Tag: cognitive dissonance

Why Are Anti-Vaccine Folks Panicking over the Measles Outbreaks?

Do you sense something in the air?

No, it’s not measles.

Ever notice that it is folks who don't vaccinate who use words like epidemic and panic whenever we have large measles outbreaks?
Ever notice that it is folks who don’t vaccinate who use words like epidemic and panic whenever we have large measles outbreaks?

It is talk of panic about measles.

Why Are Anti-Vaccine Folks Panicking over the Measles Outbreaks?

I’m not panicking.

I am definitively concerned about these outbreaks, because I understand that they put a lot of folks at unnecessary risk for getting a life-threatening disease. And I understand that these outbreaks are getting harder and harder to control, but ultimately, since more and more people get vaccinated during an outbreak, they will eventually end.

So why are anti-vaccine folks panicking?

Yes, your immune system gets to a whole new level after a natural measles infection - it resets.
Yes, your immune system gets to a whole new level after a natural measles infection – it resets.

It’s easier to be anti-vaccine and leave your kids unvaccinated and unprotected when you don’t think that you are taking much of a risk.

You likely still know it’s wrong, so cognitive dissonance pushes you to believe that vaccines don’t work, vaccine-preventable diseases aren’t that bad, vaccines are full of poison, or that you can just hide in the herd.

It gets much harder during an outbreak, when you realize that it is almost all intentionally unvaccinated kids getting sick. And typically an intentionally unvaccinated child or adult who starts the outbreak.

Why wait until an outbreak starts to get your kids vaccinated and protected or to start recommending that your patients be vaccinated and protected?
Why wait until an outbreak starts to get your kids vaccinated and protected or to start recommending that your patients be vaccinated and protected?

Is my child going to start an outbreak?

If measles is so mild, why do so many of these folks go to the ER multiple times and why do some of them get hospitalized. Why do people still die with measles?

Full Stop! Someone did die during the 2015 measles outbreaks in Washington.
Full Stop! Someone did die during the 2015 measles outbreaks in Washington.

That’s when the panic starts to set in.

Are you really doing what’s right for your child?

Who are these people I’m getting advice from and what’s their motivation?

The only "mass hysteria" is in anti-vaccine Facebook groups. Is Larry Cook using it to raise money for himself?
The only “mass hysteria” is in anti-vaccine Facebook groups. Is Larry Cook using it to raise money for himself?

Am I really supposed to skip my kid’s MMR because they did a Brady Bunch episode about all of the Brady kids getting measles?

Will I regret not vaccinating my child?

Why don’t any of the people in my Facebook groups who talk about how marvelous measles used to be in the old days talk about how they called it a “harmless killer?”

Of course, there is an easy way to stop worrying and panicking about measles and other vaccine-preventable diseases – get your kids vaccinated and protected. Vaccines are safe and necessary.

More on Measles Panic

Making Sense of Anti-Vaccine Arguments

Have you ever tried to understand or make sense out of the things anti-vaccine folks say?

How did it go?

Making Sense of Anti-Vaccine Arguments

Consider what a group of anti-vaccine folks did with the above post about a child with severe complications to a chicken pox infection…

It's always a vaccine injury...
It’s always a vaccine injury…

What are some of the big complications of chicken pox infections? Complications that help make chicken pox deadly?

That’s right, secondary skin and soft tissue bacterial infections (cellulitis and necrotizing fasciitis). In fact, bacterial super-infections of the skin are the most common complication of chicken pox infections.

“Necrotizing fasciitis can lead to sepsis, shock, and organ failure. It can also result in life-long complications from loss of limbs or severe scarring due to surgically removing infected tissue. Even with treatment, up to 1 in 3 people with necrotizing fasciitis die from the infection.”

Necrotizing Fasciitis: All You Need to Know

No, chicken pox is not necrotizing fasciitis, but all of the breaks in the skin from chicken pox lesions give bacteria, including group A Streptococcus (group A strep) and Staphylococcus aureus, plenty of opportunities to enter a child’s body and quickly spread.

No one in the Netherlands dies with chicken pox???
No one in the Netherlands dies with chicken pox???

We often hear that chicken pox isn’t serious in other countries that don’t routinely use the chicken pox vaccine. Don’t believe them.

On average, about two young children die in the Netherlands each year due to chicken pox.

