Should Vaccination Critics Be Silenced?
(submission to Vaccine and Journal of Public Health Policy)
If vaccine critics seem to threaten public confidence in vaccination, one option is to censor them. However, given the decline in public trust in authorities, in health and elsewhere, a more viable long-term strategy is to accept open debate and build the capacity of citizens to make informed decisions.
Keywords: vaccination; critics; free speech; censorship
Ever since the earliest days of vaccination, there have been disputes about its effectiveness and safety. Today, although medical authorities almost universally endorse vaccination, opposition continues (Hobson-West, 2007). From the point of view of vaccination supporters, the question arises: what should be done about vaccine critics?
Proponents fear that if members of the public take vaccine critics too seriously, this may undermine confidence in vaccination and lead to a decline in vaccination rates and an increase in infectious disease. How to counter critics, though, is not clear, given that there are no studies systematically comparing different strategies.
One approach is simply to ignore critics, hoping that they will not have a significant impact. Another is to respectfully address concerns raised by parents and others on a case-by-case basis, depending on their level of opposition to vaccination, countering vaccine criticisms with relevant information (Danchin and Nolan, 2014; Leask et al., 2014). Then there is the option of trying to discredit and censor public vaccine critics, an approach used systematically in Australia for some years (Martin, 2015).
It may seem obvious that silencing critics is beneficial for maintaining high levels of vaccination. However, setting aside the ethics of censorship, there are several pragmatic reasons to question this strategy.
An initial problem is the lack of evidence that organized vaccine-critical groups are significant drivers of public attitudes towards vaccination. Although it seems plausible that efforts by these groups will induce more parents to decline vaccination, a different dynamic may be involved. It is possible that organized opposition is a reflection, rather than a major cause, of parental concerns that may be triggered by other reasons, for example awareness of apparent adverse reactions to vaccines or arrogant attitudes by doctors (Blume, 2006). There is some evidence for this view: a survey of members of the Australian Vaccination-skeptics Network showed that most had developed concerns about vaccination before becoming involved (Wilson, 2013).
Another problem is that trying to discredit vaccine critics can seem heavy-handed and trigger greater support for them in what is called the Streisand effect or censorship backfire (Jansen and Martin, 2015). The targets of censorship are likely to feel disgruntled, and suppression of their views provides ammunition for their claims that a cover-up is involved. When critics are attacked or silenced, some observers may conclude there is something being hidden.
Underlying the drive to censor criticism of vaccination can be a fear that members of the public cannot be relied upon to make sensible judgments based on the evidence and arguments. Instead, they must be protected from dangerous ideas and repeatedly told to trust authorities.
However, reliance on authority is a precarious basis for maintaining policy goals given evidence—though complex and contested—for a decline in respect for authorities over the past several decades in health (Shore, 2007) and other arenas (Gauchat, 2012; Inglehart, 1999). When education levels were lower and dominant institutions seldom questioned, it could be sufficient to assert authority and most people would follow. However, many authorities have been discredited in the public eye, for example politicians for lying about war-making, companies for lying about product hazards, and churches for covering up paedophilia among clergy. Although scientists and doctors remain among the more trusted groups in society, they are increasingly questioned too, with various scandals having tarnished their reputations.
In addition, the greater availability of information means far more people are educating themselves and challenging experts. This is not simply an Internet phenomenon. In the early years of the AIDS crisis in the US, activists studied research and organized to challenge officials over HIV drug policy (Epstein, 1996). Similarly, the women’s health movement challenged patriarchal orientations in the medical profession (Boston Women’s Health Book Collective, 1971). The questioning of dominant views has spread to a wide range of issues, including for example the health effects of genetically modified organisms and electromagnetic radiation.
Therefore, it is only to be expected that there will be increasing questioning of vaccination policies, especially when they are presented as a one-size-fits-all application brooking no dissent. In this context, attempts to suppress criticisms appear to be pushing against a social trend towards greater independent thinking.
Rather than continuing to rely on authority, a different approach is to encourage open discussion and to help parents and citizens to develop a more nuanced understanding of vaccination. If the evidence for vaccination is overwhelming, there should be little risk in assisting more people to understand it. The strategy behind this approach is to democratize expert knowledge about vaccines, so that uptake depends less on the authority of credentialed experts and more on the informed investigations of well-read members of the public.
Possible consequences of this approach are highlighting shortcomings in the vaccination paradigm, for example the possibility that adverse effects are more common than normally acknowledged, and considering the possibility that childhood vaccination schedules could be modified according to individual risk factors. By being open to weaknesses in the standard recommendations and making changes in the light of concerns raised, the more important recommendations may be protected in the longer term. This would be in accord with the general argument for free speech that it enables weak ideas to be challenged and a stronger case to be formulated (Barendt, 2005).
