Cognitive and ethical reasons for the dissident movement in epidemiology

Тatyana I. Bocharova, Elena B. Kokoreva, Valentina D. Shakoly-ukova. Cognitive and Ethical Reasons for the Dissident Movement in Epidemiology. Cardiometry; Issue No. 26; February 2023; p. 114-121; DOI: 10.18137/cardiometry.2023.26.114121; Available from:

The invention and mass use of vaccines has made an enormous contribution to public health. Thanks to vaccines, the occurrence rate of many infectious diseases in the world (smallpox, diphtheria, measles, poliomyelitis etc.) has decreased by 95-100%. To a large extent, it is just the mass vaccination that has been of crucial importance to provide an increase in average life expectancy in humans and an explosive growth of the world’s population (from 1.650 billion people in 1900 to 8 billion in 2022), despite the fact that millions of lives in the 20th century were claimed by the Spanish flu pandemic and two world wars. Despite these achievements, in parallel with immunization, an anti-vaccination movement has appeared and exists, the essence of which boils down to an opposite statement, namely: the abolition of vaccination promises people a healthy life free of vaccine-induced allergic, infectious, autoimmune, oncological and other diseases. This article makes an attempt to analyze some reasons for the existence of the anti-vaccination movement and a negative view on vaccination. Some examples presented herein are drawn from the history of smallpox, cholera and coronavirus epidemics.

Smallpox

Smallpox, the only infectious disease that has been completely eradicated, was one of the worst disasters in the history of mankind. Smallpox killed 25 to 30 percent of all those infected; most of the survivors were disfigured with horrific pitted scars. Beginning with the sixteenth century, smallpox affected both rich and poor, constantly changing the course of human history. The initial symptoms of smallpox are those typical for an infectious disease with fever and headache, but the further symptoms cannot be confused with anything else. The skin of the body and of the face of the patient turns to fluid-filled blisters, which smell heavily and hurt. Smallpox is highly contagious and spreads easily even by talking, resulting in almost everyone being infected. It is believed that more people died from smallpox than from the “black death”: the plague, namely about 500 million people [1, P. 2]. Many monarchs died from smallpox, the Russian Tsar Peter II among them. But the largest consequence of this epidemic was a reduction in the indigenous population of the North America from about 70 million to

600 thousand people, when the European conquerors brought smallpox there [1 P. 12].

There was no vaccine against that disease available until 1796, when it was developed by the English rural doctor Edward Jenner. After Jenner had published his relevant monograph in 1798, his method of vaccination spread with a surprising speed throughout England, reaching not only large cities, but also many small and rural settlements. Very quickly, Jenner’s research work was translated into several languages, and the vaccination was introduced by Spain, Austria, France, Germany, Hungary, Scandinavia, and the United States. By 1820, Jenner’s vaccinations had halved the smallpox death rate in Europe. Smallpox was such a terrible disease of mankind that vaccination against it seemed to be a salvation, and vaccination against smallpox in Britain 1853 became mandatory according to the Vaccination Act for all newborn children [2 P. 13].

But as soon as the occurrence rate of smallpox and its mortality declined, the anti-vaccination movement intensified. In the middle of the 19th century, there were already quite a few parents in England who refused the vaccination of their children. In 1866, Richard Butler Gibbs, his brother George and his cousin John Gibbs founded the Compulsory Vaccination Fighters League [3 P. 38]. The Gibbs brothers called: Stop the hand of the grafter, join our fierce war against the procedure that sows so much disease and death. May Britain trample under foot this monstrous, deadly interference with the laws of nature, may it crush it forever! [2 P. 92] They published a huge number of leaflets, booklets and posters against vaccination. Among them, for example, there was a leaflet with “Vampire Vaccinator”, where the doctor was likened to a vampire hovering over a pregnant woman, waiting for her to have a child in order to torture it [3 P. 138]. Vaccine opponents have argued that vaccination “accounts for countless human sacrifices every year to appease an imaginary Satan”. Some performances were held in some English villages, where doctors rode cows, holding on to their tails, and at the end Jenner’s effigy was hung, beheaded or dragged to the police station for interrogation [3 P. 51]. Of course, the quality of the vaccine in those days was far from ideal, and the rules for disinfection were often not followed at all, so there were side effects from vaccinations, of course, but people were not concerned about the purity of vaccines, they were rather cared, for example, that vaccination might induce some cow-derived properties in humans.

