This essay, on a study of global attitudes to science and to vaccines, was my Observer column this week. (The column included also a short piece on Facebook’s launch of its digital currency Libra.) It was published on 23 June 2019, under the headline ‘A growing lack of trust in authority poses a serious danger to our health’.
Virtually every Bangladeshi and Rwandan believes that vaccines are safe. Fewer than half of Japanese or French do so. In Western Europe, one in six of those with college education reject vaccines. In Southern Africa, you’re twice as likely to do so if you attended university.
These are among the often disturbing facts that tumble out of a new study, the Wellcome Global Monitor, published last week. A survey of 140,000 people from 140 countries, it is at heart an exploration of the relationship between science, trust and attitudes to vaccination.
Trust has become a vital political issue. Many worry about the erosion of confidence both in expertise and in public institutions and about the social consequences of that erosion. One is the growing refusal to believe medical authority, especially about vaccination. From measles outbreaks in America and Europe to the spread of Ebola in central Africa, scepticism about vaccines has had a devastating impact.
The Wellcome survey suggests that the relationship between scientific and social trust and attitudes to vaccination is more complex than many imagine. One might think, for instance, that better scientific education and greater confidence in healthcare professionals would be linked to greater trust of vaccines. It isn’t. There tends to be greater scepticism about vaccines in richer, better-educated countries than in poorer states in which people have less education and are more sceptical about the benefits of science.
Western Europe shows some of the highest levels of trust in both scientists and healthcare professions: 88% have ‘high’ or ‘medium’ trust in scientists, 68% have ‘a lot’ of trust in medical professionals and 78% believe that science benefits people like them. But, with the sole exception of Eastern Europe, Western Europe also has the lowest level of trust in the world in vaccines.
Compare this with north Africa. Here, just 61% have trust in scientists, medical professionals are trusted ‘a lot’ by less than a third of the population and fewer than half think that science benefits people like them. Yet whereas only 59% of Western Europeans believe that vaccines are safe, 85% of north Africans do so.
In low-income countries, 81% of even those with low trust in scientists have confidence in vaccines. In rich countries, that figure drops to less than half.
Poor countries remain ravaged by diseases long eliminated from western nations. Globally, some 2.5 million children under five die every year from vaccine-preventable diseases. In countries such as Bangladesh and Rwanda, vaccination programmes have helped transform the lives of millions. In richer countries, medical advances, including vaccines, have been so effective that many no longer recognise their importance or the consequences of rejection.
There are, however, deeper problems than just a lack of historical memory. Trust is shaped by myriad social forces. Inequality is one.
According to the Wellcome report, the more unequal a nation, the greater the distrust of science. In both rich and poor countries, those whose lives are more precarious are more sceptical of science than those who say they are ‘living comfortably’, a trend particularly pronounced in rich nations.
There is also the question of the relationship between scientific and political trust. According to Wellcome, ‘The level of confidence people have in their national institutions – their government, judicial system and military – was a good predictor of their level of trust in science.’
Scepticism of authority is good. Too little scepticism allows those in power to maintain power. It also allows for the spread of disease when, for instance, there is an unwillingness to challenge religious authority. Indispensable to the project of creating a better, fairer society is the questioning of authority and of received wisdom.
Today, though, scepticism about authority has become an end in itself. Rather than leading to more rational views of society, it often drives people towards conspiracy theories about elites and experts and to believe in all manner of irrational claims. The anti-vax movement has exploited such scepticism to foster wild fears about vaccination.
And not just in Western nations. A study last year suggested that in the Democratic Republic of the Congo, nearly half the population thought an Ebola outbreak was being fabricated to destabilise the region or for financial gain. The result was Ebola ‘spreading under the radar’ as sceptics often evaded treatment.
Trust, or, rather, the lack of it, clearly shapes much of our political landscape. But it can also have a direct impact on physical wellbeing. From America to the Congo, distrust without reason can be matter of life and death.
I have read your essays with deep pleasure for years. I share them often. I value reason. I value the method of science. I value clarity. Because I have children, I avidly follow the science on vaccine safety and efficacy. I would encourage to carefully consider your use of the term “anti-vax”, as it is used mostly as a smear term and rarely as a careful accurate ascertained description of the attitudes of actual individuals who decline one or more vaccine products. The people I know in real life who have declined one or more vaccines are in the great majority not opposed conceptually to the process of vaccination. I know people who have declined one or more recommended vaccines due to injuries/conditions within the family, and I know some who have declined due to a careful assessment of what is known/unstudied about comparative risk.
