Ridiculous Thing #43: Vacillating about vaccinating

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Here’s a scene for you. When you’re reading, I want you to think about risk. What risks you notice; which ones seem more and less acceptable.

In a kitchen, a man is wondering what to have for dinner. He opens the fridge and has a look inside: there’s a takeaway carton full of two-day-old king prawn bhuna and rice. He has a sniff, doesn’t fancy it, and because he is exactly like my other half puts it back into the fridge instead of just binning it. Toasted sandwich it is, then: he grabs some bread and cheese, and plugs the sandwich toaster into the socket. The kitchen lights go out. A faulty wire in the sandwich toaster plug has blown the fuse and tripped the circuit breaker. He unplugs the toaster, then fumbles about in the understairs cupboard to throw the switch and put the lights back on. Abandoning his plans for haute cuisine he grabs a bag of crisps out of the cupboard and feasts on those while watching TV. After fifteen minutes he realizes that the parent unit of the baby monitor went off when the circuit went, and switches it back on again. The phone rings. It’s his wife, out for girlie drinks. She’s had one too many and wants a lift home. He goes out, locks the door, gets in the car and drives the one-mile trip to fetch his wife, then drives back home with her. Their one-year-old son remains asleep at home in his cot throughout.

Feel like you’ve watched the first five minutes of Casualty yet?

This scenario, or at least the last few sentences of it, played out in a mum group I’m in on Facebook, when they happened to a friend of one of the members. The condemnation for the parents’ choice at the end was universal: leaving your child home alone, everyone felt, was unacceptable. But at the time it made me think, and I’ve often wondered since whether our perceptions of the risks to which we subject our children are realistic. I sometimes used to discover we were out of milk and had guests on the way while my daughter was having a long lunchtime nap. I live opposite a corner shop; it’s nearer to my house than the end of the back garden is. The chances of anything untoward happening if I had popped out and picked up a pinta were so small, it was almost tempting. Yes, I could have been hit by a car crossing the road. Better, then, to wait til the baby woke and pop out with her, giving us both that chance to be hit by a car? It made me wonder. When we try, as parents, to process risk, are we thinking rationally, statistically? Or are we subject to fears of monsters and moral panics that steer our reactions much more strongly?

Navigating risk is one of the central frustrations of becoming a parent. If you’ve been previously in pretty good health yourself, having a baby is perhaps the first time since childhood that you’ve noticed that you’re on the receiving end of a public health initiative. I think this is part of the root of that feeling that on becoming a parent you become public property, subject to some kind of baby police and a charge sheet of things you are supposed, or not allowed, to do. And the feeling that these measures are often rather blunt instruments reflects the reality that, in many aspects of parenting, there are just no really good evidence-based guides as to what you should do. It starts in pregnancy: in 2012 the Royal College of Obstetricians and Gynaecologists published new advice that identified a whole laundry list of substances as potential risks to developing foetuses. This paraphrase comes from Mumsnet:

“The RCOG says pregnant women should ‘play safe’ and avoid products and foods that may contain chemicals, such as bisphenol A and phthalates, that could harm their unborn baby.

To do so, it recommends you avoid:

• Food in plastic containers and cans
• New cars
• Non-stick frying pans
• New furniture
• Air fresheners
• Paint fumes
• Pesticides and insect sprays

And you should minimise your exposure to toiletries, such as shower gel and sunscreen, which could theoretically pose a chemical risk. In short, assume there may be a risk, even if it may be minimal or eventually unfounded.”

So what would it look like, avoiding those things? It would probably look a fair bit like abandoning civilisation to live in a log cabin. Only once there you would of course be subject to a whole new set of risks, being remote from modern healthcare facilities not the least of them.

Lists like this are, I think, the first manifestation of the weird way in which we are taught, as parents, to think about risk. Many people when told they should avoid things even though the danger may be slight or even nonexistent make the logical move to thinking that “no amount of risk is acceptable “. That, of course, isn’t how risk works. We simply cannot ever put our children into a context where we can absolutely guarantee their safety. But we do have a constant, gnawing sense that we ought to try. And this was the line that some of my friends took in condemning the couple who left their sleeping baby at home: an accident was terrifically unlikely, but unlikely was not good enough. People want certainty, whether or not it can be found. And in weighing up risk, as parents we habitually take part in a morbid sort of crystal-ball exercise where we try to see the future, and, critically, imagine the kind of judgement we would invite: “I could never forgive myself if something happened.” When we do this, we are moving from a statistical realm — numerically, what is the likelihood of a bad outcome — into a social realm: what would people think of me if something went wrong; what would I (with my own standards, formed in part by the society around me) think of myself?