“Based on the results presented in this study we estimate that between 3 to 8% of all Dutch patients with varicella, depending on age, consult a GP due to a complication. Our findings are similar to data from Germany, France and the United States of America, were it is estimated that in approximately 2 to 6% of cases attending a general practice. Furthermore of these varicella patients 1.7% experiences complications severe enough to seek hospital care.”

Pierik et al on Epidemiological characteristics and societal burden of varicella zoster virus in the Netherlands

And folks in the Netherlands have similar rates of complications as we did in the United States in the pre-vaccine era and many are hospitalized.

Do you understand what’s happening in these comments? When folks choose to skip or delay their child’s vaccines, they will work hard to justify their decision.

Escaping cognitive dissonance explains a lot of anti-vaccine arguments.
Escaping cognitive dissonance explains a lot of anti-vaccine arguments.

That’s not surprising.

“the state of having inconsistent thoughts, beliefs, or attitudes, especially as relating to behavioral decisions and attitude change.”

cognitive dissonance definition

If you aren’t going to vaccinate your kids, do you want to think that you are leaving them at risk for such a serious complication, even if it is rare, or will you make up reasons for why the story can’t possibly be true?

Now these folks become skeptics?
Now these folks become skeptics?

Sure, these folks believe every vaccine injury story on Facebook without any proof, but all of a sudden they all become skeptics when faced with a story highlighting the known complications of a vaccine-preventable disease.

That’s the modern anti-vaccine movement.

More on Making Sense of Anti-Vaccine Arguments

Where Are the Latest Chickenpox Outbreaks?

Breaking News – 32 cases at a school in Northern Kentucky (see below)

Chicken pox is a now vaccine-preventable disease thanks to the chicken pox vaccine that was first licensed in 1995.

Despite being added to the childhood immunization schedule in 1996, and the addition of a booster dose in 2007, we do continue to see occasional outbreaks of chicken pox.

Chicken Pox

Although chicken pox is said to have been a rite of passage for kids, it was never something that any of us looked forward to.

At best, you had five to seven days of fever and an itchy rash that covered your body.

“My life changed forever on June 30, 1988, when I had to stand by helplessly as an infectious disease claimed the life of my oldest child, Christopher Aaron Chinnes, at the age of 12.”

Rebecca Cole on Chickenpox Claimed the Life of My Son Christopher

But of course, some people had much more severe cases of chicken pox and some people died.

Chicken Pox Outbreaks

In the pre-vaccine era, before the mid-1990s, most kids got chicken pox.

And chicken pox parties, while not as common as some folks imagine, were definitely a thing, because you didn’t want your child to become an adult and get chicken pox, when it was more dangerous. But since most kids got chicken pox so easily, most got it when they were kids, even without a chicken pox parties, and tragically, many learned that it wasn’t only dangerous to adults.

Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?
Why are we still seeing clusters of chicken pox in schools when a safe and effective vaccine is readily available?

These days, most cases and outbreaks of chicken pox are in unvaccinated children and adults.

  • 32 cases at the Our Lady of the Sacred Heart and Assumption Academy in Walton, Kentucky leading to the quarantine of all unvaccinated students (March 2019)
  • 7 new cases in the outbreak associated with the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 41 in that outbreak, including 4 cases in the community as the outbreak continues to spread (Nov 2018)
  • 6 new cases at the Asheville Waldorf School in West Asheville, North Carolina, bringing the case count to 34 in that outbreak (Nov 2018)
  • several students at Hoquiam High School in Hoquiam, Washington (Nov 2018)
  • at least 28 cases at Asheville Waldorf School in West Asheville, North Carolina (Nov 2018)
  • at least 5 cases at Daybreak Primary School in Battle Ground in Clark County, Washington, leading to quarantine of at least 38 unvaccinated students who will be kept out of class for at least 21 days (Oct 2018)
  • at least 5 cases at two schools in Ottawa County, Michigan, including Waukazoo Elementary and Kids First – Early Childhood Center in Jenison, leading to the quarantine of at least 34 children (Oct 2018)
  • a cluster of chicken pox cases in Grant County, Washington at Park Orchard Elementary, North Elementary and Longview Elementary schools (Sept 2018)
  • at least 5 cases at the The Little Red School House Too daycare in Westbrook, Maine (May 2016)

These cases are just the tip of the iceberg though, as there are still about 7,000 to 10,000 chickenpox cases reported in the United States each year. And that’s with some states, like Oregon and Washington, not reporting cases of this Nationally Notifiable Condition to the CDC.

Cognitive dissonance helps explain how these folks try to explain that chicken pox isn't dangerous.
Cognitive dissonance helps explain how these folks try to explain that chicken pox isn’t dangerous.

