Contrary to impressions (and Donald Trump’s antivaccine views) most Americans support vaccine mandates

Being as involved as I have been refuting antivaccine pseudoscience as I’ve been over the last 12 years, I frequently forget that antivaccine views are not the mainstream. It’s an easy thing to do. If you were to immerse yourself in the antivaccine echo chamber as much as I do, you too would start to think that enormous swaths of the country, if not an outright majority, think that vaccines cause autism, sudden infant death syndrome, asthma, a wide variety of neurological disorders, and basically every autoimmune disease under the sun. I know that that’s not true, but often it doesn’t feel that way. In particular, I’ve been concerned ever since Donald Trump became President, given his long sordid history of antivaccine ramblings, his having met with Andrew Wakefield leading to antivaccinationists thinking that he will be satisfying some of their deepest darkest wishes with respect to the CDC, and his having met with Robert F. Kennedy, Jr. to discuss (if you believe RFK Jr.) a vaccine safety commission or an autism commission (if you believe the Trump administration. When the President of the United States is an antivaxer, you know we could be in for trouble when it comes to public health.

That’s why it’s good to be periodically reminded that the vast majority of Americans don’t support antivaccine views, as I was by an article by Lena Sun in the Washington Post telling us that Trump’s vaccine views are at odds with those of most Americans, study says. Basically, it’s a news story about a Pew Research Center survey about the benefits of vaccines and school vaccine mandates. It was a Pew Research survey conducted among a nationally representative sample of 1,549 adults, ages 18 or older from May 10-June 6, 2016 (before the election) whose results are being published now. It’s mainly about the MMR (measles-mumps-rubella) vaccine because that’s the vaccine that Andrew Wakefield cast doubt upon and is therefore the most famous and commonly mistrusted vaccine.

First things first, though. Before I get to the support for vaccination, the pedant in me can’t resist mentioning that this study confirms what I’ve been saying all along, that support for vaccines is pretty much even on the left and the right, or, as I like to put it, antivax is the quackery that knows no partisan boundaries:

The new Pew Research Center survey finds Republicans (including independents who lean Republican) hold roughly the same views as Democrats (including leaning Democrats) about the benefits and risks of the MMR vaccine, consistent with a 2015 Pew Research Center survey on this topic. Republicans and Democrats (including those who lean to either party) are about equally likely to support a school-based vaccine requirement. However, political conservatives are slightly more likely than either moderates or liberals to say that parents should be able to decide not to have their children vaccinated, though majorities of all ideology groups support requiring the measles, mumps and rubella vaccine for all children in public schools because of the potential health risk to others.

On the other hand, there is a significant difference in how conservatives and liberals perceive school vaccine mandates:

Conservatives (25%) are a bit more likely than either moderates (15%) or liberals (9%) to say that parents should be able to decide not to have their children vaccinated even if that creates health risks for others. At least seven-in-ten of all three ideology groups say that the MMR vaccine should be required for healthy schoolchildren, however. There are no significant differences in views about this issue by political party in this survey.

Even with a margin of error of 4%, I’m hard pressed to look at figures that show 25% of conservatives believe that parents should be able to decide not to vaccinate their children even if that may create health risks for others while only 9% of liberals do to be a “bit more likely.” That’s almost three times as likely. If these figures are reasonably accurate and generalizable to the population at large, this would definitely explain why otherwise moderate Republicans like Chris Christie would pander to the antivaccine movement during the run-up to the Republican primaries in 2015. It’s why antivaccine dog whistles have become more prominent on the right than on the left. Heck, my very own state senator panders to antivaxers.

OK, I’ve taken this opportunity to indulge my pet peeve and point out yet again that it is a myth that antivaccine quackery is somehow the purview of the left. What else does this study show us? First, most Americans support a school-based vaccine requirement:

An overwhelming majority of Americans (82%) support having a school-based requirement that healthy children be vaccinated for measles, mumps and rubella. Older adults, ages 65 and older, are especially strong in their support for requiring the MMR vaccine.

Seniors, ages 65 and older, support a school-based requirement for the MMR vaccine by a margin of 90% to 8% who say that parents should be able to decide this. Smaller majorities of younger age groups support a school requirement for the MMR vaccine.

That’s not to say that there isn’t somewhat concerning information in this poll. Take a look at these graphs:

PS_2017.02.02_vaccines_0-04

As you can see, the overwhelming majority of adults support school vaccine mandates, but there are disturbing differences in the level of support based on age and whether or not the adults have young children. For example, only 8% of adults 65 and 14% of adults aged 50-64 and older say that parents should be able to decide not to vaccinate their children even if that may create health risks for others, 21% of adults under 50 say this. Even worse, 22% of parents of children age 0-4 years say this, compared to only 15% of parents with no children under 18.

