Transcriber: Eunice Tan
Reviewer: Tanya Cushman So I gave birth to my second child
about a year after 9/11, when our fear of terrorism
was the highest we had ever known. It was the first year
of the so-called "war on terror," and we had a brand-new
Department of Homeland Security. At one particularly panicked moment, we were all advised to go out
and buy duct tape and plastic sheeting so we could seal our doors and windows
in case of a bioterrorist attack. We were told to be prepared at all times, that the air could become poisonous and that infectious diseases
could be weaponized against unsuspecting communities. The last stores of smallpox
in a handful of labs around the world seemed an obvious choice. And so first responders, which included my husband, Dave, and my friends in
my Health Policy Fellowship, were asked to be vaccinated against a disease
that was eradicated in 1969. At the same time, as a mother
of a newborn and a three-year-old, 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 usual motherly advice,
there was an unusual trend: mothers suggesting that you don't actually
need vaccines against childhood illnesses and that, in fact,
they might be dangerous. So here I was, on the one hand,
watching as mothers said you don't really need vaccines
against known diseases, like whooping cough and measles, and on the other hand, while healthcare providers I knew were debating getting 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 and tell me stories about children
with vaccine-preventable diseases: babies on ventilators with whooping cough, a child paralyzed with tetanus. These contradictions
seemed hard to understand. And so as a sociologist, I set out to study this
the way I would any other project, to try to understand
why parents were rejecting vaccines despite evidence that they've helped
to keep generations of children healthy. I set out to interview parents, which turned out to be mostly mothers because women make most of the
healthcare decisions for their families. We talked about their fear of vaccines and the harms they were afraid
they could cause. They told me about their distrust
of pharmaceutical companies and the government agencies
that are supposed to monitor them. Some told me infection
actually is normal and natural and that the body can heal itself
so long as it's healthy. But throughout, mothers told me
how hard they're working: making baby food from scratch, dyeing Halloween cookies
with crushed semolina and beets to avoid artificial colorings, 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 avoiding vaccines. Now, it's easy to dismiss these mothers
as ignorant, selfish, or delusional, to say that they just don't understand how serious vaccine-preventable
diseases can be, or to label them as anti-science. And if you're like most Americans, you already have firsthand experience
with these conversations on Facebook, at particularly contentious
Thanksgiving dinners, (Laughter) hopefully not, but maybe
on your children's playgrounds. And while I disagree with their claims and have fully immunized
my own three children, what I've come to understand
in the course of my research is that parents who reject
some or all vaccines are actually responding in ways that are pretty logical
to the pressures placed on parents today, and that this movement is actually
a symptom of a much larger problem. So let me explain. Think about what we tell women
from the moment they're pregnant - sometimes even before conception - and throughout their children's lives about what it means to be a good parent. From birth plans to food
to school choice to college admissions, we mothers are told that our children's successes
or failures rest on our hard work. We can see this culture
of individualist parenting in the way we blame mothers for anything
that goes wrong with their children. Your child's sick, your child gets bad grades, your child's poorly behaved? It's probably your fault. And when you fail to make perfect choices, someone will let you know because others are watching. (Laughter) When I was pregnant, I was stopped, not once, but twice,
while ordering coffee by other women who wanted
to make sure I was ordering decaf. (Laughter) And we know that for low-income mothers
and mothers of color, the pressures are much, much worse, resulting not just in dumb questions but sometimes in reports to social service
or law enforcement agencies. But we don't just scrutinize mothers. We also don't believe
that there's enough resources for everyone's children to succeed: not enough room at the good school, not enough spots
on the traveling soccer team, not enough jobs after college. And so we pit parents against each other, competing for what seems
like a small pool of resources, trying to do what's best
for their own children. In this light, the recent college admissions scandal
starts to make sense. They paid a high price to try to ensure
their kids could be successful in a world where there doesn't seem
to be enough to go around. But our problem is not just
individualist parenting; it's also what we tell each other
about what it means to be healthy. Public health agencies, physicians, websites, blogs, magazines, apps, your watch, friends, even family will tell you that health is a personal project. It is your job to stay healthy. Count your calories, count your steps, eat less fat, eat less sugar, drink more water. I don't remember what we're supposed to do
with carbs, but something with carbs. (Laughter) When we hear that someone we know is sick, we almost always wonder what they did
or failed to do that led to that illness. And the truth is that most of illness
is beyond individual control. Some of it's genetic, much of it's environmental, and some of it's just bad luck. But we don't act that way. We act like if you make
all the right decisions, you can stay healthy. If we put these two trends together - one that says it's your
personal choices as a parent that determine
if your child is successful and one that says
it's your personal choices that determine health or illness - it's really not that surprising that an increasing number of parents
see vaccines as a personal choice and one that's part of a broader strategy
for their own families. But our personal choices
affect others in significant ways. Vaccines work best
when everyone uses them. Yes, there is almost always
personal benefit for the person who gets it, but their real power
lies in lowering risk of infection for everyone in the community. So take something like rubella, the most easily forgotten component of the measles, mumps, rubella - MMR vaccine. Rubella is a fairly mild disease
for virtually everyone who gets it. But it was a leading cause
of birth defects when pregnant women
would become infected. And so we immunize
young children against rubella not because they most personally benefit, but because they're most likely
to be around pregnant women who most need protection. Our best public health interventions
and social programs have come from the belief that we can do more together
than we can alone. Free public education, sanitation,
national parks, even fire stations are all examples of things
we collectively fund and support but might not equally use
and benefit from. And the same is true of vaccines, but we seem to have lost sight of that. Instead, pharmaceutical companies tell us that our daughter could be
one less woman with cervical cancer if we use their vaccine, and public health agencies tell us we can show our love for our own children if we immunize them. Throughout, vaccines get referred to
as a consumer product and not a public good. And so, like all consumer products then, it's up to you to decide if you need it, if you want it,
or if you'll benefit from it. More generally, we tell young families today that they should support
their own children to the limits of their resources but that they don't need to worry
about other people's children - just their own. None of this is making
our communities better. This is what I was talking about when I said that vaccine refusal
is a symptom of a much larger problem. Because this culture
of individualism is a crisis, and it affects most of the social problems
we face as a society. Because if your child has access
to clean drinking water, do you really care if the kids
in Flint, Michigan, don't? And if your child has access
to lots of nutritious food, does it really matter if the kids
in the next town live in a food desert? And if your child can get access
to a charter school, do you really care if your neighborhood school is failing
and can't pay its teachers a fair wage? We could solve all these problems if parents just stood up and said, "Not my child, and not your child either." (Applause) We have to start dismantling
this culture of individualist parenting. The first step is let's stop blaming
each other for everything that goes wrong, (Applause) particularly because so many things
are beyond individual control. So when we meet a mother
of a child with disabilities, let's not ask or even wonder
what she did wrong during pregnancy. (Applause) Just like when we meet somebody
with cancer or heart disease, it doesn't really matter
how healthy their lifestyle is or isn't. Let's just support them anyway. (Applause) And let's find ways
to help mothers who are struggling. Let's just give them
a friendly smile sometimes or a word of encouragement, and yes, even when their children
are screaming at the grocery store or on an airplane. (Applause) Most importantly, let's find ways to show that we're invested
in each other's children because - this is important - if we start acting like
we're invested in other families, other families become invested in ours. (Applause) Now, this won't solve the problem
of declining vaccine rates overnight, but it will start to move us towards a culture of public investment
in each other's health. And then we could build communities where everyone's children
and parents can thrive. Thank you. (Applause)