Still, since chicken pox caused a few hundred deaths and at least 10,000 hospitalizations each year less than twenty-five years ago, that’s a lot of progress.

Getting Chicken Pox

How do you get chicken pox?

Since it is very contagious, if your child is exposed to someone with chicken pox or shingles, then they might develop chicken pox in about 10 to 21 days (incubation period).

Of course, if they vaccinated and protected, then they probably won’t, although mild, breakthrough chicken pox infections are still possible in vaccinated kids.

Their risk is higher if they:

  • are unvaccinated, either intentionally, because they have a true medical exemption, or because they are too young for the vaccine, which is first given when kids are 12-months-old
  • are partially vaccinated, with only one dose of the chicken pox vaccine
  • have a problem with their immune system, including kids getting chemotherapy

In addition to being at risk for chicken pox, non-immune pregnant women, newborns born to women who develop chicken pox at around the time of delivery, premature babies, and those are immunocompromised can be at risk for severe disease.

Avoiding Chicken Pox

Want to avoid chicken pox and the chance of ending up in a chicken pox quarantine and having to stay out of school for 3 weeks or more?

Get your kids vaccinated.

That’s not an option for some kids with true medical exemptions though, including most kids who are immunocompromised. When they get caught up in one of these outbreaks and get exposed to chicken pox, it becomes a matter of life and death to work to try and prevent their getting chicken pox.

More on Chicken Pox Outbreaks

Updated on March 14, 2019

10 Reasons You Aren’t Vaccinating Your Kids

Yes, we know.

It’s because you have done your research.

“Many would argue that we have become a culture characterized by intolerance of any risk (particularly of co-mission as opposed to omission), such that when harm does occur someone is to blame.”

Poland et al on Understanding those who do not understand: a brief review of the anti-vaccine movement

But that’s not really why you aren’t vaccinating your kids.

10 Reasons You Aren’t Vaccinating Your Kids

Research has explained the real reasons, most of which happen subconsciously, and they include the following  well known cognitive phenomena:

  1. ambiguity aversion – the idea is that people tend to prefer known risks rather than unknown risks and while you would think that would tend to widely favor getting vaccinated (known, very small risks of a vaccine) vs remaining unprotected (relatively unknown risk of getting a vaccine-preventable disease and coping with possible complications), that’s not how vaccine-hesitant people think. If you are skipping or delaying any vaccines, you are likely to overestimate the risks of vaccines, include ‘risks’ that are not even associated with vaccines, and make getting vaccinated seem like a much bigger and ambiguous risk than it really is. Also, some vaccine-hesitant parents see much more ambiguity in the whole getting vaccinated decision than there really is, mostly because of the false balance in media reporting. There is no ambiguity – experts agree that vaccines are safe and necessary.
  2. anticipatory regret – you might decide to skip or delay a vaccine because you “wouldn’t be able to forgive yourself” if your child had a severe reaction, explaining the anti-vaccine slogan that “You can always get Vaccinated, but you can never get Unvaccinated.” While it is a catchy slogan, it misses the fact that some parents do regret their decision to not vaccinate their kids because they did wait too long and their child did get a vaccine-preventable disease. You can’t always get vaccinated and severe reactions are very rare.
  3. availability heuristic – we think things are likely to happen if we can easily remember them and we are most likely to remember things like vaccine scare stories because we see them all of the time. That doesn’t make them true or mean that they really are common though. Have you seen many of those videos?
  4. bandwagoning – many of us like to jump on the bandwagon – doing what everyone else is doing. So how does bandwagoning fit into vaccine hesitancy, considering that most people vaccinate and protect their kids? Just consider that many of unvaccinated kids we see today are grouped together in “pockets of susceptibles” because their vaccine-hesitant parents are also clustered together in an echo chamber, making it seem like skipping or delaying vaccines is a more popular option than it really is. Also, so much of the vaccine sentiment online is negative, it is easy for it to seem like it is the same in the real world. For example, it has been found that 75% of the vaccine sentiment on Pinterest, 66% of the vaccine sentiment on YouTube, and 30-35% of the vaccine sentiment on Facebook and Twitter is negative! Do your friends and family members vaccinate their kids?
  5. cognitive dissonance – this is the anxiety you get from believing in two things that contradict each other, like if you are afraid to vaccinate your child, but you are just as afraid that if he isn’t vaccinated, then he will get measles. One belief eventually wins out and makes it easier for you to believe anything else that reinforces it, even things that aren’t logical and which are easily disproven. Even if you don’t realize it, and you probably won’t, this is when you begin to use cherry picking, confirmation bias, survivorship bias, etc., and become a Dunning Kruger master.
  6. control – most of us like to be in control, or at least feel like we are in control. Saying no to a vaccine, especially a vaccine that you feel is involuntary (your child needs it to attend daycare or school), may help you feel a little more in control of what may seem like a never ending bombardment of risks facing your child.
  7. explanatory attribution – people like, or even need, to find a meaning for things, such as why kids are autistic, and when you don’t have one, it becomes very easy to make one up or latch onto someone else’s idea of a vaccine injury or vaccine induced disease.
  8. free-riding – while some people are hiding in the herd out of necessity, including those who are too young to be vaccinated and those with medical exemptions, others are free-riders and are benefiting from the fact that most of the rest of us do get vaccinated and do vaccinate our kids.
  9. omission bias – when given the option, some people prefer doing nothing instead of doing something, even if it leads to something much worse happening in the future. Choosing to do nothing, like skipping or delaying your child’s shots, is still a decision though, and if your child or someone else’s child gets sick, your action (by omission) is still the cause and you would still be morally responsible.
  10. optimism bias – some parents are overly optimistic about their ability to protect their intentionally unvaccinated kids from getting a vaccine-preventable disease or even that they can treat them if they do get sick with essential oils, homeopathic remedies, a trip to the chiropractor, or other alternative type treatments. They can’t.

