Falling confidence in vaccination illustrates how the media’s obsession with balance and impartiality, and its aversion to regulation, can kill.

 

In the United States it is easy to view falling rates of vaccination for diseases like measles as a simple consequence of a right wing populist Republican party that has become anti-science. However I suspect that may be confusing an effect (the promotion of anti-vax views by members of the Republican party) with a cause, albeit a very important amplifying effect.

My reason for thinking this goes back to the MMR vaccine and autism scare that was begun by a then physician, Andrew Wakefield, who published in 1998 a paper in the Lancet suggesting a link between the former and the latter. Although that paper has since been discredited, it is important that medical science, or indeed any science, remains open to unconventional ideas. Although ideally a paper using dubious methods might be rejected by peer review, in practice that often does not happen. The way science progresses is by allowing such ideas to be expressed, which then generates a scientific debate and if necessary leads to further studies to refute or confirm unconventional ideas or results.

So studies like Wakefield’s are bound to, and should, occur from time to time. What turns the normal operation of a science into an unwarranted panic is the involvement of the media. This has two aspects. The first is that scare stories about health sell newspapers. This is hardly surprising. The problem is that the scarier the story is, which invariably means the more one-sided it is, the more it will be read and talked about. The paper that did most to ensure that people knew about Wakefield’s hypothesis was the Daily Mail, but as Roy Greenslade points out here it was far from alone in producing alarmist coverage.

The second aspect involves the media’s promotion of impartiality or balance over seeking the truth. In the UK readers are aware that even their own newspaper’s reporting may often be exaggerated, alarmist or biased, and often look to the main TV channels for more objective coverage. However the default format for such coverage, particularly but not only if the story has a political aspect, is to present both sides of any argument in an impartial way. With the MMR vaccination, the overwhelming consensus of the medical profession was highly skeptical of Wakefied’s results and advocated continued use of the vaccine pending further research, but that consensus was not conveyed in much of the media’s coverage. We know that from research that was done at the time. About half the people surveyed in this research thought that because both sides of the argument were given equal coverage, then there must be equal evidence and backing for each side. Only a quarter of those surveyed knew what the medical consensus was.

As a result of this particular scare story and its coverage, uptake of the MMR vaccine declined in many countries and cases of measles increased, in some cases ending in deaths. It is too easy to put this all down to Wakefield himself, but whatever his motives it is both right and proper that unconventional ideas and pieces of evidence are debated and examined within any science. Indeed it is dangerous for medical science to self-repress ideas that are awkward for consensus views. The problem, in my view, lies with how these ideas are reported by the media.

When parts of the media have every incentive to exaggerate and scare, and the remaining parts of the media promote impartiality over and above the scientific consensus, then we are in danger of creating a deadly cycle in the uptake of vaccinations. Even if we start with almost complete uptake and a disease that has been largely eliminated as a result, newspapers or social media will occasionally find studies or data that form the basis of scare stories. Those stories will be amplified because they help sell newspapers or generate clicks, and more objective media sources will fail to counteract such stories, and indeed will give them false credence, because they insist on being impartial and ‘balanced’. Faced with the choice of getting a disease which, as a result of almost universal vaccination is both rare and largely harmless, and taking a vaccine which it has been suggested could have serious side effects, many will choose not to be vaccinated. As a result vaccination rates drop, and the disease occurs much more often, sometimes with serious or fatal consequences. When this gets media coverage vaccination rates climb again. We get a deadly cycle in vaccination uptake rather than the ideal of permanently high rates of vaccination.

The Wakefield paper and its coverage in the media produced one of these cycles. The indications are that stories around the Covid vaccine are starting to generate another for vaccination in general, not just in the US (where Republican skepticism about the Covid vaccine led to higher death rates in Republican states) but also in the UK and other European countries. In the US things will get a lot worse as a result of Trump’s victory (for example see here, or here, or here, or here), but it should be noted that Reform’s position in the UK is not much better.

