A good friend of mine, a conscious parenting mum of three who also happens to be an Oxford-educated lawyer (information I feel I have to share for fear that the perception is that all us ‘crunchy mums’ are residing in a cave in the Himalayas chanting into the mountains and doing yoga with goats–not that there’s anything wrong with that), alerted me to a paper that came to her as a reference in her work. The paper explains how people’s decisions can be influenced by, amongst other things, psychological and emotional factors; widely known as behavioural economics. She had no idea that it was going to be anything to do with vaccines.
The paper was written by lawyer Marysia Laskowski (1) for the Texas Law Review in an examination of how to use behavioural law and economics to nudge vaccine-hesitant parents towards vaccinating their children.
This document was easily found on the internet, however I’m not sure if the expectation was that parents like me would gain access to it, revealing the shocking truth of these theories for all to see. Every time information like what I am about to share is revealed, it offers more and more integrity and plausibility to the reasons why people like me spend their lives trying to expose truths despite heavy opposition, but whom most people view as tin foil hat-wearing conspiracy theorists for even daring to suggest that taking our healthcare into our own hands might be a good idea.
The title of Marysia Laskowski’s paper is Nudging Towards Vaccination: A Behavioral Law and Economics Approach to Childhood Immunization Policy, where her theory offers the concept that we can use psychology to influence—or, in her words, ‘manipulate’, ‘nudge’ and ‘shove’—parents into making the decision to follow the vaccination schedule, and, after studying this twenty-eight page paper extensively, I have extracted the parts I think will be of most interest.
Laskowski writes about ‘Bounded Rationality’ and ‘Heuristics’ (terms brought to our attention by Herbert Simon, Daniel Kahneman and Amos Tversky. The latter two using the theories in their Nobel Prize-winning paper on Prospect Theory, 1979 (2)). To put it in simple terms, her argument is that parents use these to make irrational decisions i.e. to not vaccinate. As a parent living in the realms of counter-mainstreamism, where we are vilified for decisions that do not conform with the conventional way of thinking—decisions we have made following years of research—my own take on this is that parents use these bounded rationalities to make irrational decisions to vaccinate. The difference is the underlying assumption that she makes: She describes one heuristic as follows: “One of the most significant heuristics implicated in the childhood vaccination decision is the availability heuristic, ‘a pervasive mental shortcut whereby the perceived likelihood of any given event is tied to the ease with which its occurrence can be brought to mind.’ It is easy to see how this comes into play in the context of childhood immunisations. Parents underestimate the necessity of vaccinating their children because the diseases that vaccines protect against have no specific meaning to them. It is difficult for parents to weigh the cost of not vaccinating because they cannot picture what it would be like for their child to become ill or die of a disease with which they have no experience. Thus, the great paradox about vaccines: The more effective they are, the less necessary they seem.”
I would argue that parents decide to vaccinate as a result of the very existence of the vaccine schedule and its associated campaigns and well-funded propaganda. Another way of looking at this is to ask: why are we not afraid of being exposed to those things against which there is no vaccine or which is not on the schedule. Let’s take polio for a moment. Polio does not exist in UK but it’s on the schedule. People are thought of as crazy if they choose not to vaccinate against polio, most probably because of stories offered to them by parents or grandparents that remain lodged in their minds. What about Hep A? No one thinks it unreasonable to not vaccinate against Hep A as its not on the schedule, but it is much more prevalent worldwide than polio. This theory illustrates that we are scared of what we are told to be scared of.
“People often believe something because other people believe it,” Laskowski continues, “or they pretend to believe it to avoid reputational harm. These cascades create a significant danger of widespread misperceptions about risks.” If this is the case, doesn’t it confirm that the majority of the population stick to the vaccine schedule due to scare-mongering, and because they see other people doing it?
The following paragraph particularly struck a chord: “These cascades become particularly dangerous in insular groups where feedback is poor. They help to explain why anti-vaccine parents tend to be found in clusters. Individuals tend to surround themselves with like-minded people, resulting in increased polarization and promoting an ‘us versus them’ mentality in these pockets of society. Interestingly, the residents of these clusters often tend to be well off and well educated.”
This lady certainly enjoys stereotyping, which although not okay in any other aspect of human life, is apparently completely okay when it’s to do with parents who don’t vaccinate. For starters, the opposite applies to me. I find myself the social pariah of my community. Yes, I have found like-minded people locally, but only because I have searched them out. In the same way that people with illnesses benefit from being friends with people who have similar illnesses, to make them feel they are not alone. Or how people often live in communities where there are many people of their own religion, people living more holistic lifestyles search out others who are doing the same. Not because we then create an anti-vaccine, pro-breastfeeding, baby-wearing crusade against all who oppose us, but because it offers us a kind of sanctuary where we can openly talk about things that other people (believe it or not) often fall out with us over. My like-minded friends and I are also not particularly well-off. It is true that the demographic for people who use homeopathy and other holistic therapies is a more middle-class one, which is down to nothing more than the fact that 1) People of lesser means cannot afford treatments that are not available on the National Health Service (which is exactly why NHS England should not be attempting to remove them). 2) Following on to her next point, using the fact that these parents tend to be educated isn’t exactly an appropriate argument to convince people that that’s a bad thing. Won’t well-educated people be in a better place to assess studies, journals, documents and books written on the subject of vaccinations? Won’t educated people have the confidence to ask questions and make well-informed decisions?