Of course, none of these things would be able to take hold so well without one other thing – fear.

Fear helps these cognitive biases, heuristics, and logical fallacies take hold and change your perception of risk into something that is much different from reality. That’s why some people think that the risks of vaccines are greater than the risks of catching a vaccine-preventable disease or even greater than the risks of having a vaccine-preventable disease.

They aren’t. Vaccines are safe.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

Again, some people fear vaccines more than they fear the complications of vaccine-preventable diseases. Surprisingly, this effect is well known and has been predicted. If you don’t know or have never seen anyone with a vaccine-preventable disease, like polio, measles, diphtheria, or tetanus, then it’s easy to believe that they really were mild diseases.

They weren’t. And they still aren’t. Vaccines are necessary.

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
My daughter getting all of her two month vaccines to make sure she was safe and  fully protected. Photo by Vincent Iannelli, MD

But why are some parents so afraid of vaccines that they have panic attacks if they even think about vaccinating their baby? It certainly doesn’t help if you believe one or more of the 100 myths about vaccines that you might see on Facebook, Twitter, Pinterest, and YouTube. Or that you are likely constantly being hit with vaccine scare videos that make it sound like every child has a vaccine injury.

All of that propaganda can make you more susceptible to the cognitive biases that we all have to deal with from time to time, even leading you to believe in the many anti-vaccine conspiracy theories that are always floating around.

But fear shouldn’t be what drives your decision making.

We shouldn’t have to wait for outbreaks for folks to start vaccinating their kids again.

Get educated and understand that vaccines are safe, with few risks and many benefits. Learn to think critically, be more skeptical about the things you see and read about vaccines, and overcome your biases.

What to Know About Why You Aren’t Vaccinating Your Kids

You aren’t vaccinating your kids because something or someone has scared you and a series of cognitive bias are making it hard for you to see the truth that vaccines are safe, necessary, and that they work.

More On Why You Aren’t Vaccinating Your Kids

The 3 Components of Anti-Vaccine Propaganda

Can you recognize anti-vaccine propaganda?

This anti-vaccination caricature envelope was likely issued by the Anti-Vaccination Society in 1879.
This anti-vaccination caricature envelope was likely issued by the Anti-Vaccination Society in 1879.

Do you know how some folks scare parents away from vaccinating and protecting their kids?

“Recognizing disingenuous claims made by the anti-vaccination movement is essential in order to critically evaluate the information and misinformation encountered online.”

Anna Kata Anti-vaccine activists, Web 2.0, and the postmodern paradigm – An overview of tactics and tropes used online by the anti-vaccination movement

No, it’s not just about saying vaccines are full of toxins and poison. The problem with that strategy, is that while parents would be afraid of vaccines, they would also still be afraid of their kids getting sick if they were intentionally not vaccinated and caught a vaccine-preventable disease.

John Birch (B) and the other anti-vaccine heroes of the day on their way to fight the vaccination monster.
Anti-vaccine propaganda hasn’t changed much since vaccines were depicted as a monster in the early 19th century.