To avoid such cycles in the future, two things need to happen. First, there has to be a media regulator with teeth prepared to sanction media outlets that publish scare stories that fail to give due weight to the scientific consensus and evidence. If media outlets and social media platforms just have an incentive to scare people, some if not all will do so. Second, media organisations that you would hope would behave in a more responsible fashion need to put promotion of the scientific consensus over and above the need to be impartial. Rather than just report both sides they need to explain and promote the scientific consensus. .

Opponents of media regulation love to talk about censorship and state interference, because both terms are emotive. But the regulation I propose involves neither. Media outlets would not be prevented from reporting stories, but only incentivised to not report them in a misleading way designed to unnecessarily scare people into doing things that would do them or others harm. The regulator would not look to the state to assess such things but to science and the scientific community.

Proponents of impartiality say that it embodies a democratic implementation of free speech, and as long as coverage is balanced then consumers of media can make up their own minds as to which side is correct. With issues like the wisdom or otherwise of vaccination, a moment’s thought shows why this idea is absurd. To make a judgement about the safety and effectiveness of vaccines requires detailed, peer reviewed studies, and trained medics to interpret and assess them. A non-expert consumer of a few moments of media comes nowhere near duplicating that process.

I discuss these issues further here. As Trump’s regime illustrates, the loudest proponents of free speech are sometimes those prepared to enact severe penalties on their opponents for saying things they don’t like. More generally free speech proponents like the status quo where money gives you a voice while the majority are rarely heard. But whoever gets a voice, for whatever reason, should use it responsibly. Shouting fire in a crowded space for no good reason is potentially a criminal act in the UK, because it can lead to public disorder and could even be fatal. Reporting health scare stories in a very partial, misleading and alarmist way could and has caused harm and death, and should be regarded in a similar way. The most effective way of providing an incentive not to do this is through regulation.

Once journalists were taught that their job was to get the facts and truth and inform their readers or viewers what that is. With issues like vaccination that is what medical research is all about, so the journalist looking for the truth should reflect the scientific consensus (when one exists). If a significant number of people outside the medical profession don’t know or believe the consensus, a good journalist should both explain why the medical consensus is what it is and why that consensus rejects/refutes alternative views.

Nowadays it seems that journalists are being told to simply report views or opinions about facts and the truth, and to give no judgement about whether some opinions are more valid than others. The most blatant example of that is Vox-Pop reporting. As David Jordan, head of editorial policy at the BBC, put it: “It’s critical to the BBC that we represent all points of view and give them due weight.” For him, it appears that ‘due weight’ reflects the number of people who hold that view.

Under this approach, the media would be giving much more airtime right now to those who were skeptical about using vaccines. Now if that airtime involved listening to their concerns and then explaining why those concerns were misguided, that would be a debatable approach. However in practice impartiality just means giving them airtime to explain and promote their views. While impartiality may be appropriate in contests between political parties, when it comes to matters of fact and science it is not. Indeed such an approach is effectively anti-science, and as the example of vaccination shows it is dangerous and can kill.

The moves to weaken Germany’s debt brake are welcome, but ultimately higher defense spending should be matched by higher taxes. Public spending cuts will promote right wing populists.

 

To say I have never been a fan of the way Germany views government debt is an understatement. Here I asked whether Germany’s debt brake mechanism, foolishly enshrined in the country’s constitution, was the worst ever fiscal rule. The answer was not quite, but it came close. The root cause of why it’s such a bad rule is that much of the German policy making community sees the main goal of fiscal policy as the control of government debt, rather than seeing debt as a means of having better fiscal policy (I discuss this here.)

So the serious moves in Germany to exempt defense spending (beyond 1% of GDP) from that mechanism are very welcome. So is the recognition (at last!) that Germany is in urgent need of renewing its infrastructure through additional public investment. If there was ever an issue that might make politicians realise that sometimes debt needs to rise significantly it would be a war. If you look at the time series for US or UK government debt, the major fluctuations occur during wartime. Governments typically pay for wars by, at least in part, issuing debt. There are good economic and political reasons why this happens.

As I have argued elsewhere, debt (or money) financing makes economic sense when expenditure is temporary and where the benefits of that expenditure accrue to future generations. Debt financing for one-off increases in spending allows tax smoothing, and if the spending benefits future generations then it makes sense for future generations to contribute something towards it, which paying interest on debt or slowly paying back the debt allows. The political reasons for wanting to minimise tax increases while fighting a war are obvious.

