Policy debates about scientific topics have an infuriating habit of seeming to disregard the obvious facts. That’s what makes recent developments in the debate about childhood vaccination so tantalizing. With record-high cases of measles around the world generating media attention, the Senate holding hearings about the dangers of the anti-vaccination movement, and Facebook adopting new rules for vaccine-related content, it seems we might be on the verge of squelching vaccine misinformation. Perhaps clear, concise, and evidence-based answers to questions about vaccine safety along with some myth busting can sort everything out after all.
But getting the facts right is not the most important part of the debate. When confronted with evidence that the vaccines are safe and effective, opponents find a way to raise doubts. They present their own facts, demand unrealistic evidentiary standards—rock-solid proof of 100 percent safety—and question the integrity of those producing the evidence. Before we can make a meaningful dent in the number of people who refuse to vaccinate their children, we have to accept that “because science” won’t convince anyone. At the end of the day, it’s values—beliefs about what matters, what’s important, what should guide our lives and societies—that are most important. Values are not ignored in the vaccine debate; claims about parents’ rights and harms to children are common. But too often, the pro-vaccination discourse fails to recognize or thoroughly explore the role they play in the discussion, and in parents’ minds. Whether it’s doctors talking to patients, experts writing for the public, public health messages designed to increase the vaccination rate, or ordinary citizens posting on Facebook, just arguing about the facts won’t get at what’s really driving debate.
What we see in the debate about vaccines is not unique, of course. Think climate change, for example, where debate focuses on the effects of greenhouse gases (spawning a further debate about what counts as good science). Or genetically modified organisms, where the central issue is consumers’ health. In these debates, too, it’s not enough to explain the facts and debunk the misconceptions.
Some of the better-recognized reasons for this phenomenon are rooted in human psychology. There is an enormous literature on the various cognitive biases that cause people to see and understand the world in ways that may not square with the facts. Confirmation bias—the tendency to accept facts that fit our prior beliefs—is thought to be particularly important in the vaccine debate, but other biases (aversion loss, status quo bias) may also play a role. Such biases are typically regarded with disdain and despair, but the important point is not really that people are bad at thinking. It’s that what they feel strongly about—their values—helps guide them as they navigate the world.
There are also social reasons. People can be classified according to the set of basic values that motivate them, and differences across these value sets probably drive some of the disagreement in the science debates. Some people care more than others about cleanliness and purity, for example, and research suggests that they tend to dislike vaccines more strongly. Such concerns, reflecting views about human nature and the relationship of humans to the rest of nature, might lie submerged in political claims about parents’ rights—the simpler political values motivated by the more intricate and obscure values. Because they are in part matters of upbringing and culture, basic value sets are closely connected to personal identity and group allegiance, generating another influence on cognition: Somebody seen as challenging views that define one’s “tribe” is unlikely to get a fair hearing. And finally, social and economic trends have spawned a deep distrust, on both the right and left, of expertise, privilege, and power. And with good reason: The public has legitimate interests in asking challenging, even distrusting, questions about who’s in control of the scientific enterprise.
Other, less widely discussed reasons have to do with the very nature of facts. First, as the political theorist Deborah Stone explains in her influential book Policy Paradox: The Art of Political Decision Making, “facts do not exist independent of interpretive lenses, they come clothed in words and numbers.” The point is not that every fact is a changeable social construction; it’s that most interesting phenomena can be described and explained in many contrasting ways, and the descriptions and explanations we end up with can vary according to the questions we’re asking. Whether a vaccine is better described as a well-tested tool for preventing disease or a foreign incursion into the body may hang on whether you’re comparing it to medical interventions or to causes of disease and disability. When vaccine opponents ask about the standards of evidence, they’re not just being obstructionist. What counts as “good enough” evidence is a question of interpretation, influenced by the comparisons that dominate their thinking.
Second, the facts about socially important issues are almost always contestable, and how they support moral and political judgments sometimes depends on the weight we give them—which is to say, on the values we attach to them. Which is worse: a low-likelihood but high-impact outcome like an allergic reaction, or a high-likelihood but low-impact outcome like the ouchie your kid will get from the needle? A cost-benefit analysis, that paradigm of policy rationality, might assign equal weight to these outcomes, but must everyone see it that way? And come to think of it, how “low-impact” is it that you are consciously allowing someone to hurt your child? Some parents are untroubled; others find it very difficult. (Similar questions arise in other debates. If you care about the effect of genetically modified crops on nature, which matters more: that insect resistance can lead to lower herbicide use, or that a plant’s genetic code has been “hacked”?)
The result of all this is that, although measures to slow the spread of misinformation can be helpful, “myth busting” and appeals for “science-based” policymaking usually are not. They are often just efforts to shut down one’s opponents in a way likely to be deeply threatening and infuriating to them. At best, they ignore what’s most important. While the debaters dwell on facts, what drives them apart are competing values about (for example) personal liberty, political power, human nature, science and technology, the relationships of individuals to society and of humans to the rest of nature, and the weights assigned to different kinds of harms and benefits, and even to uncertainty. Facts inform policy, but values are the basis.
To have a better debate, we need to change how we communicate with the people we’re trying to persuade. The approach we should take will likely vary depending on the relationship and the audience. A doctor-patient interaction is different from a televised debate with a vaccine skeptic, for example, and a vocal and determined vaccine denier is extremely unlikely to be won over. Before an audience of the merely vaccine-hesitant, emphasizing the scientific consensus and correcting misconceptions may yet be helpful, if it’s done just right. In all contexts, though, we should find ways to express and elicit underlying values.
There’s helpful advice in the nascent literature on how experts should talk to the public. Some of this advice can come across as vaguely disingenuous and manipulative: Experts can “nudge” people into accepting the facts by framing the conversation appropriately; cognitive biases can be turned in the scientists’ favor; establishing a personal connection with an audience is a first step in winning them over. But the chief points are to stop haranguing people, to address their interests, and to put values up front. Often, it’s helpful to think about what makes for an effective face-to-face conversation. Instead of treating people as criminals, misfits, how about listening to their concerns, practicing a little modesty, and recognizing that everyone loves their children? Narratives can play an important role, both as a way of finding out about the other person’s concerns and conveying the importance of vaccination. Putting values up front does not magically make everybody come to affectionate agreement, of course, but it is more respectful of diverse views, it helps clarify the points of disagreement, and it is usually a necessary first step toward compromise.
This work was supported by the John S. and James L. Knight Foundation and the National Science Foundation (award No. 1,827,935).