Vaccine refusal as a symptom of individualist parenting culture

Transcriber: Eunice Tan Reviewer: Tanya Cushman So I gave birth to my second child about a year after 9/11, when our fear of terrorism was the highest we had ever known.

It was the first year of the so-called "war on terror," and we had a brand-new Department of Homeland Security. At one particularly panicked moment,

we were all advised to go out and buy duct tape and plastic sheeting so we could seal our doors and windows in case of a bioterrorist attack. We were told to be prepared at all times,

that the air could become poisonous and that infectious diseases could be weaponized against unsuspecting communities.

The last stores of smallpox in a handful of labs around the world seemed an obvious choice. And so first responders,

which included my husband, Dave, and my friends in my Health Policy Fellowship, were asked to be vaccinated

against a disease that was eradicated in 1969. At the same time, as a mother of a newborn and a three-year-old, I was online, reading advice from other mothers:

how to find childcare, how to make breastfeeding easier, how to get your baby to sleep.

But among all the usual motherly advice, there was an unusual trend: mothers suggesting that you don't actually need vaccines against childhood illnesses and that, in fact, they might be dangerous.

So here I was, on the one hand, watching as mothers said you don't really need vaccines against known diseases, like whooping cough and measles,

and on the other hand, while healthcare providers I knew were debating getting vaccinated against a hypothetical risk.

And while I was trying to make sense of all of this, Dave would come home from the children's hospital where he worked and tell me stories about children with vaccine-preventable diseases:

babies on ventilators with whooping cough, a child paralyzed with tetanus. These contradictions seemed hard to understand.

And so as a sociologist, I set out to study this the way I would any other project, to try to understand why parents were rejecting vaccines

despite evidence that they've helped to keep generations of children healthy. I set out to interview parents, which turned out to be mostly mothers

because women make most of the healthcare decisions for their families. We talked about their fear of vaccines and the harms they were afraid they could cause.

They told me about their distrust of pharmaceutical companies and the government agencies that are supposed to monitor them. Some told me infection actually is normal and natural

and that the body can heal itself so long as it's healthy. But throughout, mothers told me how hard they're working: making baby food from scratch,

dyeing Halloween cookies with crushed semolina and beets to avoid artificial colorings, growing organic food in their backyards.

These mothers were working hard to do what they thought was best for their own children, and that included avoiding vaccines.

Now, it's easy to dismiss these mothers as ignorant, selfish, or delusional, to say that they just don't understand how serious vaccine-preventable diseases can be,

or to label them as anti-science. And if you're like most Americans, you already have firsthand experience with these conversations

on Facebook, at particularly contentious Thanksgiving dinners, (Laughter)

hopefully not, but maybe on your children's playgrounds. And while I disagree with their claims and have fully immunized my own three children,

what I've come to understand in the course of my research is that parents who reject some or all vaccines are actually responding in ways

that are pretty logical to the pressures placed on parents today, and that this movement is actually a symptom of a much larger problem. So let me explain.

Think about what we tell women from the moment they're pregnant - sometimes even before conception - and throughout their children's lives

about what it means to be a good parent. From birth plans to food to school choice to college admissions, we mothers are told

that our children's successes or failures rest on our hard work. We can see this culture of individualist parenting in the way we blame mothers for anything that goes wrong with their children.

Your child's sick, your child gets bad grades, your child's poorly behaved?

It's probably your fault. And when you fail to make perfect choices, someone will let you know

because others are watching. (Laughter) When I was pregnant,

I was stopped, not once, but twice, while ordering coffee by other women who wanted to make sure I was ordering decaf. (Laughter)

And we know that for low-income mothers and mothers of color, the pressures are much, much worse, resulting not just in dumb questions

but sometimes in reports to social service or law enforcement agencies. But we don't just scrutinize mothers. We also don't believe that there's enough resources

for everyone's children to succeed: not enough room at the good school, not enough spots on the traveling soccer team,

not enough jobs after college. And so we pit parents against each other, competing for what seems like a small pool of resources,

trying to do what's best for their own children. In this light, the recent college admissions scandal starts to make sense.