However, as Keynes set out in 1940, even in the case of a temporary major war there is a case for raising taxes to prevent an increase in inflation. If productive resources (labour and capital) need to be used to produce armaments (and perhaps some labour diverted into the army), then if the economy is at ‘full employment’ there will be less resources available to produce other goods. If the demand for those other goods doesn’t fall to match lower supply, this will be inflationary. Demand can be reduced by either raising interest rates to encourage saving, or by raising taxes to reduce incomes.

The problem Europe faces is knowing whether it is increasing military spending on a temporary basis or whether this increase is permanent. The answer is probably both. The short term need to replace what the US provided (where Europe can) to Ukraine is clear, and ideally this additional spending will lead to a peace deal which gives Ukraine the longer term security it needs. To that extent the extra military spending is temporary.

However it also seems realistic to think that Europe needs to spend more on defense permanently. There seem to be two future states of the world where this isn’t necessary. The first is that Putin is quickly replaced by a Russian leader who has no expansionary ambitions and who doesn’t see Europe as a threat. The second is that Trump 2 is so bad that in elections (if they happen on a fair basis) the Republicans are heavily defeated, and the party rethinks its attitude to Russia. Only then could the US go back to being the primary defender of the West. Neither option seems at all likely, so it does look like defense spending in Europe will need to be permanently higher.

So while additional deficit spending makes sense to cover some of the increased military production heading to Ukraine, it should not from an economic point of view cover the permanent increase in defense spending designed to fill the gap left by the US. However raising taxes, or cutting public spending, to match additional defense spending is always difficult politically. I would therefore not be surprised if European countries cover most of the additional military spending by increasing government deficits in the short term.

As John Springford notes here, one of the reasons that using deficit financing alone to pay for additional military expenditure is not sustainable (at least spending that is not all imports from outside Europe) is that most European countries are reasonably close to operating at normal capacity at the moment. So producing goods for the military will have to replace goods that would otherwise have gone to private sector spending. As I have already noted that requires either tax cuts or higher interest rates. It is this, rather than any change in risk, which was behind the large rise in longer term interest rates on European government debt after Germany’s announcement on potentially easing the debt brake. If governments take their time in raising taxes, then higher military spending will be accompanied by significantly higher short term interest rates to prevent higher inflation. That in turn implies higher longer term interest rates now.

In contrast in the UK additional defense spending has so far been financed by cutting spending on overseas aid. Could permanent cuts to public spending be an alternative to tax increases as a way of financing (and creating the resources for) military spending? The problem many European governments have is that they are fighting a battle on two fronts, where the second front is political and is against right wing populism. To win on this second front it is a very bad idea to ration the provision of government services. I think this point is just not understood by most mainstream commentators, so it’s worth spelling it out in detail here.

Right wing populists main and most effective appeal comes on the issue of immigration. It is important to differentiate why this issue appeals to voters. For some voters it simply appeals to their racism. To others it appeals to their xenophobia. But a third group is influenced by economic arguments, particularly around the rationing of public services. Racism and xenophobia is not generally enough to bring victory to the populists. So those swayed or otherwise by arguments linking economic problems to immigration are where most of the key marginal voters are.

This group sees immigrants as demanders of public services, and therefore for them more immigration means it is more difficult for the group to access these services. This feeling is irrational in that it ignores the immigrants working in these services and as taxpayers helping to provide these services, but it is understandable irrationality given how infrequently this misconception is corrected by politicians and the media. The more difficult access to good public services becomes, the more voters will see immigration as a cause.

So the more public services are rationed, the more it provides ammunition for populists. The evidence for this effect is strong, as I outline here. The idea that immigration is responsible for shortages in public services is frequently used by populist and right wing politicians. Tax increases are of course unpopular as well, but they do not play into the hands of right wing populists the way rationing public services does.

This is one of the ways the traditional political right, obsessed with tax cuts and reducing the size of the state, lays the ground for right wing populists to thrive. It is why Cameron’s austerity helped achieve Brexit, and why European austerity after 2010 encouraged the populist vote. It is why it would be so dangerous for European governments to pay for higher military spending by cutting public services.