How do they help reduce this cognitive dissonance?

That’s easy.

They make it sound like vaccine preventable diseases really aren’t that bad, which isn’t hard to do, since few people actually remember what they are like since vaccines work so well. In fact, they might even try and make you believe it is good to get these diseases.

Lastly, they push the idea that vaccines don’t even work. They even have graphs!

Throw in some a lot of vaccine injury stories, a few conspiracy theories about doctors and Big Pharma, some cherry picking of quotes and evidence, and maybe say something about package inserts,  and you have the basis for most anti-vaccine talking points.

So the basic idea (of anti-vaccine propaganda) is that you shouldn’t vaccinate your kids, but you also shouldn’t be concerned that you aren’t vaccinating your kids because vaccines don’t work anyway, and measles, polio, and smallpox, etc., are basically just a mini-vacation from school

Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over...
Even the mildest cases of smallpox (no other complications), as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules all over your body, and then a few more weeks of waiting for the lesions to scab over, which left you with pitted scars…

Think you can recognize anti-vaccine propaganda now?

The 3 Components of Anti-Vaccine Propaganda

Do you see how anti-vaccine propaganda works?

One or more of these three basic themes is repeated over and over again in most anti-vaccine arguments, posts, or stories:

  1. Make you think vaccines are dangerous by overstating the side effects and risks of getting vaccinated. And never mentioning any of the many benefits of vaccines.
  2. Make you think it’s no big deal to get measles or polio, by underestimating the risks of vaccine-preventable diseases and overstating the benefits of natural immunity over the protection you can get from vaccines. And never ever mention that the reason you aren’t likely to get polio is because most people are vaccinated (hiding in the herd strategy).
  3. Make you think that vaccines don’t even work. They even push the false idea that there are still big outbreaks of measles in China, that the smallpox vaccine didn’t eradicate smallpox, that herd immunity isn’t real, that DDT caused polio, and that vaccine-preventable diseases have never been controlled or eradicated – we just changed the names to something else. After seeing the smallpox photo above, do you really think that anyone would fail to recognize a kid with smallpox?

Don’t be fooled.

Get educated about vaccines.

What to Know About Anti-Vaccine Propaganda

Anti-vaccine groups use standard propaganda methods to manipulate folks into thinking that vaccines are dangerous and don’t work and that your child would be better off getting sick with a vaccine-preventable disease, like polio or measles.

More About Anti-Vaccine Propaganda

 

Cognitive Bias and Vaccine Education

Most of us think we use good judgement when we make decisions.

We research things, consider pros and cons, and put a lot of thought into our decisions.

Unfortunately, no matter how careful we are, subconscious cognitive bias can lead us to make mistakes.

Cognitive biases are defined as:

“mental errors caused by our simplified information processing strategies.”

Cognitive biases often make it difficult for vaccine hesitant parents to see through anti-vaccine myths and misinformation and lead them to fall for anti-vaccine talking points.

These cognitive biases include:

  • confirmation bias
  • blind spot bias
  • survivorship bias
  • selective perception
  • backfire effect
  • choice-supportive bias
  • conjunction fallacy
  • Dunning-Kruger effect
  • hindsight bias
  • illusory correlation
  • ostrich effect
  • pessimism bias
  • semmelweis reflex
  • false consensus effect

What’s behind these cognitive biases?

Cognitive Dissonance

One explanation is cognitive dissonance:

“anxiety that results from simultaneously holding contradictory or otherwise incompatible attitudes, beliefs, or the like, as when one likes a person but disapproves strongly of one of his or her habits.”

So for example, if you are scared to vaccinate your child, then also thinking that your intentionally unvaccinated child could catch measles and get very sick might cause some cognitive dissonance. This leads you down the road to also start to believe in much of the pseudoscience of the anti-vaccine movement, including that:

  • vaccines don’t work anyway (they do)
  • vaccine-preventable diseases, like measles, aren’t that bad (they are)
  • it is actually good to get a vaccine-preventable disease (it isn’t)
  • everyone else is vaccinated, so it doesn’t matter if my kids aren’t (it does)
  • bacteria and viruses don’t even cause disease (they do)

Vaccines work. Vaccines are necessary. Get your kids vaccinated.

What to Know About Cognitive Biases

As you get educated about vaccines, don’t let any of these cognitive biases get in your way.

More Information on Cognitive Biases:

Updated on September 24, 2017