‘Storytelling’ key to vaccination debate

However, he says that while anti-vaccine activists have used narrative to great effect, it is not right for vaccine advocates simply to abandon reason in favour of rhetoric.

“It’s important is that you use stories to illustrate data rather than as a substitute for data. So it’s fair to say that the numbers of children with a particular disease is on the rise, and then to say ‘here are the figure and here is the story’. That contrasts with people saying ‘numbers are not what matters, that the stories are all that matters’,” Mnookin told Vaccines Today from his New York office.

It’s a dilemma that Mnookin – a contributing editor at Vanity Fair – faced when relaying heart-wrenching tales in his new book.

“There are a couple of stories in the book about parents who either had children who got sick from vaccine-preventable diseases because they were deliberately unvaccinated or children who died because they were too young to have been vaccinated. I struggled with that question of whether it is fair for me to use these emotional gripping personal stories to make my point at the same time as I was criticising [others for using] that kind of tactic.”

Panic Virus

In the new book, Mnookin traces the fallout from the Andrew Wakefield affair in 1998 which he says led to “one of the most devastating health scares ever”.

He says the myth that vaccines were the cause of development disorders has been perpetuated by celebrities and the media even though the weight of evidence overwhelmingly shows no connection between vaccination and autism.

The cost of this scare, according to Mnookin, is a surge in preventable diseases and the diversion of millions of dollars in autism research funding.

The media comes in for considerable criticism in the book (something of a pet theme for Mnookin given his award-winning book on the New York Times). The major criticism is of the tendency to devote air time and column inches to “both sides” of a story about which there is little debate.

While the book devotes much time to the consequences of the MMR-autism scare, Mnookin uses the story to launch a deeper investigation into our modern mistrust of authorities, our tools for diving truth, and the limits of our rationality.

“We as a species tend not to think nearly as rationally as we would imagine ourselves doing. More often, we have an emotional reaction and try to create a narrative around it,” he told Vaccines Today.

Full transcript of conversation between Seth Mnookin and Gary Finnegan

Vaccines Today: You’ve stressed that for much of the debate on vaccination and safety, anti-vaccine advocates have had narrative on their side: their first-hand experiences lend themselves well to storytelling. And you’ve said that dry scientific facts are nowhere near as effective.

Seth Mnookin: Yes, data alone is not always so persuasive.

Vaccines Today: But to what extent should vaccine advocates try to beat vaccine skeptics at their own game by appealing to the ‘gut’ rather than reason? Is there a limit to how far this can be taken or is everything fair game in doing what they might believe to be ‘right’?

Seth Mnookin: This is something I thought about a lot when writing the book. The question is what responsibility do advocates of science have to rely on science versus figuring out a language that’s easier for the public to understand.

There are a couple of stories in the book about parents who either had children who got sick from vaccine-preventable diseases because they were deliberately unvaccinated or children who died because they were too young to have been vaccinated. I struggled with that question of whether it is fair for me to use these emotional gripping personal stories to make my point at the same time as I was criticising that kind of tactic.

For me, what’s important is that you use stories to illustrate data rather than as a substitute for data. So it’s fair to say that the numbers of children with a particular disease is on the rise, and then to say “here are the figure and here is the story”. That contrast with people saying “numbers are not what matters, that the stories are all that matters”.

Vaccines Today: There was a time when it was thought that providing more information to the public about vaccines would solve the problem of low vaccination rates. However, it now seems like rates of may be highest among well educated people. Do you have a view on this?

Seth Mnookin: There are a number of different forces at play here. It’s true that vaccine scepticism has grown among educated, environmentally conscious, politically conscious, involved parents. These are the exact people the term ‘helicopter parenting’ was coined for. We as a species tend not to think nearly as rationally as we would imagine ourselves doing. More often, we have an emotional reaction and try to create a narrative around it. I think vaccines affect us in a much more personal way than any of these other issues – like global warming or recycling and so on. Anyone who has been through it – vaccinating their kids – knows it’s an emotional experience.

