Protecting the Science Communication Environment: The Case of Childhood Vaccines

"Displaying a level of inattention to evidence-based methods of science communication as aggressive as its dedication to evidence-based practices of medicine, the institutions best situated to counteract influences subversive of public confidence in vaccines have been rendered into passive observers of their corrosive effects."

This paper focuses on the risk that inattention to the "vaccine science communication environment" poses to public health. Its goals are to: (i) illustrate how the quality of the science communicating environment - the sum total of practices and cues that orient individuals in relation to what is known by science - affects the public's recognition of decision-relevant science; and (ii) underscore the critical need for self-conscious management of the quality of the science communication environment to protect public health. The author Dan Kahan's argument is that "[t]here just isn't any mechanism anywhere in the public health system for protecting the science communication environment in which the public comes to know and make use of the scientific knowledge that public health depends on. This is itself a deficit in our public health system that puts public well-being at risk."

The paper starts with the case of the widespread rejection of the requirement of universal immunisation of adolescents against the human papilloma virus (HPV) in the United States (US). Almost immediately after Federal Drug Administration (FDA) approval, the Centers for Disease Control and Prevention (CDC) proposed that the shot (a series of them) be administered to girls at 11 to 12 years of age, before the likely onset of sexual activity (CDC, 2006). However, unlike every immunisation previously identified as appropriate for universal administration, the HPV vaccine provoked a firestorm of controversy. Research confirms that cultural cognition - the tendency of members of close-knit groups to conform their assessments of evidence on disputed risks to the positions that predominate among their peers - played a role in the conflict over the HPV vaccine. Individuals of opposing cultural outlooks, such research suggests, were predisposed to form opposing stances. Those who prize traditional gender roles and the autonomy of individuals to make their decisions about how to provide for the well-being of themselves and their families tended to perceive that the risks of the vaccine outweighed its benefits. In contrast, individuals subscribing to more egalitarian norms and favouring collective attention to individual needs concluded exactly the opposite. That outcome, the paper argues, was "attributable in full to reckless private and governmental decisionmaking that aggravated influences known to detract from the capacity of diverse citizens to recognize valid decision-relevant science."

Kahan explains why Merck's decision to push for fast-track FDA approval to orchestrate a high-profile, highly politicised legislative campaign triggered the polarising forms of information-processing that are the signature of cultural cognition. "The dominant message of media coverage of the Merck legislative campaign was that the risks and benefits of the vaccine were matters of dispute between culturally identifiable groups - indeed, the very ones divided over climate change, nuclear power, gun control, and other highly polarizing issues (Gollust et al., 2015). These are the conditions, the study of cultural cognition implies, that entangle competing positions on risk with antagonistic cultural meanings, turning them, effectively, into badges of membership in competing groups. It's under those conditions that individuals use their reason not to align their actions with the best available evidence but instead to form beliefs that reliable express their commitment to identity-defining affinity groups....Merck's marketing strategy contaminated the science communication environment in which ordinary American parents learned about the HPV vaccine....What it disabled them from doing effectively was discerning what experts believed about the vaccine's risks and benefits: rather than judging whether the HPV vaccine was safe and effective based on the views of trusted experts, they used the conformity of their pediatricians' views with the ones identified with their cultural groups to decide whether they could trust them (Helmy, 2008)."

Next, the paper examines the situation for other childhood vaccines (e.g., mumps, measles, rubella, polio), finding that the same laissez-faire stance has in that context left the science communication environment unprotected from influences that threaten to corrode confidence in this public health policy. Kahan suggests that the science communication environment for childhood vaccines is "rife with contaminants that could easily generate a state of confusion and conflict at least as virulent as the one that derailed the proposal for the universal administration of the HPV vaccine." As he had indicated at the outset of the paper, the efforts of science miscommunicators is only one source of contamination. "Another even more serious source originates in the active efforts of (largely) well-intentioned nonprofessional risk communicators, whose evidence-free, uncoordinated efforts to combat a contrived 'public crisis of confidence' is creating the risk of exactly that sort crisis. A precondition of the dominant role of these evidence-uninformed, decentralized, unprofessional, and unmanaged risk communicators, moreover, the absence of evidence-informed, centrally managed communication by professional risk communicators associated with one or another institution within the public health establishment." Members of the public are being bombarded with information on the vaccine-risk perceptions of other members of the public, Kahan observes. Advanced in media reports, blogs, advocacy reports, and occasionally by individual health professionals, this information paints a picture of that vaccine rates are collapsing because of a groundswell of generalised public anxiety over vaccines. (In reality, the proportion of children receiving no vaccinations in the US has persisted at or below 1%.) This message, so-called "feral vaccine-risk communication", precipitated by the infectious anti-science attitudes of one or another cultural group is, according to Kahan, not only false but dangerous to public health in that it threatens to disrupt cues and processes that members of the public rely on to recognise and give proper effect to science.

