENTION. This is probably why cities with lots of illegal immigrants have lower crime rates. Seriously. Go Google it.

  10. CountryGirl says:

    I live near a Northern city. Most drunk driving, knifings, molesting of children, trying to snatch children off the street, large drug busts and about half of the gang shootings are committed by illegals. I’m guessing these illegals are not following your rule of trying to not attract police attention.

    I think most/many experts feel pressured to be politically correct, not make waves and avoid saying anything that might cause them to lose their job. The belief that the experts are almost always wrong is widely held. I didn’t invent it.

    • As with EVERY SINGLE COMMENT you’ve made: REFERENCES! You are (to all appearances) just makeing assertions. Those assertions are no different than just pulling random crap out of your behind. If you want to be at all taken seriously, cite what you say, otherwise I would kindly ask you to defer from using the comment function.

      I hope the northern city you live in is far away from my northern city… I’d hate to think someone as predjudiced sounding as you lives anywhere near me. :(

      • CountryGirl says:

        That seems to be the excuse of weasels on all subjects. That is: “If you cannot cite proof (that of course I will not accept) then it isn’t true”. You can like or dislike what I said but you cannot refute it. So instead you must slur me by claiming I am prejudiced. The body of evidence is enormous. 1/3rd of prisoners in California are illegal aliens at a cost of billions every year. Are you so in denial that you are blind?

    • “I didn’t invent it.”

      Prove it. By all appearanced, you did!

      • CountryGirl says:

        Try googling the phrase “never trust an expert” or “Experts are always wrong”. You will get many hits and none of them will be mine. Perhaps you never heard the phrase before. I would think that would make you research BEFORE you commented and thus showed your ignorance. I didn’t make up the phrase but I do believe it.