Editor's note: This popular story from the Daily Briefing's archives was republished on July 29, 2020.

U.S. measles cases are occurring in numbers public health officials have not seen in decades, and while most experts blame vaccine refusal for the disease's resurgence, it's less clear exactly why some parents refuse to vaccinate their children.

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Writing in Vox, Jennifer Reich, a professor of sociology at the University of Colorado Denver, shares what she has learned from speaking to anti-vax parents.

Who are the anti-vaccine parents?

Reich, a mother of three vaccinated children, has spent the past decade talking with anti-vax parents about their decision not to vaccinate their children. Based on her research, Reich has found that parents who opt not to vaccinate their children "are most likely to be white and college-educated, and to have a higher-than-average family income."

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While Reich notes that she spoke with many fathers, her research revealed "that health care decisions tend to be maternal terrain."

She writes, "It's easy to question why any parent would choose not to vaccinate, and to look at [them] with suspicion, confusion, or disgust," and "to dismiss [them] as anti-science, selfish, ignorant, or delusional." But she adds, the explanation for why they have not vaccinated their children often "is much more complicated."

Why parents don't vaccinate children

According to Reich, all of the anti-vax parents she spoke with believed parents should independently gather information about vaccinations to make informed decisions, without feeling pressure to follow recommendations from experts. She found all the parents also agreed that whatever happens to their children will be their responsibility.

But beyond that, Reich wrote, the reasons for vaccine refusal vary widely. For example, a few parents expressed to Reich that they believe healthy lifestyle choices and prolonged breastfeeding will be sufficient to convey some immunity to vaccine-preventable diseases, while other parents said they believe their children's immune systems would be stronger if they are allowed to contract vaccine-preventable illnesses. Some parents said they do not believe vaccines are safe because the federal agencies approving them are "too close" to the pharmaceutical industry, Reich writes.

The two types of anti-vaccine parent

According to Reich, "[T]here's a small number of people who will never believe vaccines work and will never be persuaded to accept them." But, she noted, this group does not represent the entire anti-vax population.

Reich wrote there's a "larger and more interesting group" of anti-vax parents "who say they believe in vaccines but just don't want them for their children—or don't want all the vaccines that experts insist are safest and most efficacious."

Reich said she "believe[s] their decisions are less about how informed they are and more about the culture of what I term individualist parenting—one that insists parents are personally responsible for their own children, but not other children."

According to Reich, it's this population that poses the greatest threat to herd immunity—but is also "most likely to be persuaded as long as we don't call them ignorant and selfish."

How to appeal to anti-vax parents

While "public health campaigns aim to convince parents to vaccinate because they love their children," Reich believes public health officials instead should appeal to parents' sense of community responsibility.

"[T]he reality is that vaccines work best when used at a population level," and a parent's decision to not vaccinate their children affects others, Reich writes.

"In fact, many vaccines provide more protection to others than the child who receives them," Reich writes. "For example, rubella, which is the third component of the measles-mumps-rubella … vaccine, is a mild disease in childhood but can cause blindness, deafness, mental disabilities, and a range of birth defects in fetuses, or miscarriage, when pregnant women are infected," she writes. As such, Reich writes parents should "consider that those too young, too old, or too immune-compromised to be vaccinated might benefit most from the herd immunity caused by mass vaccination."

"Like high-quality education, safe drinking water, food inspection, or any number of resources children need to thrive, infectious diseases cannot be controlled with individual hard work, and thus cannot remain a private concern," Reich concluded. "In the end, we must find ways to protect each other's children and support everyone's family. And perhaps then, mothers who don't think their children need vaccines will consent anyway" (Reich, Vox, 5/8).

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