This is also true for the Labour government in the UK. Cutting overseas aid to fund the additional UK defense spending announced so far is a very socially conservative thing to do. It makes it yet clearer that Labour are aiming to stay a socially conservative party in government under Starmer/McFadden. But if immigration remains a major issue for enough voters at the next election, and much of the media will aim to ensure it does, it will not be the governing party that gains from its socially conservative stance, but the socially conservative parties in opposition.

The most effective way the Labour government can reduce the threat from the populist right is to ensure the economic arguments made by populists against immigration have as little purchase as possible. That means providing more money for public services, not keeping taxes low. That Labour keep pursuing [1] the opposite approach, at a time when the two right wing populist parties in the UK attract nearly half of all voters in opinion polls, is very worrying.

[1] Quick note to Faisal Islam, one of the better economic journalists. Mediamacro may believe that fiscal rules “are designed to maintain credibility with financial markets”. However in reality fiscal rules were originally, and continue to be, formulated to influence fiscal policy. The markets do not need rules to decide whether fiscal statements are credible.

Current UK stagnation may have many causes, but one we know about is the UK media. Plus why the UK definition of a recession is no longer fit for purpose.

 

In the UK the definition of recession used by most people is two successive quarters of falling GDP. This definition always involved a knife edge problem. If GDP fell by 0.1% in two successive quarters we were officially in recession, but if output fell by 1% in one quarter and grew by 0.1% in the next there was no official recession. If a recession is meant to indicate periods in which output growth is particularly poor, then in this example it fails. The knife edge problems also means that mild recessions can easily disappear after data revisions.

A second problem has only become significant since immigration flows have been large and variable. The UK’s definition of a recession refers to GDP rather than GDP per capita (total output per head of population). GDP per head is much the more relevant number for most people, because it is a better indication of average personal prosperity. So the definition of recession should really relate to GDP per head. As the chart below shows, on that basis we have had two recessions since the end of the pandemic recovery.

A much more relevant way of putting it is that GDP per capita has still not recovered its pre-pandemic position.

The third and most important reason why our current definition of recession is not fit for purpose is that it only makes sense when underlying growth is significantly positive. Since WWII but before the financial crisis, when UK GDP per capita grew on average by over 2%, a recession indicated a lack of demand in the economy. The way to get out of recession (inflation permitting) was to boost demand by cutting interest rates or with a fiscal stimulus (tax cuts or increases in government spending). The pandemic was different of course, but it was so different there was little risk of confusion.

In contrast, the recessions since 2022 have had nothing to do with deficient demand in the economy. We know that because the Bank of England started raising interest rates over that period to stop a rise in domestically generated inflation. The labour market remained tight over this period, with unemployment at historic lows by recent standards. The economy wasn’t growing because of a lack of demand, but because the supply of goods was not increasing.

The reason for this can be seen in the following chart.

Labour productivity (here measured by output per hour) has remained close to the level achieved just before the pandemic, so GDP per head has failed to rise above pre-pandemic levels. [1] For more detail on this and some of the measurement issues involved, see Chris Giles here.

This ‘supply side’ stagnation is very different from the recessions of the early 80s, early 90s or late 2010s. Because of the latter, most people think of a recession as a short-lived demand side problem, whereas what we are seeing today is supply stagnation that has lasted nearly five years. The problems and their solutions are very different. Either we need to start referring to what used to be the normal type of recession as ‘demand deficient recessions’, or we need an alternative definition of a recession. [2]

Why has UK productivity growth been so poor since the pandemic? As we don’t have a good handle on the causes of productivity growth at the best of times, any answer is speculative. However, looking at other countries may be helpful. The UK is not alone in seeing stagnant productivity over this period. The situation in Japan, France and Germany is just as bad or worse. The major economy that seems to have done best by far over this period is the US.

US policy during the pandemic stands out from major European countries in two ways. First, the US did not have a furlough scheme financed by the government. As a result, unemployment rose much more during the pandemic, but that might have allowed efficiency gains that otherwise would have been more difficult. Second, the US gave a substantial boost to the economic recovery from the pandemic through a large fiscal stimulus.

