Donald Trump's fear-stoking and hysterical takedowns of established facts fuels a dangerous movement that has brought back diseases scientists long ago vanquished. Will defiant ignorance kill us?
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As of last Friday, April 26, 2019, the Centers for Disease Control and Prevention is reporting 704 measles cases across 22 states. It’s the greatest number of cases reported in the U.S. since 1994, and since the disease was eradicated in the country in 2000. And we’re not even halfway through 2019.
A handful of large outbreaks—one in Washington and two in New York City that began in late 2018—are responsible for the growing case count of the highly contagious disease, according to the CDC. The outbreaks were caused through importation: An unvaccinated person travels to a country where measles is widely transmitted, contracts the disease, then returns to the U.S., and exposes an under-vaccinated community to it. Large-scale outbreaks can be avoided by populations that achieve “community immunity” or “herd immunity.” If a sufficiently high percentage of the population is immune to a contagious disease, it provides a level of protection for individuals who are not immune or cannot be vaccinated, such as cancer patients or newborns. For measles, about 95 percent of a community must be immune to stop its spread.
Dr. Matthew F. Daley, Senior Investigator at the Institute for Health Research at Kaiser Permanente Colorado, says the reason for the outbreaks and pockets of under-vaccination is simple: “They’re there because parents are delaying or refusing vaccines.”
The longer these outbreaks continue, the CDC warns, the greater the chance measles will again get a sustained foothold in the U.S.
Despite the extensive scientific research supporting vaccines and their success in preventing diseases such as smallpox, polio, whooping cough, and influenza, people are choosing not to vaccinate. The reason why does not have a single, perfect explanation, but physicians, psychologists, and cognitive scientists point to misinformation and the societal trends that have defined American socio-political life in recent years. Increasingly, it seems decisions—from families at the doctor’s office to the White House—are made based on fears and anxieties, distrust of traditional authorities, and a fractured sense of what information is true and false. The measles outbreaks are evidence of our current misinformation age.
One of the most notable ways information processing becomes distorted is through motivated reasoning. Dan Kahan, a psychologist at Yale, explains it as “the unconscious tendency of individuals to fit their processing of information to conclusions that suit some end or goal.” People are quicker to recognize and believe information that confirms what they already know and will dismiss facts that refute their truth. Additionally, it often means that maintaining an identity as a member of a group alters a person’s understanding of reality. For example, some sects of New York’s ultra-Orthodox Jews, who live in insular communities, are the epicenter of some of the worst measles spread in the U.S. and maintain vaccine views that contradict scientific evidence. Pamphlets warning that there is no greater threat to public health than vaccines, saying they cause autism and contain cells from aborted human fetuses, circulate among these communities. Though most prominent Orthodox rabbis urge their communities to be immunized, the sensational and shocking misinformation plays on the fears of parents in the group.
Motivational reasoning is emotionally driven, perhaps to avoid cognitive dissonance, but a person’s decision-making, in general, is rooted in a need for self-preservation. And for anti-vaxxers, choosing to delay or refuse vaccines is, in fact, rooted in concern for a child’s safety.
“Parents are making decisions based on what they think is best for their children,” Dr. Daley says. He explains how even though information about vaccines passed between friends at a soccer game or on social media might not have any scientific basis, if it’s scary and coming from a trusted source, the misinformation stokes the fear and concern around vaccine safety. And scary, negative information is almost always more memorable than positive information.
“There are cognitive reasons why we are wired to pay more attention to threatening information,” says Shana Gadarian, assistant professor of political science at the University of Syracuse Maxwell School. It can help us reduce harm and avoid threats. “So negative, threatening information becomes more valuable, and that’s what people pay attention to. But that doesn’t mean that it doesn’t have downstream consequences.”
For parents debating vaccine safety, the perceived threats of the adverse effects of vaccination, though extremely rare, outweigh disease prevention. The downstream consequence: measles outbreaks.
The concept of stoking negative emotions to prompt decision-making is not unique to anti-vaxxers or fringe conspiracy theorists. “Politicians [and leaders] have an incentive to make you scared because when you’re scared, you’re paying attention, and you’re looking for solutions,” Gadarian says. “They can dictate what you should be scared of and offer the solution to the threat that’s causing you to feel anxiety.”
