Anti-vax dog whistles
You can't teach an old dog new tricks
First, a plug: I have a short commentary about Theranos and the problem of “black box medicine” in the The BMJ this week. Please give it a read.
The anti-vaccine movement has been quite influential in reducing uptake of COVID vaccines, especially in the United States. This is a sad outcome that has cost many people their lives. But while the anti-vaccine movement is powerful, it is not very original. Those of us who followed it before the pandemic could easily see the same narrative patterns being repeated.
Fundamentally, most serious anti-vaxxers are motivated by conspiracy theories. They read fringe publications or follow specific personalities that promote paranoid falsehoods. This is what separates the merely hesitant or those with specific qualms about narrow vaccine issues from actual anti-vaxxers. None of this is a reflection of intelligence. Smart, credentialed people can be anti-vax just like anyone else; assuming this can’t be so is a common mistake. We all have a conspiratorial side.
Another aspect of the anti-vax movement that trips people up is that most anti-vaxxers claim not to be anti-vax. It’s easy to understand why. We should give everyone the benefit of the doubt, but we shouldn’t doubt that the anti-vax movement is real. I have no problem with contrarian takes. I talk to medical skeptics as both vocation and hobby. But this movement is insidious. It is an organized network of advocates, publications, and commercial interests—yet somehow its proponents claim that it can’t possibly exist.
There are many anti-vax “dog whistles” out there, meaning issues that are supposedly at the core of the movement but are actually secondary to the conspiratorial concerns. You’ll hear about “medical freedom” and “vaccine safety,” for instance. And who could argue with those important issues? But you can never convince an anti-vaxxer that inoculations are safe or needed.
I wrote a short piece about this subject for The BMJ before the pandemic, excerpted below. I don’t believe much has changed except the death toll.
I think it’s important not to wade too deeply into the “medical choice” rhetoric dominating the Texas anti-vax movement. The vaccine “debate” is the art of not talking about what we are talking about. In political science, there is the concept of the “dog whistle.” When Donald Trump says he wants to “build a wall,” for example, some interpret it as a call for a brick and mortar border wall. Others hear an anti-immigrant rallying cry or ignoble racist demagoguery. Vaccines are similarly dog whistle medicine. The appealing call for choosing one’s own medical care is political subterfuge, a way to open the door to conspiratorial digressions.
When doctors respond to “medical choice” activists by emphasising the need for herd immunity, they miss the political point. Even though the vast majority of Americans vaccinate, a small oppositional movement has successfully influenced this intervention’s emotional geography. Every conversation, even between those who support vaccination, is now an anti-vaccine conversation. Doesn’t every doctor’s chest tighten when they hear the word “vaccine” in a media report? Imagine how confused and apprehensive the average patient must feel.
Given the 20th anniversary of the Wakefield paper and the influence anti-vaxxers are wielding in politics, we hear a lot about Wakefield’s turn of the century anti-vaccine boom. But if Andrew Wakefield did not exist, he would need to be invented. The anti-vaccine movement is as old as vaccines themselves. America’s founding fathers even waded into the vaccine controversy. In ebbs and flows, hesitation has sadly always tarnished these miraculous little jabs.
More than a historical flashpoint, the anti-vaccine movement is part of an entrenched alternative medicine worldview. In trying to make sense of this wide ranging sociopolitical belief system, I have argued that alternative medicine can be viewed as a reactionary movement, driven by distrust and revulsion of the modern medical world. No matter how much I learn about it, however, the soul of alternative medicine feels ethereal, with seemingly impossible to reconcile political, cultural, and psychological characteristics. It is challenging to move forward when this movement feels deliberately erratic in the issues and arguments it advocates.
In the face of such a cultural movement, where does that leave the medical establishment? Do we continue knocking down anti-vaccine talking points? Some now argue that we need a Newtonian response to anti-vaxxers—an equal and opposite political movement. While a logical dissection of anti-vax misinformation is tedious, a passionate political campaign, complete with slogans and spokespeople, is compelling. If some people are “anti-vaxxers,” we can create even more ardent “vaxxers”—no longer simply people who vaccinate.
I don’t know if I’m ready for cynical tribalism, where a public health victory is defined not by informed action but by accruing the most fanatics. Nor do I look forward to more alt-med political proxy wars, like the one that just took place in Texas. But if doctors are in this for the long haul, we should decide whether to combat the tool or the ideology, for each strategy has its risks. For those of us raised on a diet of journal club and medical conference debates, combatting the “tool” of fallacious argument seems like the dignified, scientific approach. But the belly rumbles at the prospect of a self-righteous cultural and political fight.
Thanks for reading!