Social Status and Immunizations

Alicia Silverstone has been in the news lately promoting dangerous anti-vaccination ideology. I've been having this debate with other moms in the wild since the early 2000s, when Andrew Wakefield first published his, now completely discredited, spurious research linking the MMR vaccine to autism. 

What is going on? Why are parents, and most vocally mothers, still so resistant to vaccinating their children? They put not only their own children at risk, but also the most vulnerable members of our society: the neonates too young for vaccines; the elderly whose immunity has waned; cancer patients; HIV+ patients; people whose immunity is compromised due to illness; and on and on. I'm asthmatic and therefore particularly vulnerable to respiratory diseases even though I'm fully vaccinated according to the adult booster schedule. 

I’ve written previously about how difficult and also how important it is to apply critical thinking to parenting. There are myriad internal and external pressures to be a “perfect” parent, and the criteria for perfection varies across different social groups. Parents can bond or bicker over all kinds of emotionally-charged issues: how to diaper (or not); whether to and how long to breastfeed; the softness of unbleached, organic cotton; or the purported health benefits of unpasteurized(!) milk. In my opinion, the controversy over childhood immunizations represents the ultimate line of demarcation among many parent peer groups. 

Because few people are actual infectious disease experts or experts in immunology, vaccinating children requires reliance on the authority of the scientific consensus, which is that vaccines are very safe and effective. 

There are also a couple of barriers to analyzing the medical literature. The details of scientific primary sources require subscription or fee-based access. Even when access is available, most members of the lay public are simply not trained to accurately interpret the data. I rely on secondary sources, primarily Science Based Medicine, for an accessible and credible overview of the literature. It’s straightforward and matter-of-fact, which is exactly how I like to consume scientific information. Unfortunately, SBM is not as seductive or emotive as purveyors of medical misinformation such as Mothering Magazine.

Mothering is a gorgeous publication that features delicious recipes, lovely family activity ideas, eco-friendly lifestyle advice, and other harmless-yet-interesting fluff that resonates withe me. Unfortunately, readers also encounter a great deal of medical misinformation. The format taps into fears of inadequate mothering and offers counter-culture solutions that will finally make one a “good” mother. It’s very seductive, especially when it elevates even mundane parenting choices to self-righteous political positions. Of course Mothering is strongly against vaccination, and provides all kinds of science-y sounding language and anecdata to support this position. It’s very hard to sort out credible information about vaccines, and I have a lot of empathy for parents who refuse to vaccinate. It’s even more difficult when anti-vaccination confers social status.

I have long thought that alpha moms jockeying for position within parent groups contributed to decreasing rates of vaccination. More recently, I’ve been thinking about the larger societal pressures that influence anti-vaccination.

I was inspired by a discussion in the comment section of an SBM article by Dr. David Gorski about Mothering Magazine’s deadly medical advice, including a plethora of vaccine misinformation and HIV denial.  The entire comment thread is worth reading because there are a number of very bright people who contribute a great deal of interesting insight. Below is an excerpt of my small bit.

Commenter Windriven asks:

“So what drives Mothering’s readers? Why are so many people willing to ignore science and medicine in favor of anecdote? Clearly these are engaged parents; why else would they subscribe to a parenting magazine? One presumes that they have been exposed to the pro-vaccination argument. One presumes that they are aware of the thorough discrediting of the MMR link to autism.

Are there any studies examining this?”

I responded:

“@ Windriven: I’ve actually thought quite a bit about this, and I have some ideas about what I think might be going on. This is based on my anecdotal observations, not on any rigorous study.

Many women who can afford to stay home gave up careers to do so. Larger society undervalues stay-home moms (as well as teachers and other child care workers). So bright, educated women find themselves in clusters, isolated from prestige, and they bring the work ethic and focus that advanced them in careers to parenting. They must seek status and validation from other members of the stay-home community, and this requires separating themselves from the unwashed masses. (My friend calls this “competitive parenting.”)

This subculture fosters increasing intensity and extremism, and practices that might have begun as reasonable choices are pushed to extremes. Once everyone in the group is breastfeeding infants, for example, the higher-status women are the ones who breastfeed kindergartners.

This trajectory translates to increasingly harmful cultural norms. Once everyone treats vaccination as an ala carte menu, the higher-status women are the ones who are rejecting vaccines, or rejecting prenatal care, or obstetrical care, or whatever. Statistics are such that the individual mothers and children are likely to be unharmed by these decisions, and this leads to strong confirmation bias.

Mothering is one more source of validation and status. It feeds right into the paradigm I attempted to describe. The pressure to conform is intense, and I’ve actually heard mothers defensively/apologetically rationalize to other mothers things like weaning early, or allowing a doc to prescribe antibiotics for something potentially serious. [...]”

Windriven:

“@Anthropologist

Yours is a fascinating conjecture. It certainly explains the herd mentality. But why woo instead of science? Why don’t these mothers end up as uber-vaccinators?”

Me:

“@ Windriven:

‘Why don’t these mothers become uber-vaccinators?’

My personal biases tends to lead me (correctly or not…) to conjectures involving status and power. My read is that challenging the authority of conventional medicine and MDs is one way of artificially ascribing status to oneself. [...]”

The contemporary anti-vaccine movement should by all rights be a small fringe movement. Its tenants have been roundly and repeatedly discredited, and yet it persists. It’s going strong both on the pages of Mothering and other parenting sites, and in real-life parent subcultures. I think that there is a good deal of observational evidence favoring my off-the-cuff theory of a convergence of in-group status and societal marginalization of stay-home parents. This, coupled with misinformation that appears credible published on mainstream sources, fuels the unfortunate rise in potentially deadly preventable diseases.

Whether or not my assessment about the anti-vaccine movement is correct, treating parents, teachers, and childcare workers like respectable, contributing members of society would benefit everyone.

A version of this article originally appeared on She Thought