Fear of vaccines is perhaps THE classic example of "The Perception Gap", the phenomenon I've written about here before, where we are either more afraid of a lesser risk or not afraid enough of a bigger one, based on the best available evidence, and the gap itself creates danger. The fear of vaccines is causing significant risk to the public. It is time society for society to act, and regulate the behavior of people whose perceptions of the risk of vaccines are putting other people at risk.

The psychology of this Perception Gap can be explained, but first, a few facts about the danger the fear of vaccines is creating.
• The European Center For Disease Control reports outbreaks of measles in many countries where vaccination rates have gone down: As of June - France (12,699 cases in 2011, more than in all of 2010 already, including six deaths), Spain (2,261), Italy (1,500), Germany (1,193, one death). There have already been 550 measles cases in England and Wales this year compared with 33 all of last year.
• The U.S. has had 156 cases as of mid-June, compared to a total of 56 cases per year from 2001-2008. The CDC has an emergency health advisory for measles, a disease officially declared eradicated in the United States in 2000.
• A 2008 study in Michigan found that areas with "exemption clusters" of parents who didn't vaccinate their kids were three times more likely to have outbreaks of whooping cough than where vaccination rates matched the state average. In 2010 as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County, one of the richest and most educated areas in California, had one of the lowest rates of vaccination statewide and the second highest rate of whopping cough.
• The risk is not just to people who have opted out of vaccination. Of the 156 measles victims in the U.S. as of June, nearly one in five of them had been vaccinated but the vaccine didn't work, or had weakened. Infants too young to be vaccinated are getting sick, and some of them are dying, when exposed to diseases like whooping cough in communities where ‘herd immunity' has fallen too low to keep the spread of the disease in check. Unvaccinated people cost the health care system millions of dollars, and local and state government millions more as they try to chase down each outbreak and bring it under control. A recent economic analysis found that "...vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.

In other essays (The Los Angeles Times, BigThink.com) I have laid out a more detailed case, including ideas that society might want to discuss about how to regulate the behavior of people who put the greater community at risk because they decline to vaccinate themselves or their children (make it harder to opt out of vaccinations, favor vaccination with discounts or penalties on the cost of health insurance, restrict the social/community facilities unvaccinated people can use or activities in which they can participate). Here I'd like to describe a little of the underlying psychology that helps explain why the fear of vaccines exists, and why it is so strong, and why no amount of communication or discussion or reason will get people deeply worried about vaccines to stop worrying. Which is why society has to step in and act.
• Control. Risks are scarier when we don't have a sense of control. It is entirely understandable that any parent of an autistic child wants answers, and hope, and a sense of control, over the fate they've been cruelly dealt. Powerlessness makes things feel worse.
• Risk versus Benefit. We intuitively weigh risks against benefits, so it is understandable for a parent to decline vaccinations they fear might be a greater risk to their kids than the diseases the vaccines have largely (but not entirely) eliminated.
• Imposed or Voluntary. A risk imposed on us worries us more than if we engage in it voluntarily, so it's understandable that people are troubled by state-mandated vaccination (though the individual liberty argument rings hollow against the fact that in 21 states people can opt out of having their kids vaccinated for "philosophical reasons", and in 48 states for religious reasons - without any proof that their faith actually bans vaccination).
• Trust. We fear risks from institutions we don't trust, like the pharmaceutical industry, and government, and even, for some of us, big business generally.
• Cultural Cognition. Some people feel that that society should be more fair and flexible than it is and that people should not be constrained by rigid social or economic class hierarchies. These people, known in the study of Cultural Cognition http://www.culturalcognition.net as Egalitarians, criticize the major institutions of the modern economy - big corporations (and their products) - which Egalitarians blame for contributing to unfair and restrictive class structures. (Egalitarians are commonly politically liberal, like the population in Marin County.)

Mistrust, lack of control, risks that seem to outweigh benefits, risks that are imposed and not voluntary...given these powerful instincts, the fear of vaccines is understandable, even if it flies in the face of overwhelming evidence. And while many may insist that denial of the evidence is irrational, it is also irrational for the health care community and policy makers to ignore the overwhelming evidence that risk perception is subjective, a mix of facts and how those facts feel. It's irrational for these ‘rationalists' to continue to expect that an evidence-based argument alone will change vaccine opponents' minds.

So it is time for us to act, to recognize that the risk of The Perception Gap must be managed just as much as the risk of disease, and to regulate the behavior of those who refuse to vaccinate themselves or their children. This is not a call to create more government to intrude further into our lives. There is already too much of that. This is a call for government to do what it's there for in the first place, to protect us from the actions of others when we can't protect ourselves as individuals. We do this in countless ways already; drunk driving laws, public smoking bans, even laws allowing for quarantines that curtail civil liberties during disease outbreaks. It is appropriate, and urgent, that we act to protect ourselves from those whose fear of vaccines are putting the rest of us at risk, and do the same thing we do whenever one person's behavior endangers the greater community. We make them stop.

(The concept of The Perception Gap comes from the book "How Risky Is it, Really? Why Our Fears Don't Always Match the Facts"

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