Almost everyone believes the following: Vaccines are a good and necessary part of medicine.
Some people, and more people every day, believe this, too: Those who don't believe in the virtues of vaccines — anti-vaxxers — are ignorant and dangerous lunatics, possibly evil.
I spent most of my life believing that. During my early 20s, I lived in the skeptic blogosphere, a mid-2000s constellation of internet communities theoretically organized around highly charismatic bloggers, vloggers, and other intellectuals. In practice, however, these groups were centered on a more basic principle: hostility toward anyone and anything it deemed "irrational." It was then and is still now a very white, male, and defensive place.
It was there that I developed a deep antipathy toward the anti-vaccination movement. It wasn't that I knew they were wrong about vaccines. It was more than that. I believed myself intellectually and morally superior to those people, and I reinforced that belief each time I left a comment or watched a vlog or republished a snarky article on the subject. I mastered a face, a kind of appalled, disapproving look for any time anybody even broached the subject of vaccine skepticism.
Then I married an anti-vaxxer.
Here's what I learned.
1) Anti-vaxxers aren't paranoid misfits
I met my wife nine years ago. I wanted to take up swing dancing and decided to take a private class to get over some of my anxiety. She was the teacher who picked up the phone when I called.
I was immediately attracted to her, but at the time she was engaged to her dancing partner, the father of her daughter.
So at first we built a platonic friendship. We spent time together. We bonded over our mutual interest in dancing. I had known her for more than a year the first time she mentioned that her daughter was not vaccinated.
What do you do, then, when someone you believe is both smart and sensible comes to a conclusion you find completely wrong? Does that person stop being smart at that precise moment?
My time reading (arrogant) skeptic blogs had convinced me of my moral and intellectual superiority. I believed that because I was a smart, sensible, and empathetic person I could see the value of vaccines. Yet here this woman was. I knew she wasn't dumb — in fact, I thought she was very insightful. I knew she wasn't dangerous or conspiratorial — we had talked for days about how we care about people, and the society we live in, and what it means to be human. I already trusted her.
Did I have to completely reassess my opinion of this person? Did I have to examine my own biases and mental caricatures, decide that anti-vaxxers are people too?
Well, no. I did what most people did: opted for cognitive dissonance. I decided it wasn't worth getting into a fight over, that she could be my friend and have weird opinions about vaccines at the same time. Even as she broke up with her partner, and I broke up with mine, and we found ourselves spending a lot of time together, I ignored the issue. The subject of vaccines came up once or twice over dinners, but so what? I could see she loved and cared deeply for her daughter. She was someone I admired and respected and was beginning to love. Vaccines didn't get in the way.
And, of course, I believed that if we spent enough time together, I'd eventually change her mind.
2) It's all about fear
It's not that anti-vaxxers are stupid, or that they're corrupt. It's that they're afraid.
This is the beating heart of any real discussion about anti-vaxxers. It's impossible to understand their position without considering the amount of fear that goes into the anti-vaccine narrative, and considering how people construct and deal with fear.
Now, you might think that a fear is a fear and public health is something else — and you might be right. That's the rational point of view. But then, how rational are your own fears?
Maybe you're afraid of heights. Maybe it's spiders. In either case, you're lucky: Coping with your fear the way most people do — avoidance — doesn't come at a cost to others. But vaccines only work when everyone buys in. Public health depends on anti-vaxxers confronting their greatest fears for the benefit of others.
For people who don't share their fear, it's very easy and convenient to demand that anti-vaxxers just suck it up and take the shot. I wish they would, too. But we'll never get there by bullying them, by insulting and demeaning them and refusing to take the fact of their fear seriously, even if there isn't much that's serious in its content.
That's hard to do. Have you ever tried to stare a loved one into the eye and tell her you are going to put her child in danger?
Despite initially avoiding the subject, I decided, after we were married, that I should convince my wife to vaccinate her daughter. Vaccines are good, after all. Vaccines are safe. Measles outbreaks had been on the news — what better time to raise the subject?
But when I did, I realized that from her perspective, all of my confrontational reasoning sounded like me asking to point a gun at her daughter and have her trust that it was full of blanks. Looking into her eyes, I realized her trust in me was threatened. She asked why I would do that to a child. All of my insistence that vaccines are safe didn't matter. Go tell arachnophobic parents that you must put spiders on their child because society depends on it, and see how that goes. The benefits of getting the shot, expressed in the abstract, simply could not overpower the immediate, disarming fear.