Dr. Peter Aaby has worked in Africa for decades, planning and executing vaccine programs. In 2017 and 2018, he published two important studies https://www.ebiomedicine.com/article/S2352-3964(17)30046-4/abstract and https://www.frontiersin.org/articles/10.3389/fpubh.2018.00079/full. They report evidence that administration of the DPT vaccine — now only given in relatively poor countries — seems to be associated with higher rather than lower all-cause mortality. 5-10x higher mortality.
Conversely, in other studies, he has found that both measles infection (if survived) and the single measles vaccine to be associated with higher survival odds post-measles or measles vaccination https://sci-hub.se/10.1136/bmj.e3769. At a recent conference on scientific integrity, Dr. Aaby warned that we don’t know as much as we think we know about all the ways the process of vaccination is impacting our immune systems. https://www.youtube.com/watch?v=NPNHYAevTwg
I bring up his work to share a sense of the open questions that exist related to the safety, efficacy and advisability of various vaccines in different situations.
I think of you as a most careful parser and user of language. Forgive me if I misunderstood, but your post seem to imply that a regard for “science” goes hand in hand with acceptance of view that all vaccines on offer represent a health bargain for all individuals, but can not be the driver of critical views of vaccine ingredients, schedules, safety studies and policies. I don’t believe that’s true. It is precisely because of my now four year long study of the science terrain on which this debate is taking place that I have what I feel are legitimate questions about the the ways in which industry has influenced vaccine science, the type of studies that were and were not done to establish foundations for safety/benefit claims for various vaccines, and how much of current policy is based on science, and how much on assumptions. Interestingly one of the historic titans of vaccine development, Dr. Stanley Plotkin, gave a sworn deposition in 2018 that shed a lot of light on just where that demarcation lies. Long, but worth the read. https://www.docdroid.net/8zJh4QQ/1-11-18-matheson-plotkin.pdf
Thanks for hearing me out. It’s a riveting topic as so much is on the line in terms of health, life, ego, institutional power, reputation, and money.
Jennifer, thank for this. However, I am not sure what point you are trying to make.
Are you suggesting that many parents refuse to vaccinate for the best of reasons? That’s undoubtedly true. Few parents take any decision about their children that is not for what they imagine to be in their best interests. But that does not necessarily make those decisions right. Nor does it mean that much of the opposition and fear of vaccines is not based on myth and misinformation.
Are you suggesting that vaccines can have side effects, and sometimes awful side effects? That is undoubtedly true, and nobody would deny it. But much of what are claimed to be the side effects or consequences of vaccinations are simply fabrications. For, instance the MMR-autism link is a pernicious myth, but belief in it has led to dramatic falls in MMR vaccination, and a host of measles outbreaks.
Are you suggesting that the medical establishment or ‘the industry’ is covering up studies about the impact of vaccines? Now, I’m not the biggest fan of the pharmaceutical industry, and, certainly, it is more than capable of trying to bury adverse studies. But consider the case that you specifically raise – that of DTP. You seem to imply that Peter Aaby’s studies are the only ones that have investigated its possible adverse effects, or possible rise in mortality rates. There have, in fact, been dozens of studies. The WHO has a highly detailed public document highlighting the studies of adverse reactions.
The original concerns about DTP, as you know, go back half a century, and led to the development of DTaP, or acellular pertussis (aP), as opposed to whole-cell pertussis, vaccines. There have certainly been some studies that have indicated higher mortality with DTP, but most have not. What studies have shown, rather, is that the real danger comes from not being vaccinated.
Are you suggesting that the refusal to vaccinate is not having adverse effects? Take measles, where in certain areas vaccination rates have fallen, often because of the fabricated MMR-autism scare. All that we know about measles outbreaks in America, in Europe, in Indonesia and elsewhere, in areas of low vaccination, suggests that the fall in vaccination rates has had real adverse consequences.
Vaccines have, to my eyes been one of the great medical advances. From the eradication of smallpox to the virtual eradication of polio, to the huge reduction in deaths caused by diphtheria, yellow fever, measles and many other diseases, it has transformed global health. I’m not sure whether you are denying all this, or whether you think that the price of vaccines has not been worth the benefits, or whether you think the world would be a better place without vaccines.
One of the problems, I think, is that people, especially in the West, have forgotten what the world was like before vaccinations. And, indeed, what much of the non-Western world is still like, where poverty and lack of development means poorly-functioning healthcare system and hence often a lack of vaccination programmes. Where poor countries do have such programmes, as in Egypt, Rwanda and Bangladesh, most people support them, because they recognize the enormous benefits brought about by vaccination and the way that vaccination can transform the lives of millions.