Vaccines Today: To what extent does reduced trust in vaccines represent a wider decline in faith in science, professions and authorities?

Seth Mnookin: I think it’s indicative of a number of larger trends. It’s something you can probably trace back half a century. There was a really dramatic decrease in faith in institutions of power and traditional authority structures. If you look at the Kennedy administration, the term ‘intellectual’ was not a slur; expertise was to be valued. That is something that has really shifted.

Vaccines Today: So experts are not as respected as they once were?

Seth Mnookin: A lot has changed in recent decades. The internet has played a role in that it has unmoored information from its context. It’s also much harder to distinguish reliable information from unreliable information. If you do an internet search on autism and vaccines you’ll get a fair number of hits saying “yes there’s absolutely a connection”. It’s hard to know how to parse all of that out.

Vaccines Today: So this is not something specific to vaccination but rather the vaccination issue is a symptom of wider trends?

Seth Mnookin: Yes, one reason I called my book The Panic Virus and didn’t include the word vaccines or autism was because this story is really illustrative of a much larger trend. It tells us something about society in general.

Vaccines Today: Does the vaccines debate differ from one country to the next?

Seth Mnookin: One really huge difference is that in the US you have mandatory vaccination laws of the type that are not present in many places in Western Europe for reasons that date back to the 19^th century. That changes the whole tenor of the debate. In the US you have discussion about state control, about state experimentation.

Obviously, the MMR vaccine issue was more pronounced in UK, but I think the underlying emotion is pretty similar. It’s reminiscent of some different anxieties about modernity.

There are contrasts between vaccination debates in develop and developing countries. In Nigeria, for example, vaccines were seen by some as a tool of the western world.

Vaccines Today: You’re based in the US where The Tea Party movement has become popular. Does this reflect a further decline in trust in government?

Seth Mnookin: The Tea Party movement is something with a fair amount of support but I think that it probably doesn’t have quite the support you would think based on press reports. That’s true of the anti-vaccine movement too. Vaccination rates remain quite high given how the debate is sometimes presented.

Vaccines Today: Would you lay the blame at the door of the media for presenting a distorted view; for acting as though there are two equal sides to every story?

Seth Mnookin: The media have gone for the outlandish controversial attention-grabbing elements of the story. There are differences between, say, the Tea Party story and the vaccination story. One problem is the institutional inability to understand scientific issues involved in vaccines; when you’re on deadline and you’ve got an editor putting pressure on, the easy thing to do is just get a quote from both sides.

Vaccines Today: You’ve just published your new book ‘The Panic Virus: A True Story of Medicine, Science and Fear’. Since the publication of your book, have you been on the receiving end of much abuse?

Seth Mnookin: Yes. I’ve had some angry messages ranging from suggestions that I am naïve or ill-informed, to blanket allegations of being a vaccine industry shill.

Vaccines Today: Vaccines are an area where all sides seem to think the media has failed or is biased against them. How should health and science journalists balance the professional need for scepticism with the pressure to perform public health education ‘duties’?

Seth Mnookin: Reporters should be sceptical. This is not a case where we need to say that we are just accepting what governments or drug companies tell us. There are years and years of evidence that can be cited.

There is a difference between when a drug company comes out with a new product and says “we’ve done one safety study and were’ ready to go” – there are good reasons to be scepitcal about that that and point out that there are other cases of when something that seemed safe turned out not to be. There certainly have been times in the past when very sceptical coverage of vaccines was wholly appropriate. But we’re now in a place where we have data and information.

Vaccines Today: How would you improve communication about vaccines?

Seth Mnookin: I try not to make prescriptions about what should or shouldn’t be done just because it’s not my place as a journalist. Certainly one real problem that we have right now is that there is not effective communication between points of contact for vaccination or health officials and parents. One of the big issues is people are told to take something on faith. We need to figure out ways to communicate more directly and openly with parents.