Chen’s theory of the phases of a vaccination cycle

Let us consider the Chen’s theory of the phases of a vaccination cycle as the first, most obvious, reason for the emergence and strengthening of the anti-vaccination movement. In 1998, Robert Chen, being employed by the US Centers for Disease Control and Prevention, brought to the attention of scientists his theory called The Natural History of an Immunization Program. He plotted the population’s long-term response to immunization and divided it into several stages. At the first stage, everyone is very afraid of an infectious disease. For example, in the 40s of the 20th century, parents saw with their own eyes how small children died from diphtheria and pertussis, since these diseases were very common, and willingly agreed to vaccination. And in the fifties, everyone was prepared to immediately vaccinate children against polio, since many had some acquaintances, who were paralyzed or died from that virus. In the sixties, people saw the terrible consequences of measles, mumps or rubella. Measles could initiate pneumonia or encephalitis, mumps might cause deafness in children, and pregnant women with rubella had children with serious congenital birth defects. In the first section of the above mentioned plot, the immunization curve goes up.

At the second stage, when the used vaccines drastically reduce the incidence and seem less dangerous for parents, the fear of side effects from vaccinations comes first. It can be said that vaccines become “victims of their own success”. At this stage, the level of immunization reaches its plateau.

At the third stage, as more and more people become ‘vaccinated’, the overall immunization rate drops. At the fourth stage, due to the insufficient percentage of those vaccinated, the herd immunity protecting the unvaccinated individuals falls, and they begin to fall ill. Mortality from diseases that could have been prevented by vaccinations is on the rise, and parents are once again rushing to get vaccines for help. Immunization rates are on the rise again. If people would be able to be taught by history, the fourth deadly stage could have been avoided [4 P. 282]. Thus, Robert Chen shows that the scope and activity of the anti-vaccination movement largely depends on the actual phase of the immunological cycle in question.

Cognitive-psychological causes of dissidence. The effect of cognitive simplicity

By the word “cognitive” we mean the process by which information is processed in our mind. This process has its own laws and regularities. The effect of cognitive simplicity suggests a simple explanation of a phenomenon. Such simple explanations are easy to accept, easy to borrow, and easy to spread. According to Moscow anthropologist Alexandra Arkhipova, simple explanations are like “sugar” for the human brain: this is largely due to the rapid spread of talks and gossips, simple stories and conspiracy theories. What is quickly understood is easily translated further. It is difficult for an individual far from science to realize an effect of a vaccine or a structure of a virus. In order to somehow understand this, the human subject is trying to simplify scientific information that leads to a cognitive distortion and a production of an illusion of a proper understanding thereof. Such a cognitive deformation of the perception and the analysis induces the creation of illusions in the human individuals that they really understand the causes of the appearance and development of the epidemic, including vaccination [7].

In the 19th century in England, people believed that since the vaccine was made from the fluid taken from the pustules on the body of cows, then through the vaccination a person could take over something from the cow. Of course, such a primitive understanding distorted the real picture to the point of grotesque, and now it seems rather ridiculous to us, but even scientists could not explain the mechanism of vaccination at that time, because the science of microbiology simply did not exist yet. And common citizens were looking for their simplified explanations. The painting by James Gillray is widely known, where in the center he depicted Jenner vaccinating a woman. Something is happening to people around there: someone has a cow’s muzzle instead of a human face, another person has grown horns, someone has calves in the form of boils on their hands or tumors on their faces... Now we perceive this picture as a cartoon, but what did the author bear in his mind when painting it in 1802? How did the audience perceive it at that time?! Even 90 years after the painting of this picture, in 1895, in the city of Gloucester, some parents refused to vaccinate their children, since they did not want “the beast to move into their child”, otherwise it would “fall on all fours and run to graze in the field” [3 P. 125]. A similar 116 | Cardiometry | Issue 26. February 2023

example of today is the statement of opponents of vaccination against coronavirus that the vaccine changes human DNA, which is an absolutely unscientific statement.

