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.