So I backed down. The anti-vax position was not a deal breaker for me, but suggesting that we should expose her daughter to grave dangers for no good reason was a deal breaker for my wife. I loved my wife. I had no desire to end things. Yes, I think it was very important for her daughter to receive vaccines — but it's not as if my wife would have changed her mind over a breakup fight.
I backed down and resolved to have that conversation in less confrontational terms when the opportunity arose.
3) If you think something is dangerous, it's logical to avoid it
My wife is one of the smartest, most sensible people I know. So what do smart, sensible people do when they perceive a threat? They do the smart, sensible thing: take precautions and warn others.
What do you think anti-vaxxers believe they're doing?
Again, it's easy to dismiss the worries of anti-vaxxers as irrational and chalk up their activism to paranoid behavior, but this misses a crucial point: The reasoning, once you accept the big, unsubstantiated premise, is valid. It isn't even that far-fetched, if you don't think about it too hard: There are some heartbreaking precedents that feed this logic. Lead paint, tobacco, bloodletting — every time we feel the urge to reply, "But vaccines are safe, everyone knows that," we ought to remember that the same sentence has been said, earnestly and confidently, about things that absolutely were hazardous.
If you've come to believe that vaccines are dangerous, then anti-vax behavior follows almost rationally. If we want to reach these people, dismissing their logic as ridiculous or fringe is the worst strategy. It plays right into the anti-vaccination narrative: that they are the "only sane ones," warning the careless masses about a very real and hidden danger.
My wife (and her family) sincerely believes that though her worries are being recognized as irrational, they aren't. It's easy to imagine how the very first person to notice the dangers of something ubiquitous, like lead, was dismissed by her peers as irrationally afraid — and to imagine you might be one of these people. The first anti-lead folks were called cranks — until they were proven right.
My point isn't that the anti-vaxxers might be right. They're not. My point is that once you believe something untrue, it's very easy to keep rationalizing that belief. It's very easy to dismiss your critics as shortsighted. And when you're constantly attacked, it's natural to make your resilience part of your identity, to become even more committed to maintaining it.
People are not essays, where you can go back to a previous paragraph and undermine the priors through careful, unperturbed dissection. People talk, and people balk. My wife would not stand to have me pick her apart like she is a problem that needs to be solved; her priors — like everyone else's — are part of her identity. All of us have beliefs of this sort; it's just that most of us can get away with them more easily. We need to stop seeing anti-vaxxers as people who can be persuaded to abandon a bad idea, and instead as people we're asking to abandon a part of themselves — people whose defensive sense of identity we've encouraged with bad tactics.
4) There's an industry supporting anti-vaxxers — and we're driving them into its arms
A sense of identity isn't the only thing that makes anti-vaxxers impervious to confrontational argument. If you take a deeply controversial position, especially in the beginning, you won't last long without a strong support system. Unfortunately, fear sells — and there's always someone willing to give you that support for a price.
Evidently, people who don't trust or value conventional medicine still get sick. In Canada, where I live, socialized health care covers almost all conventional health-care costs, but there is a serious private market for people who would rather get their treatments from alternative sources. These alternative sources can do some good: Sick people need care, and some amount of care is usually better than no care at all. But the alternative health industry is also a business, and at its worst, this is how the business works: Articles about children turning "autistic" after a shot are circulated by authors selling books, websites selling ads, and merchants selling cures. When you're in the business of selling treatments against a subsidized competitor, your pitch needs to be emotive, essential. It needs to appeal to the values of your audience. Since there is a real economy hinging on people not trusting conventional medicine, its actors churn out sensationalist scare pieces by the truckload, which validates the preexisting anxieties of anti-vaxxers ad nauseam — and drive them into the arms of the people willing to sell them a solution.
Support networks can also come from somewhere closer to home.
Back when my wife and I were just friends, I met her sister a couple of times. She is a very pleasant, completely agreeable, and naturally sociable person. I really had no reason to be anything less than friendly to her. Then my wife told me that her sister is a naturopath who studied the toxic effects of vaccines "extensively."