Locus of control and response to epidemic

An important property of human psychology is the concept of “locus of control”. Those human subjects who tend to believe that they can control the circumstances and achieve results by themselves are individuals with a predominance of “an internal locus of control. ” On the contrary, human subjects with a predominance of “an external locus of control” believe that circumstances are beyond their control, and that everything that happens to them is determined by the external factors. In situations of social catastrophes, to which epidemics belong, the number of people with the “external locus of control” increases enormously, that is, uncertainty, anxiety, a tendency to “hide” from unsolvable problems or find a simple, affordable solution or to contact supernatural occurrences can grow in a society. [6].

An example is the pagan ritual behavior of the population during the cholera epidemic in Russia in the 19th century. Refusing doctors, the people, however, actively used their own, often mystical, ways to fight the epidemic. So, for example, the Ingush, in order to protect their villages from cholera, arranged mysterious processions through some local underground galleries. First, two wells were dug, connected by an underground passage, and people in turn, descending into one well, squeezed through a narrow underground gallery, spitting everywhere along the way, to reach the second well. In the villages along the Malka River, processions were held at dead of night along the roads and fields. That was attended by guys, equipped with pitchforks, pokers and cudgels, and girls with their underwear only, having their loose hair down. According to their beliefs, cholera entered the villages at night in the form of a living creature, which, upon meeting, had to be beaten. For a casual belated traveler, such a meeting could involve his or her death. The Dukhobors during the epidemic struggled with the “infected fire. ” They kindled a fire by rubbing two logs, called it “live”, and, knocking on the doors of the villagers at midnight, offered them to extinguish the existing, “infected” fire, and take a new one from them [7 P. 131]. Thus, in times of epidemics, the ancient customs of the times of idolatry were revived. The writer Vladimir Korolenko wrote: “The most absurd rumors, the most insulting rumors for our “national pride” were swept by clouds. Mostly, they rushed from the lower Volga regions, from the Caspian Sea and Astrakhan. It seemed that before the infection, ahead thereof, the wind drove that cloud of absurd rumors, which then scattered, buzzing over all of Russia, like poisonous flies” [7 P. 134]. “Indeed, under the conditions of social catastrophes, people not only do believe in illusory phenomena more and more, but also begin to exchange information about it in a more extensive way, ” suggests Alexandra Arkhipova [7].

In a 2008 study descriptively titled “Lacking control increases illusory pattern perceptions” scientists Jennifer A Whitson at the University of Texas, USA and Adam D Galinsky at Northwestern University looked at how internal organization affects psychological well-being. They have arrived at a conclusion that when people are unable to objectively acquire a sense of control, they try to achieve it through their sensory-illusory perception. People tend to escape and avoid uncertainty with responding to the latter by searching for some patterns in their environment. A sense of control is necessary for our well-being: a person can think clearly and make informed decisions only in a state, where he/she can recognize and realize that the situation is controlled by him/her. As a result, human subjects instinctively identify some patterns, which contribute to restoration of control over the situation, even if these patterns are illusory. They begin to see the patterns even there where they are not available at all [8].

Michael Shermer presents his observations of modern athletes that when players on the field are constantly successful, they hardly resort to superstitious rituals, but when they fail, magical thinking suddenly appears from somewhere, and they utilize all sorts of the bizarre ritualized behavior [6].

Inability of risk ranking

Although the level of education is not decisive in the problem of a person’s commitment to the anti-vaccine movement, it does matter. A broader outlook, an ability to compare different phenomena with each other, a more developed logical thinking – these features of an educated person can support him/her in taking his/her more objective position in matters related to infections and vaccinations. To a large extent, the skills of comparing risks and mak- ing decisions are also associated with the subject’s education and awareness. A person should be able to evaluate an event. What is the probability of its implementation? A small, medium or a high score? Another set of variables is related to the consequences thereof: what will they be? Tolerable, very serious or critical, inacceptable? Some people can rank risks and make decisions in a more reasonable manner, and crucial for them are those events that are both serious and highly probable. The other part of people, especially in a state of stress, when deciding on vaccination, consider minimal or moderate risks, as well as significant, but acceptable ones, to be critical, that is, inacceptable. This group of people can be called “overreacted individuals”, states Alexandra Arkhipova. They are afraid of some harmful effects of the vaccine on their health, but at the same time they cannot adequately assess the risk of the consequences of the disease itself. In this situation, a small risk of vaccination cannot be correlated with a high risk of death or disability as a result from infection. To a greater extent, “the overreacted cohort” includes people with chronic diseases. Distorted orientation of them is also facilitated by the fact that “the overreacted cohort” for the most part is quite satisfied with simple information and do not make efforts to familiarize themselves with strong evidence data [7].

