Over the last few months, those of us in the United States have been engaged in a vigorous debate about whether parents have the right to refuse to vaccinate their children. It’s a conversation that evokes passion on all sides of the issue.

I’m captivated by all of the colorful characters and riveting personalities that have surfaced, many of them make Jenny McCarthy seem dull. This debate is a powerful example of just how difficult it can be to resolve collective action challenges. It also presents us with an opportunity to share what we believe are three things you can do to improve the conditions for collective action.

Let’s start by exploring the story of Jennifer and David Simon.

jen and david simonJust to Be Safe

The Simons live in Oakland, California and have a six-month old infant girl named Livia. A few weeks ago, mom and daughter were battling a cold, and like most vigilant parents Jennifer made an appointment with her pediatrician “just to be safe.” They were seen by the doctor and after the examination the doctor reassured Jennifer it was likely a common cold.

But then, a few days after their visit, Jennifer received a call from that same pediatrician that caused alarm. Apparently, the pediatrician’s office had recently treated an unvaccinated child who had signs of the measles. Jennifer and Livia may have been exposed.

Jennifer and her husband were understandably worried. Livia, like many infants, is too young to receive the measles, mumps, and rubella vaccine (MMR). In fact, as you probably know by now, children under a year old are routinely not given the MMR vaccine, potentially placing their immune systems in the hands of those who can take the vaccine.

Therein lies the challenge.

A few days after that visit to the pediatrician’s office, Jennifer was encouraged by officials in the county to place Livia under a self-imposed quarantine for 28 days–“just to be safe.”

You can imagine the fear and the angst that have gripped the Simon household. As it turns out, the Simons are not alone. They represent thousands, if not hundreds of thousands, of families who have infants or children in the home who are simply not able to receive the MMR vaccine. As a result, they find themselves at the mercy of others, hoping those who can receive the vaccine do so–“just to be safe.”

“I think some parents see it as a personal choice, like homeschooling,” 36-year-old Jennifer Simon of Oakland, Calif., told The Washington Post. “But when you choose not to vaccinate, you’re putting other children at risk. You’re relying on others to vaccinate their kids but you’re not taking on your social responsibility to protect others. You’re putting your child above other people’s children.”¹

The measles outbreak that has gripped the nation is an example of the importance of understanding how to live in a world with complex collective action challenges. As I recently learned from my research, you can’t force parents to vaccinate a child. In many states there are religious and other kinds of exemptions that allow parents to “opt-out” of the requirement to vaccinate their children. This is not something that we can resolve by policy alone.

There is a strong and insular community of so-called “anti-vaxxers” who vehemently hold on to their belief that vaccines are dangerous and that the MMR vaccine is linked to autism. That leads me to Dr. Jack Wolfson, a controversial Arizona physician who has quickly emerged as a vocal champion for the anti-vaxxer community.

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Dr. Jack Wolfson. Source: Washingtonpost.com

Dr. Jack Wolfson. Source: Washingtonpost.com

You’re a Bad Mother

Dr. Wolfson is skeptical of vaccines and he is not afraid to express what comes across as disdain for those who want to force reluctant parents to comply with vaccination guidelines.

Despite the science that suggests the link between vaccines and autism is a myth, anti-vaxxers like Dr. Wolfson don’t seem ready to back down and they don’t appear to be moved by the argument that complying is part of the social contract.

“Don’t be mad at me for speaking the truth about vaccines,” Wolfson said in a telephone interview with The Washington Post. “Be mad at yourself, because you’re, frankly, a bad mother. You didn’t ask once about those vaccines. You didn’t ask about the chemicals in them. You didn’t ask about all the harmful things in those vaccines…. People need to learn the facts.”²

Community Immunity

The debate over vaccines touches upon so many of the issues we deal with at Symphonic Strategies. It is a great example of a collective action challenge that has been recast as “community immunity.”