They paid a high price to try to ensure their kids could be successful in a world where there doesn't seem to be enough to go around. But our problem is not just individualist parenting;

it's also what we tell each other about what it means to be healthy. Public health agencies, physicians, websites, blogs, magazines,

apps, your watch, friends, even family will tell you that health is a personal project.

It is your job to stay healthy. Count your calories, count your steps, eat less fat, eat less sugar,

drink more water. I don't remember what we're supposed to do with carbs, but something with carbs. (Laughter)

When we hear that someone we know is sick, we almost always wonder what they did or failed to do that led to that illness. And the truth is that most of illness is beyond individual control.

Some of it's genetic, much of it's environmental, and some of it's just bad luck.

But we don't act that way. We act like if you make all the right decisions, you can stay healthy.

If we put these two trends together - one that says it's your personal choices as a parent that determine if your child is successful

and one that says it's your personal choices that determine health or illness - it's really not that surprising

that an increasing number of parents see vaccines as a personal choice and one that's part of a broader strategy for their own families. But our personal choices affect others in significant ways.

Vaccines work best when everyone uses them. Yes, there is almost always personal benefit for the person who gets it,

but their real power lies in lowering risk of infection for everyone in the community. So take something like rubella,

the most easily forgotten component of the measles, mumps, rubella - MMR vaccine.

Rubella is a fairly mild disease for virtually everyone who gets it. But it was a leading cause of birth defects when pregnant women would become infected.

And so we immunize young children against rubella not because they most personally benefit, but because they're most likely to be around pregnant women

who most need protection. Our best public health interventions and social programs have come from the belief

that we can do more together than we can alone. Free public education, sanitation, national parks, even fire stations are all examples of things we collectively fund and support

but might not equally use and benefit from. And the same is true of vaccines, but we seem to have lost sight of that.

Instead, pharmaceutical companies tell us that our daughter could be one less woman with cervical cancer if we use their vaccine,

and public health agencies tell us we can show our love for our own children if we immunize them.

Throughout, vaccines get referred to as a consumer product and not a public good. And so, like all consumer products then,

it's up to you to decide if you need it, if you want it, or if you'll benefit from it. More generally,

we tell young families today that they should support their own children to the limits of their resources

but that they don't need to worry about other people's children - just their own. None of this is making our communities better.

This is what I was talking about when I said that vaccine refusal is a symptom of a much larger problem. Because this culture of individualism is a crisis,

and it affects most of the social problems we face as a society. Because if your child has access to clean drinking water, do you really care if the kids in Flint, Michigan, don't?

And if your child has access to lots of nutritious food, does it really matter if the kids in the next town live in a food desert? And if your child can get access to a charter school,

do you really care if your neighborhood school is failing and can't pay its teachers a fair wage? We could solve all these problems

if parents just stood up and said, "Not my child, and not your child either." (Applause)

We have to start dismantling this culture of individualist parenting. The first step is let's stop blaming each other for everything that goes wrong, (Applause)

particularly because so many things are beyond individual control. So when we meet a mother of a child with disabilities, let's not ask or even wonder what she did wrong during pregnancy.

(Applause) Just like when we meet somebody with cancer or heart disease, it doesn't really matter how healthy their lifestyle is or isn't.

Let's just support them anyway. (Applause) And let's find ways to help mothers who are struggling.

Let's just give them a friendly smile sometimes or a word of encouragement, and yes,

even when their children are screaming at the grocery store or on an airplane. (Applause)

Most importantly, let's find ways to show that we're invested in each other's children

because - this is important - if we start acting like we're invested in other families, other families become invested in ours.

(Applause) Now, this won't solve the problem of declining vaccine rates overnight, but it will start to move us

towards a culture of public investment in each other's health. And then we could build communities where everyone's children and parents can thrive.

Thank you. (Applause)