Pseudo-scientific talks and gossips

A separate group of reasons for maintaining the anti-vaccine movement are the so-called “pseudo-scientific talks and gossips”. Vaccine opponents often seem to love science and use it as a mouthpiece, but actually they accept pseudo-scientific talks and gossips including scientific misconceptions. This pseudo-medical advice is much more dangerous than simply denying treatment and vaccinations or believing in conspiracy theories, as it uses scientific terminology and gives an illusion of a scientific approach. These include theories that the vaccine does not protect against the disease in question, but can infect by itself, that the likelihood of side effects is much higher than the “imaginary” benefit, that the vaccine leads to infertility, chronic diseases, and, finally, that the vaccine is useless and does not protect against the disease, and so on [7]. For each of these false statements or hesitancy, anti-vaxxers can offer their own, erroneous and superficial, but using scientific terms, explanation or justification.

The level of mistrust in a society

The level of vaccination in a society correlates with the general public mood in terms of trust-distrust in their government, local authorities, judges, doctors, healthcare contractors and each other. If the level of trust in a society is high enough, then people are more likely to trust the healthcare centers that recommend vaccinations; and vice versa. According to A. Arkhipova, there is a direct connection between the level of vaccination and, in the negative scenario version, with the “corruption rating”: “The corruption rating” is the feeling that everyone around me is taking bribes, making unfair deals; that life is unfair and, in many respects, depends on nepotism connections and bribes. The higher the rating of corruption in a society, the more people believe that everything around them is filled with deceit, and the less they tend to trust vaccines and vaccination officers and doctors [7].

Discrimination against marginalized groups

Professor Michael Willrich described the smallpox epidemic in the United States at the turn of the 19th and 20th centuries in his book “Pox: An American History”: There was widespread distrust of government officials and discrimination against marginalized groups in society in general. For example, groups of African Americans were highly suspicious of white healthcare officers in general and their vaccinations in particular [11]. A hundred years later, the situation remains unchanged. On July 4, 2020, a huge audience of blacks around the world listened to a three-hour speech by the “Minister of Islam” of the United States Louis Farrakhan. He called for skepticism referring to “white drugs” to treat a disease that had disproportionately affected blacks (keeping in mind COVID-19). Addressing the Africans, Farrakhan said: “If they come up with a vaccine, be careful! Before agreeing to a Covid vaccine, you need to consult a black doctor!” [9].

How many deaths from smallpox in the 19th century in England would have been avoided if it were not for the anti-vaccination movement! In the 1870s, a wave of smallpox affected the cities of that country again. The AntiVaccination Leagues that arose at that time demanded the abolition of compulsory vaccination as an ineffective measure, but in 1871 the authorities performed harder sanctions against vaccination refusal that generated a counter wave of resistance for about twenty years. The level of public distrust of the authorities in this case is characterized, for example, 118 | Cardiometry | Issue 26. February 2023

by the fact that only in one small town in England – Leicester – about six thousand law suits referred to the issue of refusing to vaccinate have been submitted [10].

By 1884, a massive campaign against compulsory vaccination had borne bitter fruit. An example is again the Leicester data. During the second half of 1883, 2281 children were born in the city, and only 707 of them were vaccinated; 280 of 1438 unvaccinated died. Strikingly, ignoring the 280 deaths of unvaccinated children within six months only, the parents and citizens of Leicester passed a resolution stating true satisfaction with the protection of their parental rights against the supporters of vaccination and medical despotism, seeking to establish control over every household in the country [10].