Here’s how the theory of community immunity goes. The more members of the community who are immune from a disease, the less likely that disease can spread and become an epidemic. Community immunity is often referred to as “herd immunity” because it speaks to the ability of herds–notably sheep and cattle–to ward off predators by sticking together.

In this case the predator is measles and the herd behavior being promoted is compliance with the request to vaccinate children. If the individuals in a community agree to stick together, those who can get vaccinated will do so, and in the process they will offer protection for those in the community who are unable to get vaccinated. Getting vaccinated is cast as a social duty–something you do because of the benefits that accrue to others.

This is exactly the kind of situation that often is most at risk of devolving into a confusing and contentious argument that pits one group against another. You see that clearly in the stories of Dr. Wolfson and the Simon family. When collective action challenges reach a point where compromise is seen as a sign of weakness, things quickly reach an impasse.

Creating Collective Action

There are, however, things you can do to bring the conversation back from the edge of chaos.

1. Don’t ignore the emotion. It’s easy to see the emotion packed in the positions held by the myriad voices in this debate. From the Simons, to anti-vaxxers like Dr. Wolfson, to anxious public health professionals, there is a lot of pent up emotion just beneath the surface of this debate.

Don’t run from the emotion. The first thing you can do to create the conditions for a healthier and more productive conversation is to acknowledge the emotion.

Anti-vaxxers have real fears and it does no good to belittle those fears or the people who have them. Attacking anti-vaxxers and labeling them as “crazy, selfish nuts” simply reinforces their perception that they are not part of the larger community. It confirms for them that they are outsiders, and outsiders rarely advance the interests of a collective if they feel they are not a part of the collective.

On the other hand, public health professionals and others who express anger at those who fail to vaccinate also have emotions that need to be acknowledged. They do not represent “big government” and they are not “bad mothers” as Dr. Wolfson would have you believe. Their embrace of the social contract is strong and drives their sense of what is right and reasonable.

2. Facts usually don’t convince people to take action. Conversations do that.  This is often difficult for most of us to accept. We like to reason and we use facts that support our positions and to promote the actions we want to take. But, as the measles outbreak has illustrated, facts don’t always convince people to take action.

Instead, use facts to generate conversation. The key to creating the conditions for collective action is to engage all sides in conversation. Focus on engaging others in conversation first and then find ways to cultivate a shared set of facts. After all, your facts might not be their facts. It is the search for a shared set of facts that establishes yet another ingredient for collective action.

3. Break action into bite-size pieces. Start small and make it easy to act.  When someone refuses to take the actions you want them to take, don’t give up. Try asking them to take a smaller action.

One thing we’d like to see in this debate is a bigger discussion about the broader array of actions and decisions that are on table. Getting your child vaccinated is the final action. But what are all of the others smaller actions and decisions along the continuum? If someone refuses to vaccinate their child or is unable to do so for medical reasons, what can they do to address the collective concerns of the community?

We have to create a continuum of actions that allow individuals to gradually get on the ramp. If you can’t or won’t vaccinate your child, will you voluntarily keep them at home and under self-imposed quarantine when certain diseases reach dangerous tipping points in the community?  Will you pay an exemption tax that sets aside funds to pay for the additional expense the community must absorb when it has to mobilize quickly to suppress an outbreak or an epidemic?

These are just a few of the smaller actions that anti-vaxxers can take as we continue the conversation. When the destination appears to be too far for us to reach, then cast our sights on something much closer. This doesn’t mean that you abandon the ultimate goal of getting those who can be vaccinated to actually receive the MMR vaccine. What it does do, however, is keeps them engaged in the pursuit of a solution that benefits the community.

The measles outbreak offers us a ready-made case study for our work. It highlights the promise and the peril of engaging your neighbors in a conversation with so much at stake.



²Source: http://www.washingtonpost.com/news/morning-mix/wp/2015/01/30/amid-measles-outbreak-anti-vaccine-doctor-revels-in-his-notoriety/




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