This article is written for those who have friends or family that have been mislead by anti-vaccine propaganda but aren’t yet fully indoctrinated. Those who dogmatically oppose vaccines will not change their minds so spend your time elsewhere. There are, however, many fence-sitters that can be reached through intermittent, careful, patient, and kind interactions. Changing beliefs of any kind requires time. Do not expect to change minds in a single interaction. This is a process of seed-planting and nurturing. Keeping this in mind will help you avoid frustration. In this post I focus on the moral arguments vaccine skeptics make. In later posts I will cover empirical arguments. (Skip to Part 3 if you’re just interested in the arguments)
Part 1: A Quick Note on Nomenclature
There are four general attitudes towards vaccines: pro-vaccine, vaccine hesitant, vaccine skeptic, and anti-vaccine. I used to lump together the latter three but I think they are important to distinguish. Those who are anti-vaccine are ideologically opposed to vaccines. It is not a matter of empirical evidence but ideology. There is little point in engaging with this group unless you are simply interested in anti-vaccine ethnography.
Vaccine skeptics have been exposed to a lot of misinformation and have general distrust of Big Pharma, modern medicine, experts, and government institutions. They often engage in what is called “logic chopping.” That is, they have a working knowledge of critical thinking concepts but instead of using them to pursue truth, they use them to “destroy” opposing evidence. They are the lawyers of the internet comments sections. They demand impossible standards of evidence for any position but their own and confuse possibility with probability. Only engage with people this group if you have lots of free time and are committed to long-term engagement.
The vaccine hesitant should be your target. They aren’t deeply committed but have been exposed to anti-vaccine propaganda and misinformation. They haven’t done much digging on their own. They are probably a parent who has been exposed to misinformation in a community or an online parenting group.
In dialogue, I now avoid calling anyone anti-vaxx since it immediately sets them in opposition to me. Their immediate instinct is to defend themselves. This is not a good dialectical opening. We want a dialectic that frames our interaction as a collective search for truth.
Part 2: Find Common Ground
The first thing I teach my students about argument is to begin in agreement. Find common premises with the person with whom you disagree. Conclusions follow from premises and leading someone to your conclusion requires they first accept the basic premises. You can’t drive them to conclusion-town if they never get on the bus! This may surprise you but finding common ground is actually fairly easy in this case. Vaccine skeptics and hesitants only differ in the conclusions they draw from the main moral premises.
In this post I will explain the illicit inferences they make and show that from the basic moral premises we all accept, everyone–including vaccine skeptics–ought to be pro-vaccine. All aboard!
Part 3: The Principle of Autonomy and Nonmaleficence
The standard moral argument against vaccines begins like this:
I’m not against vaccines, I just think that everyone should have the right to choose what goes into their body.
Here, they are appealing to what is known as the principle of autonomy. I–not someone else–gets to choose what medical treatments my children and I receive. The principle of autonomy is a perfectly legitimate moral principle. It is the foundation of contemporary medical ethics and informed consent laws. However, in the case of the vaccine skeptic, this argument is usually disingenuous. It’s merely a way to conceal their mistaken empirical belief that vaccines are a harm to health. This is easily revealed with the following response:
Ok, I agree. You can choose whether you vaccinate your children. Are you going to do it?
And here is where they reveal their actual beliefs about vaccines.
So, why do they not vaccinate their children? Because they believe that vaccines cause harm. And they will provide you with information on the vaccine courts and side effects that have occurred with vaccines: “I’m not going to subject my child or myself to harm.”
Here they move to another fundamental moral principle. The duty of nonmaleficence prohibits actions that inflict harm and risk of harm. It is expressed in the maxim primum non nocere or “first, do no harm.” The vaccine skeptic will point to the insert from a vaccine or information on the CDC website (See! Even the CDC admits it!!!) showing you that there is a risk of harm from vaccines. And just like the vaccine court settlements, they are right. There is a real risk of harm.
But this line of reasoning relies on a confused understanding of the duty of nonmaleficence. Let me illustrate with two example. Suppose I bang my head and incur a large wound. I go to the doctor to get some stitches. Seeking to numb the area, the doctor is about to inject me a local anesthetic. As the doctor jabs me, I yell, “you’re violating the duty of nonmaleficence–you’re harming me!!!”
Clearly, this is a mistaken understanding of the duty of nonmaleficence. It’s not harm–tout court–that is prohibited but net harm that is greater than reasonable alternatives. If the doctor does not jab me, I will feel greater pain from the needle sewing stitches, and my wound will likely get infected if left open. We must think in terms of relative trade offs. Failing to jab me would be negligent since I’d be subjected to greater net harm relative to the standard of care.
Let’s consider one more example. The duty of nonmaleficence doesn’t just apply to harm but to risk of harm. Suppose I have a medical condition that puts me at a 70% risk of dying in the next month if left untreated. There’s a medication I can take to address the condition but it causes significant liver damage in 15% of patients. After the doctor explains to me the risk the medication carries I yell, “by giving this to me you are violating the duty of nonmaleficence!!! You are subjecting me to risk of harm!!!”
Again, this is a misunderstanding of the duty of nonmaleficence. What matters is relative risk not absolute risk. Given the choice between a 15% chance of liver damage and a 70% chance of dying, nonmaleficence is not violated by subjecting the patient to the 15% risk.
With these examples in place we can easily identify the problem with how the vaccine skeptic uses the duty of nonmaleficence. It’s not enough to point to risk. You must evaluate relative risk. The relative risks associated with vaccines are much lower than the risks associated with the diseases they prevent.
Again, we can employ the same dialectical strategy we employed at the beginning: Begin in agreement. Ask your interlocutor what the risks (likelihood and magnitude) of a particular vaccine are. They will send you some links. Accept whatever credible sources they offer. Then ask them what the risk of the disease are. This information is readily available on the CDC website, wikipedia, or any number of credible websites. With full information (risk of vaccinating vs risk of not vaccinating) the rational choice should be obvious. The relative risks of not vaccinating are greater than those of vaccinating. The duty of nonmaleficence tells us that we should vaccinate our children. Failing to do so violates nonmaleficence since we are knowingly subjecting children to greater preventable relative risk.
At this point the vaccine skeptic (but perhaps not the vaccine hesitant) will deny the empirical premises. They will say that you can’t trust the information. The CDC is covering up or not counting all the risks. This is a different issue which I’ll address in another post. But, so long as you can agree on the statistics, the moral premises actually support the vaccinating rather than not vaccinating.
There’s one last moral argument the vaccine skeptic can make here (which I’ll address in the next post). They can concede to being irrational and return to the principle of autonomy. That is, they can say, I don’t care what the science says or I don’t trust anything in the scientific literature, I’m going to choose the higher risk choice. It’s my right. Once again, this response requires a misunderstanding of basic moral premises that we all accept–vaccine skeptics included. I’ll leave that for the next post.
Opponents to vaccines will often make moral arguments that rely on the principle of autonomy and the duty of nonmaleficence. However, they misunderstand these principles. One way to draw this out is to begin in agreement. Accept the moral principles (as just about everyone does anyway) but show that they lead to a different conclusion. This is the most powerful way to engage with someone; i.e., show that by their own lights they should adopt a different view.
What you will find is that the moral arguments are usually just a smoke screen for false empirical beliefs about vaccines. That’s fine. We’re not going to change minds in a single conversation. We’re here to plant seeds and nurture. In subsequent posts, I’ll address how to respond to the empirical arguments by beginning in agreement.