Belief in “conspiracy theories”

The essence of distrust in a society is the flourishing of conspiracy theories. “The conspiracy theorists” believe that the vaccine (like the artificially induced epidemic itself!) is primarily an instrument of social control, that is, a means of spreading high-mortality diseases and reducing the population [7]. The idea of “Big Pharma” that seeks to poison humanity for its profits is preferred by them to the ideas of the education and progress in disease control. These sentiments are often supported by the film production industry. Many Hollywood films have been made about “bloody pharmaceutical companies” that intentionally hide the negative results of their experiments and hire killers to get rid of the activists who expose their bad deals. The activists in the films are on the side of Good, while Big Pharma is on the side of Evil. One of the most illustrative cases thereof in our time is the pseudo-scientific theory of chipization via vaccination. Under the influence of stress, it is easier to people to believe in conspiracies and the presence of an external enemy. As a rule, people who believe in the “Big Pharma conspiracy” and “Global Behind the Scenes” are the staunch anti-vaxxers [7].

Distrust in the developers and manufacturers of vaccines

Public distrust in local authorities and healthcare authorities in the United States by the beginning of the 20th century was reinforced by the fact that at that time there were no rules governing the pharmaceutical industry production in the country. The governments forced people to get vaccinated, but did not regulate the production of vaccines. The vaccines were produced by unlicensed commercial enterprises, and their poor quality was one of the reasons people resisted the compulsory vaccination. To change the situation, Congress passed the Biologics Control Act, which laid the foundation for the existing applicable vaccine safety regulations. A new system of Federal licensing and regulation of vaccine production was introduced, finally leading to safer and more efficient production thereof [12].

Real versus perceived side effects of vaccination

Of course, one of the most important reasons for the anti-vaccination movement is some adverse effects of vaccinations. However, as history shows, most of the diseases that were attributed to the consequences of vaccination were actually not linked thereto. To prove the absence of such links requires sometimes many years of research involving tens and hundreds of thousands of people, and sometimes scientific advancements. In this case, an example of a perceived adverse side effect is the association between the pertussis vaccination and the brain injury. In the 1930s, a whooping cough vaccine was developed, and in 1948 it was combined with diphtheria and tetanus vaccines, so that DTP was available for immunization. In April 1982, DPT: Vaccine Roulette was released on TV screens in the United States, which triggered a powerful movement against whooping cough vaccination, as if the above vaccine caused brain damage in children. Thousands of parents began refusing to get their children vaccinated, lawyers terrorized pharmaceutical companies submitting individual injury law suits, and Congress passed the National Childhood Vaccine Injury Act (NCVIA; P. L. 99-660) in response to worries about the safety of the licensed childhood vaccines (the Act was in force till 1995). However, later, many clinical studies have disproved any links between the pertussis vaccination and brain injury in children. This covers, for example, a study in 1983 in Britain, when they have compared the data on 134, 700 children vaccinated with triple DPT and 133, 500 children vaccinated with DPT only. Further studies were carried out in Denmark, the USA, Canada, etc. in 1988, 1990, 1994, and 2001.None of those controlled studies has found any association between pertussis vaccine and neurological disease in children [4 P. 64]. The genetic scientist Samuel Berkovic, Director of the Com- prehensive Epilepsy Program and the Epilepsy Research Institute in Melbourne, has succeeded in finally demonstrating that the whooping cough vaccine has not induced the children’s diseases. In 2006, he found a genetic defect in 11 of 14 epileptic children studied, who were given triple DTP shortly before their first seizure appearance. It has been just a defect in the SC-N1A gene that is responsible for delivering sodium to brain cells. However, a vaccine cannot change genes in a human individual. 100% of the children with the above genetic defect develop seizures. Samuel Berkov-ic stated that an identification of the genetic cause of encephalopathy should, finally, once and for all bury the idea that its root cause is a vaccine [4 P. 81].

