In 2016, in the midst of a devastating measles outbreak, California decided to repeal the philosophical exemption to vaccines, which allows parents to opt out of required childhood vaccines because of “personal beliefs.”
Soon after that law went into effect, the number of exemptions for medical reasons suddenly soared. Some have argued that the philosophical exemption ban may have in some ways made matters worse, since school administrators are powerless against medical exemptions, but may have had more room to question philosophical exemptions.
Responding to complex social issues such as the anti-vaccine movement requires a full view of human behavior and a solid understanding of what it really takes to change minds. We need to let go of the idea that we can just strong-arm people into complying. Policymakers must understand that changing attitudes and behaviors requires a comprehensive approach that doesn’t rely exclusively on punitive measures alone.
These kinds of laws should be familiar to anyone who has followed the evolution of the response to anti-vaxxers in the US and elsewhere.
Last year, France, Italy, and Germany all announced new laws and fines that in each case made more vaccines mandatory and raised the stakes of not complying. In India, Kerala state instituted a new vaccine mandate for the measles-mumps-rubella (MMR) vaccine after growing resistance led to serious declines in vaccination rates and constituted a major threat to India’s progress toward eliminating measles. Such policy responses to anti-vaccine sentiment are very common and often the first line of defense.
When faced with a viewpoint or behavior that seems completely irrational, it’s often very tempting to essentially “bully” people with facts, overwhelming them with all the reasons why their viewpoint is factually wrong. But recent research has found that not only does this approach often fail to change people’s minds and behaviors, it may even backfire. This is the basis for the “backfire effect,” a phenomenon in which people become more entrenched in their views after being bombarded with evidence against it.
A recent experiment from researchers at Dartmouth illustrates the principle well. Subjects were given fake newspaper articles that seemingly confirmed several very common misconceptions from recent history, such as that there were weapons of mass destruction in Iraq. When they were then given a corrective article indicating that weapons were never found, liberals who opposed the war accepted the new article and rejected the old, whereas conservatives who supported the war did the opposite. In fact, those who did not change their view reported being even more convinced that there were weapons after being exposed to the correct information.
Another recent study showed what goes on in the brain when someone experiences the “backfire effect.” Participants were surveyed about their opinions on particular political issues and then were placed in an fMRI machine to measure brain activity. They were then presented with a large quantity of information that disproved their stated opinions. In a follow-up survey several weeks later, researchers found stronger inclination toward original views in the majority of participants. More importantly for this study, however, is what they found about brain activity during these informational challenges. Regions of the brain associated with strong emotion were heavily activated while parts of the brain associated with cognitive reasoning and comprehension were suppressed. In essence, the parts of the brain needed to absorb the new information were shut down by the parts of the brain associated with strong emotion.
As we can see, when people are faced with challenges to strongly-held beliefs, they may become emotional and dig their heels in. This can be a response to a barrage of new information that challenges what they believe, or a response to new laws that challenge the behavioral outcomes of strongly-held beliefs. Either way, we can see how punitive policies to address strongly-held beliefs might be limited, even if they are necessary.
The answer here is not to get rid of laws and regulations in these types of situations—they are often necessary and helpful. But they need to be part of a more comprehensive strategy to change behaviors. One promising example from the vaccine world comes from Washington State, where lawmakers implemented a law similar to the one in California, but included a clause that required counseling for any parent seeking a medical exemption for their children. Adding this detail to the law led to a statewide decrease in any form of vaccine exemption, as opposed to the rise in medical exemptions we saw in California.
Additionally, public health officials and policymakers could do more in certain cases to prevent the spread of behaviors that are harmful to the public. Once again in the case of vaccines, a recent paper suggests that it is in fact possible to detect emerging “hotspots” of anti-vaccine attitudes. In these cases, early intervention with evidence-based messaging and other forms of support can help prevent the spread of harmful attitudes and beliefs that eventually lead to bad public health outcomes.
Even when new laws are passed, lawmakers must take great care about how they communicate about them, especially if the law touches on “hot-button” issues like childhood vaccines or gun control. For example, recent research has suggested that presenting people with views they disagreed with on paper made them discount the intellect of the person presenting the views much more than when there was a video explanation provided instead. This is just one of many ways in which the medium and the precise content of a potentially controversial message can change the way it is received.
When faced with difficult viewpoints and behaviors of constituents, policymakers must think very carefully about how to respond. Often laws and regulations are needed, but what gets put in place with those regulations also needs to be carefully considered before new laws are implemented, not as an afterthought.