To see this in action, look at the way people think about putting their children into cars. It’s a horrible thought, but if you have a child aged 5 to 14 they are likelier to be killed in a road traffic accident than in any other type of accident — indeed, more likely than in all other types of accident combined. Yet parents rarely agonise over whether to put their children into the car. We rarely even give it a second thought. Conversely, leaving our children alone gives us a greater fear than the statistics perhaps warrant. While staying away recently, I had put both children to bed in the hotel room before realising I needed something essential from the car. I thought for a second of popping out to fetch it. The children were asleep; it was a reputable hotel; there were regularly-checked fire alarms, a locked door, and plenty of staff around. I would have been out of sight of the room for less than a minute. Of course, I didn’t do it. The spectre that loomed in my mind’s eye was that of Madeleine McCann. The newspaper headlines. Some kinds of risk invite a degree of judgement out of proportion with their statistical magnitude.

I think that as parents we are vulnerable to the same kind of non-stats-based assessment of risk when it comes to vaccination. The fears that anti-vax figurehead Andrew Wakefield invoked live on, despite the comprehensive debunking of his claims. And sins of commission feel bigger than sins of omission: “if my child was hurt by the vaccine, I couldn’t forgive myself.” Getting a jab requires active participation, and the associated active acceptance that it’s the right thing to do; simply never taking your child along for an appointment does not. Inaction is the preferred course for waverers. Some of us, perhaps, are sticking on a post hoc rationalisation to dress up a visceral dislike for the momentary pain we inflict on our children when a needle punctures their sweet little thighs. That immediate discomfort feels far more real to us than the remote imaginings of the terrible diseases from which the vaccine will protect our children. Of course, there’s no story to ever hear from the tens of thousands of parents whose children don’t get blinded by measles, don’t lose pregnancies to rubella infection, don’t spend weeks in intensive care with diphtheria because they had the vaccinations that prevented those things from happening. The reality of those risks muted by those missing stories, we can be overwhelmed by the anecdotal stories of people who believe, rightly or wrongly, that vaccination has harmed their children.

But if this is (sometimes) about perceived risk, why are people not reassured by the clear public declarations that vaccination is safe? I think it’s partly because guidelines change. In a world full of conflicting advice, or guidelines that change, serves not to convince parents that public health is a dynamic field where better knowledge yields improved practice, but that the experts don’t really know what they are talking about and that official advice can be disregarded. Advice from other parents can feel more dependable. I’ve often seen parents online asking for health advice from peers, when my default reaction would have been to either Google it or see a doctor. Even in a Facebook group notionally devoted to ‘science – informed natural parenting’, anecdata prevails: “should we get the flu jab?” “Well I did and it was fine.”. I understand this now more than I once did: the experience of parenting, of taking on responsibility for another life and of having to make constant calculations about risk in the absence of complete (or even good) data predisposes you to turn first to others who are “in the trenches” with you. Bad experiences with out-of-touch healthcare professionals make this worse. One friend was told by a GP who was treating her postnatal depression that under the circumstances she ought to reduce pressure on herself: “You know, you can even left yourself off for not ironing the bedsheets.” So when some parents encounter an online community of fellow mums and dads who give them scientific-sounding arguments that chime with their visceral reluctance to get a jab, that echo their sense that official advice is not gospel, it does not surprise me that many take it seriously.

What could change? I think we need a sea change in the whole way in which we present official advice. Health educators in all capacities should position themselves not as Moses handing down stone-carven laws, but as scientists presenting the best possible interpretations of the best possible data. Acknowledging that even current knowledge isn’t infallible should curb the worrying phenomenon whereby any hint that official advice is (or has been) wrong makes some of the public throw up their hands in distrust of official advice in general. If public health doesn’t pretend to be something it’s not — flawless, totally objective, incontrovertible — then it’ll garner less backlash.

Image credit: Adrian Clark on Flickr at https://www.flickr.com/photos/adrianclarkmbbs/495559551/

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Ridiculous Thing #43: Vacillating about vaccinating

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