However, such openness to constructive debate will remain elusive so long as vaccine critics are stigmatized and marginalized. While the vaccination debate remains highly polarized, it is difficult for either side to make what seem to be concessions and almost impossible for there to be an open and honest engagement with those on the other side. If this remains the case, it is easy to predict that critics will persist despite (or perhaps because of) attempts to silence them, and people’s increasing expectation for educating themselves rather than automatically deferring to authorities will continue to confound vaccination proponents.
Barendt, Eric. Freedom of Speech. 2nd ed. Oxford: Oxford University Press, 2005.
Blume, Stuart. “Anti-Vaccination Movements and their Interpretations.” Social Science and Medicine 62, no. 3 (2006): 628–642.
Boston Women’s Health Book Collective. Our Bodies, Ourselves. Boston: New England Free Press, 1971.
Danchin, Margie and Terry Nolan. “A Positive Approach to Parents with Concerns about Vaccination for the Family Physician.” Australian Family Physician 43, no. 10 (2014): 690–694.
Durrheim, D. N., and A. L. Jones. “Public Health and the Necessary Limits of Academic Freedom?” Vaccine 34 (2016): 2467–2468.
Epstein, Steven. Impure Science: AIDS, Activism, and the Politics of Knowledge. Berkeley, CA: University of California Press, 1996.
Freeman, Phyllis. “Commentary on Vaccines.” Public Health Reports 112 (January/February 1997): 21.
Gauchat, Gordon. “Politicization of Science in the Public Sphere: A Study of Public Trust in the United States, 1974 to 2010.” American Sociological Review 77, no. 2 (2012): 167–187.
Hobson-West, Pru. “‘Trusting Blindly Can Be the Biggest Risk of All’: Organised Resistance to Childhood Vaccination in the UK.” Sociology of Health & Illness 29 (2007): 198–215.
Inglehart, Ronald. “Postmodernization Erodes Respect for Authority, but Increases Support for Democracy.” In Critical Citizens: Global Support for Democratic Government, edited by Pippa Norris, 236-256. Oxford: Oxford University Press, 1999.
Jansen, Sue Curry and Brian Martin. “The Streisand Effect and Censorship Backfire.” International Journal of Communication 9 (2015): 656–671.
Landau-Halpern, Beth. “The Costs and Consequences of Teaching and Analyzing Alternative Medicine.” Social Epistemology Review and Reply Collective 5, no. 9 (2016): 42–45.
Leask, Julie, Paul Kinnersley, Cath Jackson, Francine Cheate, Helen Bedford, and Greg Rowles. “Communicating with Parents about Vaccination: A Framework for Health Professionals.” BMC Pediatrics 12, no. 154 (2012). http://www.biomedcentral.com/1471-2431/12/154.
Martin, Brian. “Censorship and Free Speech in Scientific Controversies.” Science and Public Policy 42, no. 3 (2015): 377–386.
Martin, Brian. “An Orchestrated Attack on a PhD Thesis.” 1 February 2016a, http://comments.bmartin.cc/2016/02/01/an-orchestrated-attack-on-a-phd-thesis/.
Martin, Brian. “Public Health and Academic Freedom.” Social Epistemology Review and Reply Collective 5, no. 6 (2016b): 44–49.
Shore, David A., ed. The Trust Crisis in Healthcare: Causes, Consequences, and Cures. Oxford: Oxford University Press, 2007.
Wilson, Trevor. A Profile of the Australian Vaccination Network 2012. Bangalow, NSW: Australian Vaccination Network, 2013.
Wilyman, Judy. “A Critical Analysis of the Australian Government’s Rationale for its Vaccination Policy.” PhD thesis, University of Wollongong, 2015. http://ro.uow.edu.au/theses/4541/.
 See http://www.bmartin.cc/pubs/controversy.html#vaccination for my publications and commentary on the vaccination controversy.
 Wilyman, “A Critical Analysis of the Australian Government’s Rationale for its Vaccination Policy.”
 Martin, “An Orchestrated Attack on a PhD Thesis.”
 Durrheim and Jones, “Public Health and the Necessary Limits of Academic Freedom.”
 Martin, “Public Health and Academic Freedom.”
 Landau-Halpern, “The Costs and Consequences of Teaching and Analyzing Alternative Medicine.”
 Freeeman, “Commentary on Vaccines.”