The author speaks about how, if people’s feelings towards something are positive, they will judge the risks as low and the benefits as high; however, if their feelings towards something are negative, they tend to judge the risks as high and the benefits as low.
She uses this to explain that people are starting to fear autism more than measles (which she describes as a vaccine preventable disease), mainly because it is more prevalent and more familiar. What she doesn’t do is question why it has become more prevalent and familiar. It seems that the availability heuristic is preventing her from acknowledging the risks from the other side.
The paper uses behavioural economics once more to explain that the way things are framed changes perception. Therefore, by wording things in a certain way, one can increase vaccination rates. According to Laskowski, if risks are presented as frequencies i.e. 10 out of every 100 people, it is perceived by people as being worse than if you say 10%. Therefore, her recommendation is that when talking about the risks of vaccines they should be presented as frequencies but when talking about the adverse reactions that package inserts and countless studies have shown vaccines to have, they should be presented as percentages, in order to mislead people. In fact, this is how she worded it: “There are a variety of ways to frame information to manipulate the recipient’s assessment of risk.”
Now, I can understand that that the subject of vaccines is a minefield, one in which there are studies supporting and opposing both sides (if you look closely enough, you’ll find conflicts of interest and bias on most studies supporting the safety and/or efficacy of vaccines), and I judge no one based on their decisions, I only ask that people do their research before making them. But what I cannot accept, and what I feel gives my decisions total justification and spurs me to write articles like this one, is how the myriad adverse side-effects and reported injuries of vaccines are maliciously and ruthlessly hidden from us in order to protect the agenda of those spearheading this strategy, something that this paper has openly shown. Misuse of power gained from knowing that the masses have no control over it, and economical gain over the health of a population—this paper an indication of how much that is actually done—should be cause for any parent to assess their decisions when it comes to the healthcare of their children.
“Childhood immunization appears to be an area that might benefit from regulation that confronts these biases and nudges—or even shoves—parents towards making smarter decisions for their children’s health.”
The ‘nudge’ theory is nothing new when it comes to governments and the pharmaceutical industry. Professor Richard Thaler won a Nobel Prize (2017) for his perspective on it, of which an article in the Financial Times (3) summarised his findings as follows: “People are lazy. Most of us don’t want to think too hard about our beliefs, or challenges to them. His solution was to make sure those challenges were simply too intriguing to ignore.” With that in mind, it bears the question: if parents were offered complete transparency when it comes to vaccines, if they were given a fact-sheet as standard before committing to a vaccination, outlining exactly what adverse effects the vaccine in question was known to have, along with any other relevant information, would they still choose to vaccinate?
Laskowski believes that the most obvious approach to the problem of decreasing childhood immunisation rates would be to eliminate personal-belief exemptions, but concluded that the elimination of parental choice will “agitate the already adversarial relationship between immunisation advocates and anti-vaccination parents and will undoubtedly increase distrust towards the relationship between pharmaceutical companies and the government”.
The problem with these sorts of strategies being developed is that there is absolutely no appreciation of the gargantuan fact that eliminating parental choice is in fact a human-rights issue and another abhorrent misuse of power; they simply acknowledged that it will hinder the process.
Another recommendation in the paper was for doctors to change the way they word things when it comes to vaccines, in order to steer parents in the direction of vaccinating: e.g., “Well, we have to do some shots today.”, as opposed to “What would you like to do about shots today?”
Laskowski proposes imposing costs for extra consultations should parents want to talk about vaccines before administering them (USA), offering a ‘nuisance barrier’ that would deter parents from less affluent backgrounds. Laskowski says of this, “Admittedly, this approach—one that requires a physician consultation appointment in order to forgo vaccination—starts to move into ‘shove’ territory.”
Laskowski concludes by saying that “an approach that nudges—and even shoves—individuals while also maintaining autonomy of choice is more appealing from a policy standpoint, is more likely to earn support from state legislatures, and is less vulnerable to future constitutional challenges.”
The safety of vaccines remains a separate issue, but my grievance lies with a system—a system whose very existence was put in place to care for us—that would use advice like that set out in this paper, to take away our freedom to make informed choices. It seems these ‘systems’ are looking for more and more ways to mislead us to the point where informed choice simply cannot be made because we are not being given the information in a transparent way that would enable us to make these decisions with confidence.
It is simply impossible to trust a system that uses behavioural economics as a strategy when it comes to the healthcare of the population.