Opting Out: Individualism and Vaccine Refusal in Pockets of Socioeconomic Homogeneity

Abstract

Cases of measles and other highly contagious diseases are rising in the United States. Public health experts blame the rise partly on the spatial concentration of parents declining to vaccinate their children, but researchers have given little attention to theorizing why this clustering occurs in particular communities. We argue that residential and school selection processes create “pockets of homogeneity” attracting parents inclined to opt out of vaccines. Structural features of these enclaves reduce the likelihood of harsh criticism for vaccine refusal and foster a false sense of protection from disease, making the choice to opt out seem both safe and socially acceptable. Examination of quantitative data on personal belief exemptions (PBEs) from school-based vaccination requirements in California schools and districts, as well as findings from parent interviews, provide empirical support for the theory. We discuss substantive implications for lawmakers and public health officials, as well as broader sociological contributions concerning neighborhood effects and residential sorting.

“I’m Not Gonna Put That On My Kids”: Gendered Opposition to New Public Health Initiatives

“…If schools require immunizations against COVID-19, those requirements may also generate opposition. That would be consistent with pre-pandemic efforts to weaken or overturn school immunization requirements and avoid new ones (Colgrove 2010(Colgrove , 2016Diekema 2014;Estep and Greenberg 2020;Lakshmanan and Sabo 2020).…”

“…Understanding potential opposition to COVID-related school-based public health initiatives is important given schools' role in public health (Estep and Greenberg 2020;Gard and Pluim 2014). Schools conduct health screenings, provide health services, promote physical activity and healthy eating, and offer health and sex education classes (Logan and Gilmartin 2004;Luker 2007;Sparling et al 2000;USDA 2019).…”

“…Schools conduct health screenings, provide health services, promote physical activity and healthy eating, and offer health and sex education classes (Logan and Gilmartin 2004;Luker 2007;Sparling et al 2000;USDA 2019). In many states, public schools also require immunizations (Estep and Greenberg 2020;NCSL 2021). Through these requirements, states have helped to achieve herd immunity against once-prevalent childhood diseases (Lindley et al 2008;Sobo 2016).…”

“…Under an individualistic and consumeristic medical model, people are expected to take responsibility for their health and avoid health risks (Clarke et al 2003;Estep and Greenberg 2020;Reich 2020a;Timmermans and Oh 2010). In this system, mothers and women who may become mothers face particularly strong pressures to control risks to their families' health (Burton-Jeangros 2011;Elliott and Bowen 2018;Gage-Bouchard 2017b;Mackendrick 2014;Ranji and Salganicoff 2014;Reich 2014Reich , 2020aUmamaheswar and Janani 2020;Waggoner 2017).…”

“…Yet, research does link parents' opposition to required childhood vaccination to their perceptions of vaccine risks (Berezin and Eads 2016;Kahan 2013;Reich 2016bReich , 2016aReich , 2020aXiao and Wong 2020). Research has also shown that women often direct families' decisions to avoid childhood vaccinations (Estep and Greenberg 2020;Reich 2014Reich , 2016bReich , 2016aReich , 2020aReich , 2020bSobo 2015;Sobo et al 2016), play a central role in anti-vaccine activism (Blume 2006;Dubé, Vivion, and MacDonald 2015;Reich 2016a), and are more likely than men to trust the kinds of non-medical expert sources that often spread vaccine misinformation (Freed et al 2011). Thus, in the context of growing attacks on the trustworthiness of medical experts (Berezin and Eads 2016;Kahan 2013;Seymour et al 2015), we may see that women are increasingly opposed to new public health initiatives.…”