One of Trump’s core campaign promises of building a wall along the American-Mexican border relied upon stoking fear of immigrants, labeling them as drug dealers, criminals, and rapists. Despite severe backlash for his racist comments, a Pew Research Center survey conducted just before Election Day in 2016 found about 79 percent of Trump supporters who cast ballots or planned to vote said illegal immigration was a “very big” problem in the U.S. and were in favor of building a wall. As the 2018 midterm elections approached, Trump reprised the anti-immigrant message in an effort to swing conservative votes. He challenged birthright citizenship and threatened an executive order to reverse it, demonized Central American migrants, and stoked fear of a “crisis” at the border, all the while maintaining it was the result of Democratic policy. The misinformation dominated the news and social media. It was successful in clinching some races for conservative candidates, but not all, especially for candidates attempting to win races in moderate states.
Though Trump is a largely unpopular president, the “follow the leader” effect still allows him huge influence over his supporters. If a source is trusted (a president, a religious or philosophical leader), people tend to believe or act on the information and sideline their own knowledge, write Elizabeth J. Marsh and Brenda W. Yang in Misinformation and Mass Audiences. But this idea regarding belief and source is more complicated than it first appears, they explain. That’s because misattribution and repetition also play key roles in determining how people retrieve memories and evaluate truth. Instead of evaluating the quality of the source of fact, people tend to forget the source entirely yet are still influenced by the information that the source presented. Additionally, the number of sources providing the same information can make it appear more truthful. Psychologists call this “the illusory truth effect.” Simply, it’s the finding that the more often misinformation is repeated, it’s more likely to be believed. Trump has repeatedly called the Mueller investigation a “witch hunt” and “hoax,” despite having no judicial qualifications. On Twitter alone, he has used those terms as well as “no collusion” a total of 625 times and counting when referring to the probe. As each tweet circulates the web, eventually making its way into cable news debates and magazine think pieces, his message of the “rigged witch hunt” grows more familiar. For some Republicans whose motivated reasoning has already established their bias of support for the president, each tweet from @realdonaldtrump makes the idea of a hoax all the more reasonable, and the lie grows closer to truth.
As the misinformation continues to be emotionally charged, misattributed, and repeated within our identifying groups, confirmation bias leads our memory to build a consistent narrative before an accurate one. Anti-vaxxers tend to live in like-minded communities, around other families that don’t vaccinate for similar philosophical or religious regions. It’s used as a defense of the decision, Dr. Daley says. “It significantly increases the risk of an outbreak and it also gives them the impression that what they are doing is the social norm when, in fact, it is not. The social norm is to vaccinate.”
Concluding why a person believes misinformation, whether it concern vaccines or the moon landing or how many people attended an inauguration, is complicated. Each individual human mind has built in inconsistencies and there is not one simple trick in convincing a person to believe false information.
Vaccines, Dr. Daley describes, are a victim of their own success. Because of vaccines, most people today have not seen or heard of someone contracting illnesses like polio or rubella. There’s nothing sensational about a baby who receives regularly scheduled vaccinations, grows up healthy, who as an adult travels to another country and never contracts a vaccine-preventable disease. The vast majority of Americans vaccinate. Yet, the number of parents who refuses to immunize has gradually increased, according to data from the National Immunization Survey. CDC officials expect reported measles cases to continue to rise this year as a result of under-vaccination.
Yet, Dr. Daley is optimistic. Research conducted by Dr. Jason Glanz and others at Kaiser Permanente Colorado found that social media can be used to intervene and address vaccine hesitancy and increase acceptance. Big tech has made some efforts to crack down on extremist spaces, though still has a long way to go to making their platforms more safe overall. Dr. Daley advocates for meeting people where they are at, respectful communication, and acknowledging fears to reestablishing trust in credible sources. If we’re willing to take these steps, misinformation and the results of its spread—outbreaks, a warming planet, gun violence—are preventable and containable issues.