Among other risks, "feral risk communications create the risk of entangling childhood vaccinations in the sorts of antagonistic cultural meanings that generate persistent states of cultural polarization over policy-relevant science. It is natural to try to foster the impression that those who subscribe to norms different from one's one are putting general welfare at risk. In the case of the feral risk communication that surrounds vaccines, this impulse informs the 'anti-science' trope, which links supposed 'growing resistance' to vaccination and 'falling vaccine rates' to groups who hold positions on other contested risk issues like climate change and evolution....[T]here is zero correlation between perceptions of vaccine risks and positions on these other issues, or between perceptions of vaccine risks and membership in any of the cultural groups divided on them. But if people are constantly bombarded with the message that these issues are linked, they could easily form a contrary impression - one that likewise becomes self-fulfilling as individuals adopt forms of information processing geared to promoting what they take to be identity-defining and -protective beliefs on vaccine risks. This is, as we have explained, exactly how the HPV vaccine became entangled in antagonistic meanings."

The paper concludes, more optimistically, with a set of recommendations that parallel and amplify ones made by the US Department of Health and Human Services’ National Vaccine Advisory Council (2015) to systematise evidence-based science communication relating to childhood vaccination. The NVAC Report noted, for example, the consistent survey findings indicating that "a majority of parents have favorable beliefs or perceptions regarding recommended childhood vaccines." It also noted that positive attitudes such as these are themselves a science communication asset that must be protected. "Parents", the Report states, "are more likely to be confident in immunization recommendations if they perceive that others in their social group have high levels of vaccine acceptance" (NVAC, 2015). By the same token, the Report noted the serious risk that that misleading statements in the media/news stories can undermine the role that norms plays in promoting vaccination behaviour by creating the exaggerated impression that many parents are "delaying or declining recommended vaccinations", thereby "lower[ing] parental confidence in vaccines". The Report issued a call on the public health establishment to systematise its own role in generating, collecting, and acting on empirical evidence relating to science communication and public opinion formation. The Report issued calls for the development of a repository of evidence-based practices and toolkits, along with concrete practices to effectuate the use of these materials by public health agencies, health-care providers, and other stakeholders, including parent and community groups committed to promoting vaccine confidence.

Other recommendations from Kahan:

• There should be a set of institutional processes for protecting the science communication environment from, for instance, vaccine introduction in a way that posed a high risk of provoking the dynamics of cultural cognition.
• A more systematic, focused role by a government agency charged with monitoring such dynamics and correcting them could be expected to transform the media from an unwitting conduit of this form of science communication environment pollution into a reliable filter for screening it out.
• Professional associations must organise themselves to contribute to the public good of protecting the vaccine science communication environment. (On the flip side: "The passive role that the medical profession played - failing to act on concerns that many of its most prominent members voiced - contributed to the HPV disaster.")
• Protecting the vaccine science communication environment depends on the use of good empirical research. (On the flip side, researchers who treat national survey variances as if they reflected genuinely meaningful differences of opinion risk stirring up self-reinforcing, culturally recriminatory discourses of "blame".)

Kahan concludes: "Creating a culture in which all of these [and the foundations that support their work] recognize their obligation to contribute to the public good of protecting the science communication environment is the first step to creating such a capacity [to protect the science communication environment]. The most important step after that is to use science's methods of conjecture and refutation to build the stock of knowledge necessary to determine which institutions are best situated to do what to assure that society's interest in the quality of its science communication environment gets the effective attention that it merits."