Information, education, and health behaviors: Evidence from the MMR vaccine autism controversy

Abstract

In the wake of strong, although later refuted, claims of a link between autism and the measles-mumps-rubella (MMR) vaccine, I examine whether fewer parents immunized or delayed vaccinations for their children and if there was a differential response by mother's education level. Using various controls and a differencing strategy that compares in MMR take-up with other vaccines, I find that the MMR-autism controversy led to a decline in the immediate years and that there were negative spillovers onto other vaccines. I also find evidence that more highly educated mothers responded more strongly to the controversy either by not immunizing their children altogether or, to a lesser degree, delaying vaccination. Moreover, the educational gap was greater in states where there was greater media attention devoted to the controversy. This is consistent with the health allocative efficiency hypothesis whereby part of the education gradient in health outcomes is due to more-educated individuals absorbing and responding to health information more quickly. However, unlike in the United Kingdom, where previous studies find that the gap was eliminated after the link was refuted, the evidence for the United States suggests that the educational gap persisted.

Countering misinformation: Strategies, challenges, and uncertainties

“…The consequences of this failed debunking turned out to be rather severe: The controversy led to a decrease in MMR vaccine uptake and, in turn, to an increase in mumps and measles infections, leading to preventable diseases and deaths (Hargreaves, Lewis, & Speers, 2003;Nyhan, Reifler, Richey, & Freed, 2014;Poland & Spier, 2010). Studies also revealed negative spillovers onto other vaccines (Chang, 2018). The case impressively shows the fatal consequences when misinformation spreads and also illustrates the "societal cost of misinformation": the money spent on follow-up studies and information campaigns to debunk information that is factually incorrect (Lewandowsky et al, 2012, p. 107).…”

Vaccine hesitancy and (fake) news: Quasi‐experimental evidence from Italy

“…Similarly, Smith, Ellenberg, Bell, and Rubin (2008) examined MMR uptake and nonreceipt in the United States and found declines in 1999 and 2000 and then a return to previous levels of vaccination. More recently, Chang (2018) showed that controversy led to a decline in MMR immunization rates and negative spillovers onto the use of other vaccines in the United States. This paper complements these existing studies in two important ways.…”

MMR Vaccine Attitude and Uptake Research in the United Kingdom: A Critical Review

“…Other than socio-cultural and domestic context, income and education also play a large role in access and attitudes: recall the broad conclusions of Sandford et al [37], Haider et al [35], Hungerford et al [32], and Baker et al [33], that socioeconomic deprivation is positively correlated with reduced uptake and timeliness of MMR vaccination. Haider et al [35] notes that this, remarkably, is a reverse of the pattern that was well documented in the 2000s; in comparable studies conducted at the height of the Wakefield controversy, affluent groups were the least likely to vaccinate and had seen the fastest reductions in uptake [72].…”