In all countries investment fell substantially in 2020 as the pandemic hit. This lost investment would have depleted the capital stock, and also reduced the scope for innovations to be embodied in new equipment. It would be surprising if this large drop in investment didn’t have negative consequences for future productivity growth. It is also true that investment in the US during the pandemic stood up better than elsewhere, but the correlation between investment growth over the pandemic period and subsequent productivity growth is not perfect: investment in Sweden and France remained strong but their productivity growth has been weaker than in the US. It could also be the case that poor performance in some European countries is due to domestic issues rather than any common cause.

We know with some degree of certainty that this is true for the UK. Brexit reduces output permanently (eventually by a total of 4% according to the OBR) by reducing labour productivity. So part of the current stagnation in UK output and productivity is highly likely to be a consequence of Brexit. The chart below, of UK business investment compared to other major economies, comes from the FT here. 

Yet a decline in output of the order of magnitude estimated by the OBR was predicted by all the independent economists in this field who looked at this before the referendum, so it is hardly a surprise that it has come to pass. Did voters just ignore these warnings?

Not really. Most of the print media effectively ignored them, and pushed Brexit with as much propaganda as they could. The broadcast media ‘balanced’ the expert advice with counter claims from the tiny number of economists that wanted to push Brexit, giving the impression to all but the most savvy voters that expert opinion was divided. I have little doubt that with a media more committed to telling the truth Brexit would never have happened.

As I have said before, politicians find it hard to increase growth but can quite easily reduce it, and Brexit is a clear example of that. That is particularly true if the media actively promotes politicians likely to damage growth. That happened with Brexit, but the media environment has not significantly changed since then. If anything, right wing newspapers have become even more extreme, and the BBC still promotes ‘balance’ over knowledge.

Opinion polls today show the consequences of that. Reform, the party led and entirely controlled by Nigel Farage, is often ahead of the Conservatives and sometimes ahead of Labour. Farage made his name leading another party whose chief purpose was to advocate for Brexit. With Johnson out of the picture, Farage is effectively Mr. Brexit in the UK right now. So why is a politician who advocated for such a disastrous policy doing so well?

One response is to say voters are stupid, but that is not my view. The print media that gave us Brexit still fill their pages with propaganda designed to promote Farage and like-minded politicians, and will of course never admit how they lied to achieve Brexit. In the broadcast media, every interview with Farage should start and end by asking him why he made such a huge mistake in championing Brexit, and how can voters trust someone with such poor judgement. [3] After all, if any other politician had cost the average voter 4% of their income this would be the media’s approach. But it hardly ever happens with Farage.

Explaining the continuing popularity of Farage as ‘just about immigration’ hardly absolves the UK media. They as much as politicians are ultimately responsible for concealing basic truths about immigration from voters. The right wing press remorselessly pushes anti-immigration propaganda, and the broadcast media hardly ever asks about the cost of reducing immigration, or why refugees are forced to cross the channel in small boats. It never asks why most voters want lower immigration but at the same time want more overseas workers for most occupations.

Which is why I think it is possible for Farage to top some opinion polls despite being responsible for a large part of current UK stagnation and poor UK living standards.

[1] There are two stories behind why GDP per capita has fared slightly worse than productivity. The first reflects a decline in the measured level participation in the workforce since the pandemic, an issue I and others have talked about before [ref]. The second is that the measure of the workforce is too low because people have stopped answering the labour force survey since the pandemic, so the productivity series is too high (see here, section 3, for an alternative series.)

[2] An alternative would be to measure GDP per capita relative to some trend. That makes more sense to me for demand deficient recessions anyway, because then recessions would only be over once GDP per capita had regained its trend level. We would avoid the nonsense of journalists describing 0.1% growth after a large fall in output as the economy coming ‘out of recession’.

[3] Farage’s claim that the ‘opportunity of Brexit has been mismanaged by the Conservatives’ should be torn apart. The Brexit he campaigned for has set up barriers to trading with the EU, which is the ultimate reason why output is lower.