Not surprisingly, adults who have tried alternative medicine are considerably more likely to believe that parents should be able to decide not to vaccinate their children even if that may create health risks:

PS_2017.02.02_vaccines_0-07

Surprisingly, though, the absolute numbers are much smaller than I would have expected, with 13% of adults who have never used alternative medicine anbd 12% of adults who take over-the-counter medication right away when sick answering this way compared to 26% of those who have ever used alternative medicine rather than conventional medicine and 33% of those who never take over-the-counter medication when sick, respectively.

There’s also an unsurprising result in the survey. While 88% of respondents agreed that the benefits of the MMR vaccine outweigh the risks, which is good, there are definite disparities in this belief based on science knowledge. Basically, those with a high knowledge of science accept that the benefits of the MMR outweigh any risks, while those with low science knowledge are far less likely to accept that the benefits of the MMR outweigh the risks:

PS_2017.02.02_vaccines_0-09

On the other hand, contrary to the commonly held stereotype that it is affluent (usually liberal) white people who distrust vaccines the most, the higher the income, the more the trust in the MMR vaccine, with the lowest percentage of people believing that the benefits of the MMR outweigh the risks belonging to the group making less than $30,000 a year. Similarly, in the graph above that looked at how people with young children view the MMR vaccine, you’ll see that significantly fewer African-Americans and Hispanics reported that the benefits of the MMR outweigh the risks.

As the Pew Research survey report puts it:

Reports that affluent communities have lower vaccination rates lead some to speculate that people with higher incomes hold more concerns about the safety of the MMR vaccine. The Pew Research Center survey finds, however, that people with higher family incomes tend to rate the risk of side effects from the MMR vaccine as low. Those with higher family incomes are especially strong in their support for a requirement that all children be required to be vaccinated against MMR in order to attend public schools.

I think I might be able to reconcile these two disparate observations, although I admit that my explanation is speculative, albeit speculative based on my 12+ years of observations. It might well be that affluent parents have a greater tendency to accept the benefits of vaccines and support school vaccine mandates. It may well also be that more education correlates with greater support for the MMR> However, there appears to be a subset of these parents who, highly educated and full of the Dunning-Kruger effect, tend to cluster together into communities that self-reinforce antivaccine views. In other words, there is another factor that, when added to high education and high income, promotes antivaccine views. More importantly, for purposes of promoting antivaccine views and persuading others that vaccines are dangerous, these highly educated, largely white, affluent people are much more talented at using social media and their connections to promote antivaccine pseudoscience than, say lower income people and minorities.

Whether my speculations are on the money or way off, there was another finding that was simultaneously reassuring and concerning:

Public perceptions of medical scientists and their research are broadly positive. Some 55% of Americans perceive strong consensus among medical scientists that the measles, mumps and rubella vaccine is safe for healthy children. Nearly half of Americans (47%) say that medical scientists understand very well the risks and benefits of the MMR vaccine, 43% say medical scientists understand this fairly well and just one-in-ten (10%) say medical scientists do not understand this at all or not too well.

In fact, medical scientists understand the risks and benefits of the MMR vaccine very well. Still, it is reassuring that only 10% of adults seriously doubt this. This is also reassuring:

Fully 84% of Americans say they have a great deal (24%) or a fair amount (60%) of confidence in medical scientists to act in the public’s best interests. About eight-in-ten or more report at least a fair amount of confidence in medical scientists to act in the public interest across a range of subgroups including gender, age, parents, race and ethnicity, education, political party and ideology and religion.

It would be a bit nitpicky to hope that more Americans would have a great deal of confidence in medical scientists than a “fair amount,” but I’ll take what I can get. Overall, this survey suggests that, by and large, Americans trust medical scientists on the MMR, that the vast majority of Americans believe that the MMR’s benefits outweigh the risks, and support school vaccine mandates.
There’s even another little tidbit in this survey that finds that 74% of adults say conflicting news reports about disease prevention are understandable because “new research is constantly improving our understanding,” while only 23% of adults say such research “cannot really be trusted because so many studies conflict with each other.” That’s better than I would have expected.

The bottom line is that antivaxers are a minority. The are cranks. They are, for the most part, marginalized, which is as it should be. Unfortunately, they have an outsized influence on reasonable parents who just don’t have the scientific background to recognize their misinformation and pseudoscience for what they are, contributing to vaccine hesitancy. Also, Americans, by and large, trust medical science and MMR vaccine safety. After two weeks in the age of Trump, which followed 12 years of dealing with antivaccine pseudoscience, I find this oddly refreshing. It is a good way to end the week.