Subjective Decision-Making in Healthcare: The Case of Vaccinations

It has been suggested that a scientifically literate individual will have an interest in science, understand the world, engage in science, and think critically about scientific matters. The concern is that limitations to scientific literacy may limit individuals' ability to critically engage with complex socio-scientific issues (SSIs) such as vaccination. The purpose of this study was to gain a deeper understanding of what shapes and supports attitudes towards vaccination among a group of university-educated Australians from science and non-science backgrounds and to determine if training in science, and thus potentially greater scientific literacy, might result in better understanding and more positive attitudes towards vaccination and vaccination programmes.

A national survey of scientific literacy commissioned by the Australian Academy of Science indicated that, although most Australians had a basic grasp of key scientific facts, there were still large numbers who answered important and fairly straightforward scientific questions incorrectly (Wyatt & Stolper, 2013). Furthermore, a 2017 review of scientific literacy more globally argued that there was a particular need to improve science literacy in developing countries, where recognition and adoption of coherent policies remains sporadic and lacks cohesion.

Having discussed the meaning and importance of scientific literacy in the context of SSIs, the paper briefly summarises some of the successes and controversies that have characterised the history of mass vaccination. One might argue the eradication of previously fatal diseases by vaccination has led to complacency and even advocacy against vaccines. For example, the Australian Vaccination-Skeptics Network has lobbied strongly against a variety of vaccination-related programmes, downplayed the danger of childhood diseases such as measles and pertussis, championed the cause of alleged vaccination victims, and promoted the use of alternative medicine such as homeopathy and chiropractic.

The media plays a role in influencing public opinion. As the paper explores, one of the key problems with media reporting on vaccination and other issues is that giving equal voice to scientists (and indeed often non-scientists) on both sides makes it seem like there is a serious disagreement within the scientific community, when in fact this is often not the case. Furthermore, case histories used by some writers make better reading than statistics but fail to reflect the extremely low risk probabilities involved with a process such as vaccination. They also tend to increase the perception that risk is significantly greater than in reality.

There have been a number of studies and systematic reviews on attitudes to vaccination and what influences these, as well as the reasons related to vaccine hesitancy, particularly among parents. The paper summarises this literature.

In this context, the present study involved interviews conducted with a sample of 33 secondary and tertiary teachers, 19 of whom were women and 17 of whom listed science as their area of formal educational qualification.

The dominant theme to emerge from the interviews was one of support for national vaccination programmes regardless of academic background (science vs. non-science). The most cited reason for the widespread support was that such programmes are important for the eradication of previously common diseases like polio and smallpox. Of the 33 participants, only 2 individuals (both non-scientists) seemed ambivalent towards vaccination programmes, but even they did not express outright rejection of such programmes. One concern was that vaccines are unnecessary and have a negative effect on the immune system, particularly for "minor" diseases such as mumps and measles.

Out of the 33 participants, 10 reported hearing stories of adverse reactions to vaccines, although only one of them had personally experienced a bad reaction. When asked if this would stop them from getting vaccinated, most of the participants said they felt some level of concern, but not enough to refuse vaccination. However, the media coverage of a specific vaccination programme can impact even trained scientists' perception of the safety of vaccines, especially when seen as affecting close family and friends.

The participants were well placed to improve their awareness of vaccine-related information because they knew where to and how to access reliable information. The most common sources of information cited by the participants included general practitioners or healthcare workers. The internet and social media were reported as the next most common sources, followed by television and radio.

Rather than lack of information, other factors related to acceptance, such as the vaccine itself, the disease that the vaccine is meant to provide protection from, individual characteristics of participants, and social context, were more common in this study. For example, the severity of the disease that the vaccine claimed to provide protection from was an important factor in uptake. The politics surrounding national vaccination programmes could also have an impact on an individual's decisions about vaccination uptake. For example, individuals may be influenced by the perception that doctors, government, and pharmaceutical companies are in collusion and, thus, may not be accepting of evidence from sources that the medical profession might regard as reliable.

This relatively small qualitative study indicated that within this group of well-educated individuals, the type of educational background (science vs. non-science) did not, in general, appear to be a determinant of support for mass vaccination programmes, as both groups were largely supportive. Furthermore, despite being aware of or having experienced some side effects associated with vaccination, there was generally high confidence in vaccine safety. Although some of the participants reported reading articles portraying vaccination in a negative light, they appeared to trust the overwhelming view of the scientific community that vaccination is beneficial for individuals and the broader society. This may indicate that these participants were engaging critically with the media, thus indicating significant levels of critical scientific literacy.

In conclusion, the authors note that science education plays an important role in adequately preparing people with the appropriate information to make well-informed decisions about SSIs such as vaccination. McClune (2017) argues that to be relevant and useful, science education needs to engender a level of critical literacy that keeps pace with science in the news, and particularly in social media, where people are increasingly obtaining their news sources. Teaching critical scientific literacy can include training in the ability to read, understand, analyse, and critique media reports with a science component.