A friend introduced me to Charles in 2014, when I was failing at research in forensic psychiatric epidemiology, desperate for help from someone with a grasp on data science superior to mine. Since then, Charles and I have been talking about climate change, racism, and global health, wondering what tempts people to believe bogus claims and selectively reject science. Here we talk about vaccines.
I am from Kisumu, Kenya – a country whose dominant track and field athletes are the envy of the world, and whose natural environments are some of the most stunning on planet Earth. One American president and two Nobel Prize winners, among many other remarkable human beings, descend from this plucky nation.
A lakeside city
When I was growing up, I thought Kisumu was a very big city, though it has a population of about 750,000 people. Such was the scope of my world. One time my brother and I took the bus from school all the way to the place where the bus turns around. When we got there, I got off, lost my brother and ended up wandering for the whole afternoon. I had no idea where I was. I thought I’d never see my parents again. Eventually, I found my way back, but what a day!
When I went to university in Nairobi, over 200 miles away, it was the first time ever this far away from home. It was really exciting. I felt so grown-up, I spent most of my time there, including the holidays.
I ended up as a medical statistician by accident. I trained as a pharmacist and then took up a research internship after qualifying, before applying for a fellowship in London at the recommendation of my mentor at the time. It turned out to be one of my best decisions yet.
Statistics illuminates mysteries
I find it both fascinating and humbling at times, working as a statistician. Fascinating because it’s almost magical how we can illuminate the kinds of mysteries that lend themselves to statistical inquiry. Humbling because of the need to continuously learn and improve what we do.
Statistics cultivates a healthy dose of scepticism.
Anytime someone claims to have unique and special knowledge that goes against what the prevailing evidence suggests, my first question is always: Are they selling something?
If the answer is yes, I treat their claim with caution. Many of the people who propagate these wild claims – including anti-vaccine proponents – often have a financial interest in creating doubt, for example, offering allegedly superior treatments.
Isn’t it the same with drug companies?
Drug companies have exclusive financial interests in the products they offer and the health claims that they make. But, pharmaceutical products are subject to rigorous testing over many years before they can be sold. Still then, in many countries, there are strict regulations as to how medical treatments can be marketed, if at all. Companies violate these regulations some of the time and they face penalties when they do.
All in all, there is some oversight to what pharma can do that peddlers of alternative treatments are not subject to and do everything they can to avoid.
It takes on average 10 years to bring a drug from bench to beside. We can expect treatment for COVID-19 sooner than that because drugs undergoing testing already exist, we roughly know how they work in similar diseases, and trials aren't struggling with participant recruitment
High priests of bogus claims
The next thing that puts me on guard is when an idea has its “high priest” – a prominent promoter or proponent that endorses it. Ideas in mainstream medicine and science do not need priestly promoters; they rise or fall on their merits.
With “alternatives”, most of the time, there is someone with whom the idea begins and who enjoys a cult following because of it.
A lot of these high priests have perfected the art of misinterpreting science to support their claims.
One staggering example is a pack of £400 vitamins to boost your immunity to the extent that you supposedly don’t need vaccines.
Vitamins are needed for the proper functioning of the immune system, but they can never truly replace vaccines in public health policy. To suggest that they might is a public health threat.
Separate logic from magic
Unfortunately, a lot of people who listen to that message don’t know any better and the high priests use some very shaky evidence to make their claims more compelling.
We have to ask:
How do they support these extraordinary claims?
What's the evidence?
Can we independently do the same tests and get the same results?
These are very important questions. This is part of the scientific method, which allows us to draw credible conclusions from observations we make about the world around us. It’s a method that needs to be used with rigour to prevent misleading conclusions that support dubious claims.
Vaccines work
In the West, most infectious diseases have almost been eradicated thanks to vaccines; infectious diseases are no longer a constant threat to life.
Now we're all about COVID-19, which, compared to some of the diseases rampant in non-Western countries, is a relatively mild threat. And yet, we are anxiously awaiting a vaccine so we can resume our lives.
In this general sense of safety, we’ve seen a raise of the anti-vaccine movement that, interestingly, COVID-19 didn’t shake. In the developing world, where infectious diseases are ever-present, no one’s questioning vaccines. The difference that vaccines have made to a large number of people is visible.
It’s only in parts of the world where we go through life without ever seeing a case of polio that we can afford to invest in bogus claims. In places where polio is present, people tend to go with science.
Demand evidence
The claim that vaccines can cause autism may seem convincing, because symptoms of autism tend to appear between 12 and 15 months of age, around the same time when measles, mumps and rubella vaccine is administered.
This claim, first made by someone who eventually lost their medical license for making up data, is built on shaky grounds, and several reviews of the evidence have found no link between vaccines and autism.
COVID-19 and vaccines
I have a sense some of the people who loudly discredit mainstream medicine are now turning to it to protect themselves and their loved ones, as they do whenever they have a serious health emergency.
People tend to only reject science when it suits their contrarian arguments and even then, they’re very inconsistent about what aspects of it they reject.
I’m always surprised that people can blindly use modern technologies and question climate science or mainstream medicine; how can one accept science that underpins texting, but reject science that underpins vaccines?
Resist bogus health claims
There is no simple way to fight bogus claims. A lot of people find their non-mainstream beliefs to be comforting. These people are often struggling with anxieties – economic or personal – that are difficult to resolve.
This popularity of bogus claims tell us a lot about the state of the world.
People sometimes snap out of these beliefs when tragedy strikes, for example, when they or people close to them suffer catastrophic illness or death as a consequence of bogus claims, but it doesn’t have to get this far. Perhaps this pandemic serves as a wake-up call.
Legacy of COVID-19
Education and legislation are cornerstones of keeping the public safe. There is overwhelming evidence that shows vaccinating is the right thing to do and that it’s not just an individual choice with individual consequences. It has consequences for everyone.
This pandemic is a striking example of the shared consequences of individual decisions around health. We're learning in real time the importance of clearly communicating these risks to the public and building sound policies around them.
People who make decisions based on something they think they can’t grasp are vulnerable and they make everyone vulnerable. We need to protect each other.
Dr Charles Opondo is a Researcher in Statistics and Epidemiology at the Nuffield Department of Population Health, University of Oxford, and Honorary Assistant Professor in the Department of Medical Statistics, London School of Hygiene and Tropical Medicine (LSHTM). His research interests are in observational and experimental studies to improve care and outcomes for women in children living in Kenya, Sudan, Ethiopia, Malawi, Nigeria, Canada and the UK. He also teaches statistics to Masters and Doctorate students in Oxford and the LSHTM. You can find a catalogue of his work in the National Library of Medicine database.