My sister-in-law is also a big part of my wife's support network. When my wife is second-guessing herself about vaccines — like when her daughter's father raised the issue after their separation — she turns to her sister. Her sister is even deeper in the movement that she is — she's a provider of alternative medicines by trade — and when they talk, my wife comes away more sure of the anti-vax worldview. Again: This isn't a strange behavior. How many times have you wondered about something important, only to be reassured by a conversation with a loved one?
Of course, it's not uniquely devious for anti-vaxxers to seek like-minded people to validate their views; we all do it. One of the reasons I like many of the newspapers and magazines I like, for instance, is because they tell me things I already think about foreign policy, urbanism, feminism, and race — we all suffer from confirmation bias to some extent. But unlike more ordinary biases, the alternative medicine racket is completely unchecked; by definition, it eschews mainstream checks on its theories and practices. It cashes in on encouraging the isolation and dependence of its participants. This is an environment in which every hypothesis is given equal weight, and all of them come packaged with some kind of product recommendation.
Without a profitable industry, anti-vax beliefs might not survive long. But again, what do we do? The monolithic media presence of the vaccination narrative gives skeptics an "assaulted and oppressed" outlook that encourages its members to seek out corners that coddle their worldviews. Those corners then sell them back their own biases — and they become even more confident that they're right.
5) Changing someone's mind doesn't just take love. It takes empathy.
I decided to write this piece after it was revealed that Pandemrix, a vaccine designed to combat swine flu, was causing narcolepsy in children. As Julia Belluz pointed out on this site, the 2013 discovery was hardly covered by the media despite real and demonstrated side effects — precisely the kind of behavior anti-vaxxers suspect is happening with all vaccines.
I keep an eye out for stories like this, one that could allow my wife and me to discuss vaccination in nonconfrontational terms. A story like Pandemrix allowed me to engage her in good faith, to admit that sometimes medicine makes bad calls and that the media can be complicit. I brought it up to my wife to show that I care about her worries, that I don't think they are beyond the pale. When easing somebody's fears, love is rarely enough — empathy is needed, especially when you want to persuade. Refusing to engage in any open-minded discussion, to concede that things can go wrong, to admit that it's possible we don't know everything: That kind of condescension had gotten me nowhere with my wife and her daughter no closer to vaccinations. It hasn't gotten the broader fight against anti-vaxxers very far either.
A lack of personal investment is, as it happens, what led to my wife's initial rejection of vaccines: She had a very unfortunate run-in with a complacent MD in her late teens, while she was going through a lot of pain physically and mentally.
It started with a drug-induced psychotic breakdown. She grew up in something of a broken home, with an absent father, an addict mother, and a violent stepfather — an environment where drugs were easy to come by and hard to ignore. At 17, she smoked something weird and felt herself quite literally losing it. Hallucinations. Panic attacks. Nausea and heart palpitations. After a grueling week of recovering from the episode, she did the normal thing and took herself to a doctor.
She got out with a prescription and an unshakable feeling that this doctor, and his clinic, and the government that paid for his services, did not care at all about her concerns, her needs, and her fears. That she was a problem that could be solved with a couple of pills. That the fear she had felt for her sanity was not respected, not even considered. That the solution to her drug problem was more drugs.
Four clean years later, she was taking naturopathy classes with her sister.
This is not a breach of trust that can be restored by telling her vaccines are safe.
It's obvious and painful that all human systems are going to fail at some places due to human imperfection. It's probably impossible to force all doctors to be nice and considerate people.
Maybe my wife would have felt just as abandoned even if the doctor did everything right at that moment. But knowing that for many anti-vaxxers there is a root cause — something that led them to mistrust medicine and then wind up in a feedback loop that reinforced that mistrust — is vital to pushing back. I do think minds can be changed and hearts can be won, but I've made my peace: Only love, patience, and empathy will make inroads. Treat anti-vaxxers kindly, if only because it's pretty hard to feel persecuted when your adversaries are being kind. This is the road I chose, and I am happy to share my life with a person who challenges and inspires me. Someone whom, a mere decade ago, I would have considered a dangerous lunatic.
And then, last week, her daughter asked if she would be getting shots this year.
"Not with your classmates," my wife said. "But yes, it's time. We'll schedule an appointment with our new family doctor."
I didn't have to say anything.
Adam Mongrain is a writer living in Montreal.