TEDxMileHigh 2019

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I gave birth to my second child about a year after 9/11 when the fear of terrorism was the highest we’d ever known. It was the first year of the so-called “war on terror.” We had a brand new Department of Homeland Security, and at one particularly panicked moment, we were all advised to buy duct tape and plastic sheeting to seal windows and doors in the event of a terrorist attack. We were told to be prepared for poisons in the air, that bioterrorism was a real possibility—and that infectious diseases could be weaponized against unsuspecting communities. The remaining stores of smallpox in a handful of labs around the world were an obvious choice, they assumed. And so first responders, including medical providers like my husband Dave and friends in my health policy fellowship, were asked to get vaccinated against a disease that was eradicated in 1969.

At the same time, as the mother of a 3-year-old and a newborn, I was online, reading advice from other mothers—how to find childcare, how to make breastfeeding easier, how to get your baby to sleep. But among all the normal motherly advice, there was a surprising trend: a belief that childhood vaccines were not really necessary and might even be dangerous.  

So here I was, watching, on the one hand, as moms argued that vaccines weren’t necessary to protect against known diseases like whooping cough or measles, and on the other, as doctors I knew were willing to be vaccinated against a hypothetical risk. And while I was trying to make sense of all of this, Dave would come home from the Children’s Hospital where he worked & tell me about kids he saw with vaccine-preventable diseases: babies on ventilators for whooping cough or a child paralyzed with full-blown tetanus. These contradictions felt hard to understand.

So, as a sociologist, I decided to approach this like any other project – to try to understand why parents reject vaccines, despite evidence that they’ve helped generations of children stay healthy. I set out to interview parents—which ended up being mostly mothers since women make most healthcare decisions for their families. We talked about their fears of vaccines and possible harms they believe they can cause. They told me that they don’t trust pharmaceutical companies or government agencies who are supposed to monitor them. Some believed that illness is natural and that the body can heal itself so long as it’s healthy. But throughout, I heard mothers tell me how hard they are working. Making their own baby food from scratch. Dying Halloween cookies with crushed semolina & beets to avoid artificial coloring. Growing organic food in their backyards. These mothers were working hard to do what they thought was best for their own children. And that included refusing vaccines.

It’s easy to look at these parents and dismiss them as ignorant, selfish, or delusional. To say that they don’t know how bad vaccine-preventable illnesses can be or to label them as anti-science. If you’re like most Americans, you’ve had first-hand experience with these arguments on Facebook, at Thanksgiving dinner, or your kids’ playground.

And even though I disagree with their claims and fully vaccinated my three children, what I’ve come to understand in the course of my research is that parents who reject some or all vaccines are responding in ways that are actually very logical to the pressures placed on parents today.   And this movement –   is just a symptom of a much larger problem. Let me explain.

Think about what we tell women as soon as they’re pregnant—sometimes even before conception—and throughout their children’s lives about what it means to be a good mother. From to birth plans, to school choice, to food, even college applications. We, mothers, are told that our children’s health and success rests on our hard work. We can see this culture of individualist parenting in the ways we hold mothers responsible for anything that goes wrong with their kids. If your child is ill, if your child gets bad grades, if they’re poorly behaved, it’s probably your fault. And when you don’t make perfect decisions, someone will let you know – because others are watching. When I was pregnant I was stopped while ordering coffee, not once, but twice by other women who wanted to make sure that I was drinking decaf. And we know that for low-income mothers and mothers of color, the scrutiny is even worse, sometimes resulting in reports to social service or law enforcement agencies.

We don’t just scrutinize mothers. We also assume that there aren’t enough resources for everyone’s kids to succeed—not enough spots in the “good” school, not enough room on the traveling soccer team, not enough jobs after college—so parents are pitted against each other, competing for what seems like a small pool of resources, trying to do what’s best for their own children. In that light, the recent college admissions scandal starts to make sense – they paid a high price to make sure their kids could succeed in a world where there doesn’t seem to be enough to go around.

But the problem isn’t just our individualist view of parenting –   it’s also about what we tell people more generally about being healthy.   Public health agencies, healthcare providers, and a wide range of magazines, blogs, and friends tell us that health is an individual project. It’s YOUR job to be healthy. Count your calories, count your steps, eat less fat, eat less sugar. When we hear that someone we know is sick, we almost always wonder what they did or failed to do that led to this disease.   But the reality is that most disease is beyond individual control. Some of it’s genetic. Much of it is environmental. And some is just bad luck. But, we don’t act that way. We act like if we just work hard enough and make all the right decisions, we’ll stay healthy.  

If we take these two trends—one that says YOUR personal choices as a parent determine your child’s success or failure, and one that says YOUR personal choices lead to health or disease—it’s no wonder that some mothers increasingly see vaccines as a personal choice that’s part of a broader personalized strategy for their own children.  

But the reality is, your personal choices affect other people in significant ways.   Vaccines work best when everyone uses them. There are some individual benefits from getting a vaccine, but their power is in the ability to lower risks of disease for everyone in the community. Take something like rubella, the most often forgotten component of the “MMR,” measles-mumps-rubella, combined vaccine. Rubella is a mild disease for virtually everyone who gets it. But rubella can cause significant damage to a fetus if a pregnant woman is infected. So we vaccinate children against rubella—not because they personally benefit—but because they’re most likely to be around pregnant women who need to be protected.

Most of the best public health interventions and social programs were built on the assumption that we can do more together than we can do alone. Free public education, sanitation, national parks, and fire departments are all programs we collectively fund and support, even we don’t use them equally.   The same is true of vaccines. But we seem to have lost track of that!! Pharmaceutical ads for the HPV vaccine tell you that your daughter can be “One Less” woman who gets cervical cancer if you choose the vaccine for her, while government campaigns tell you that you can show your love for your children by protecting them with vaccines. Throughout, parents are told that vaccines are a consumer product rather than a public good. And like all consumer products, it is up to you to decide if your children will benefit from it and if you want them.   More generally, we’ve told young families that they should support their own children to the limits of their resources and that they don’t need to worry about other people’s children, just their own. None of this makes our communities better.

This is what I’m talking about when I said that this trend of rejecting vaccines is the symptom of a larger problem!! This culture of individualism is a crisis, and it affects every major problem we face as a society – because if your own kid has access to clean water, what does it matter if the kids in Flint, Michigan, don’t? If your own kid has healthy food, what does it matter if the neighborhood down the street is a food desert? If your kid can get into a charter school, who cares if your public school is failing, and can’t pay its teachers a fair wage? All of these problems could be solved if parents just stood up for each other, and said, “Not my kid, and not your kid either.”

We must begin to dismantle this culture of individualist parenting. The first step is to stop blaming each other for everything that happens, particularly when many things are beyond individual control. When you meet the mother of a child with disabilities, let’s not ask—or even wonder—what she did wrong in pregnancy. Just like when you meet someone with cancer or heart disease–it doesn’t really matter how healthy their lifestyle is or isn’t. Support them anyway. Let’s help mothers who are struggling or at least offer a smile or encouragement, even when their kids are screaming on an airplane or at the grocery store. And perhaps most importantly, let’s find ways to show that we are invested in each other’s kids.

Because when we begin to act like we’re invested in everyone’s families, other families will become invested in ours. These changes won’t solve the problem of declining vaccine rates overnight, but it will start moving us to a culture of public investment in each other’s health. And only then will we finally build communities where everyone’s children—and parents—can thrive.

Thank you.

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