An example of a real vaccine complication is the live-attenuated oral poliovirus vaccine (OPV) created by Albert Sabin, the recognized virologist. The use of this vaccine against polio, a disease claimed millions of victims in the 20th century, particularly among children, has completely eradicated polio by 1979 in the United States. However, that vaccine induced a rare complication: in one case from two million five hundred thousand cases, it initiated polio, and every year, about ten children in the United States developed polio. It took a lot of effort made by Informed Parents Against VAPP and their leader John Salamone in order to force the American Academy of Pediatrics to switch to the Jonas Salk’s inactivated polio vaccine, where the poliovirus is killed by chemicals and eliminates even the small risk of developing polio after receiving the polio vaccine [4 P. 132].

Career and financial reasons

The large-scale campaigns of the anti-vaccine movement can be attributed in no small part to the fact that it is often led by prominent influencers like artists, TV moderators, politicians, etc. The masses trust their favorite movie actress more than they do dry statistics or an unknown scientist ranting about some benefits of vaccination. In its turn, this can gain a number of admirers to an actress or fans to a pop star, or votes to a politician.

The digital continuum has enormously enhanced the possibilities of focusing the attention of the masses, as well as yielding profits due to their disinformation. Social networks, first of all, have become the platform, where it is possible to multiply the audience and fund rising. According to Larry Cook, one of the founders of the anti-vaccine site Stop Mandatory Vaccination, the number of visitors to his website reached two million per month [13].

The main value of anti-vaccine sites for Facebook is that they attract users who are subsequently shown advertisements. YouTube and Facebook have counted up to 62 million anti-vaccination account subscribers, which could generate up to $1.1 billion in annual revenue for social networks, mostly generated by advertisers. YouTube shares this ad revenue by giving content creators 55% and keeping the remaining 45%. This model means that vaccine opponents can earn almost $400, 000 a year from their YouTube accounts alone (YouTube itself earns their own $300, 000 or more) [13].

Conclusions

The battle between the government and the staunch anti-vaccinationists in the United States at the turn of the 19th and 20th centuries culminated in that remarkable 1902 Supreme Court decision that supported and strengthen the state’s right to enact a compulsory vaccination law and administer vaccinations to its population to protect people from a devastating disease. In Jacobson v. Massachusetts, the Supreme Court upheld mandatory vaccination measures as those to be constitutional. It was an epoch-making decision. The Court compared the right to take public health measures during an epidemic to the right of a government to protect their people from a military invasion by creating an army through forced mobilization [14]. By 1972, the smallpox vaccination in the country was canceled due to the complete eradication of the disease. As a result, smallpox became the first and only contagious disease that by the beginning of 1978 had completely disappeared in human population, and it had been precisely the compulsory vaccination that had played the decisive role therein.

Michael Willrich, the author of a book treating the smallpox epidemic in America at the beginning of the 20th century, expresses his hope that modern people should have more confidence in the recommendations of epidemiologists, experts, medical doctors and public health officials than they actually did at the turn of the century more than a hundred years ago in the USA [12].

Another important aspect of vaccination concerns the issue of liability and responsibility. Unvaccinated children (and unvaccinated adults) impair herd immunity, and those who truly cannot be vaccinated for health reasons, or who do not develop antibodies in response to vaccination, become increasingly unpro- 120 | Cardiometry | Issue 26. February 2023

tected from the diseases. An exemplary case in question is a seven-year-old unvaccinated boy who in 2008 contracted measles while traveling abroad who and brought the infection home to the United States. As a result from his contacts during the incubation period in the children’s pool, in the store and at the doctor’s office, twelve babies, who had not completed their vaccination according to the vaccination schedule because of timing, fell ill with measles, and sixty had to spend a three-week quarantine. The mother of one of those children was outraged that they had to suffer because of other people’s decisions. “I understand that getting vaccinated means taking risks, ” she said, “but when one person’s decisions affect the lives of others, there is no time to talk; responsible citizens don’t do that. ” Another mother, whose ten-month-old son was very close to death due to measles on her eyes, said: “I am shocked by the family which brought the disease to us to San Diego: what were they thinking? Did they have any compassion towards all of us?! [4]. ” If in their thinking about vaccinations people also included the concepts of solidarity and responsibility for others, albeit unfamiliar, but vulnerable fellow citizens, then for sure, there would be more decisions in favor of vaccination and less suffering and tragedies in our world.