Vaccines and the antivaccine movement were in the news a lot in 2015. The year started out with a huge measles outbreak originating at Disneyland over the holidays last year and dominated news coverage in the early months of 2015. This outbreak had enormous consequences. It galvanized public opinion such that something I had never thought possible before, least of all in the hotbed of the antivaccine movement that is California, became possible. After a prolonged debate, the California legislature passed SB 277, a law that, beginning with the 2016-2017 school year, eliminated nonmedical exemptions. Starting later this year, there will be no more religious or personal belief exemptions to school vaccine mandates.

Not surprisingly, as the bill wended its way towards passage, the antivaccine movement ratcheted up the rhetoric to ridiculous levels, its favorite analogy being, of course, comparisons to fascism. Some even went so far as to liken antivaccinationists to Jews in Nazi Germany, including everyone's favorite obnoxious antivaccine pediatrician Dr. Bob Sears, who became a leading spokesperson against the law while using it as a marketing tool. After SB 277 passed, the antivaccine movement went even more bonkers, with Robert F. Kennedy, Jr., Brian Hooker, and Barbara Loe Fisher teaming up with the Nation of Islam, which latched on to last year's main antivaccine story that had managed to bleed over to this year, namely the "CDC whistleblower" pseudo-scandal. There was even a rather pathetic joint protest in Atlanta at the CDC attended by representatives of the Nation of Islam in concert with Barbara Loe Fisher and Robert F. Kennedy, Jr.

Through it all, as much as I waded into the crazy in the name of science and reason, there was one crazy I didn't encounter—until now. I'm referring to the arrogance of ignorance personified, someone who likes to brag about being a Mensa member while heaping contempt on science and making spectacularly stupid arguments about vaccines (and other things). Yes, we're talking Vox Day (a.k.a. Theodore Beale), who is really, really psyched about a recent study:

The news that anti-vaxxers are whiter, wealthier, and better-educated than those who place blind faith in vaccines won't surprise anyone who has actually engaged a vaccine enthusiast on the subject. None of them know anything about history, few of them know anything about science, and all of them are prone to simply repeating the usual vaccine scare rhetoric:

Oh, yes. I can see why Vox would like this study. In his mind it confirms his own view of himself, as being intellectually superior to all of us mere sheeple who accept the science behind vaccines, support vaccination as the single most effective means of preventing many deadly diseases, and devote considerable time to refuting the pseudoscience promoted by antivaccine loons like Vox Day. Of course, if he were so intellectually superior, he wouldn't so horribly misunderstand epidemiology in order to blame sudden infant death syndrome (SIDS) on vaccines with such spectacularly brain dead arguments, nor would he cough up such a hairball of asininity (to borrow one of his phrases) that involves a fundamental misunderstanding of herd immunity and how vaccines work. Of course, that's part of the problem that he shares with his fellow antivaccinationists, as we will see.

So what about this study? It's in the January issue of the American Journal of Public Health and entitled Sociodemographic Predictors of Vaccination Exemptions on the Basis of Personal Belief in California. It comes from investigators at George Mason University and Stanford University, and its goal was quite simple: To examine the variability in the percentage of students with personal belief exemptions (PBE) to school vaccine mandates in California and see if there are correlations with income, education, race, and school characteristics. Investigators examined PBE data from the California Department of Public health from 2007 to 2013, including school- and regional-level models. Their rationale is as follows:

Use of nonmedical exemptions has increased over time, especially in states that make them easy for parents to obtain. In California, the percentage of schoolchildren with a nonmedical or “personal belief” exemption (PBE; defined as including both philosophical and religious objections), climbed from 0.77% in the 2000–2001 school year to nearly 3.15% by 2013–2014—well above the median rate of 1.8% across all states. Media commentators on this phenomenon have suggested that the number of PBEs in California had doubled since 2007 and pointed to wealthy, highly educated parents as the primary drivers. Although some evidence suggests that higher exemption rates are associated with higher population proportions of Whites, college graduates, and higherincome households, few rigorous, multiyear studies have investigated data beyond 2007, hindering efforts to understand and respond to recent rises in PBEs.

I actually wrote about one such study six months ago, when I referred to the faces of antivaccine parents as "overwhelmingly affluent, white, and suburban." The study basically found pretty much what I described. PBE rates correlate positively with the percentage of white students in a school, with charter status, and private schools, while schools with low PBE rates tended to be public, noncharter, and nonsuburban, with lower percentages of white students and higher percentages of students receiving subsidized lunches. The current study, which Vox likes so much, shows similar results but in a different way.

When presenting data, I like to say that a picture is worth a thousand words (not that that ever stopped me from describing a result using a thousand words, of course). So here's the picture. What it shows is the overall, state-level relationships between PBEs and key variables from the analysis.

As you can see, in general, 2013 PBE percentages were higher in regions with higher income, education, and White population. So, yes, there's a correlation there. But it's not quite as clear as Vox would make it seem, which is not surprising given that it's obvious that he just read the news reports but didn't actually look up the paper. He leapt at the observation in the New York Times article describing the study, which described it thusly:

Exemption percentages were generally higher in regions with higher income, higher levels of education, and predominantly white populations. In private schools, 5.43 percent of children were exempt, compared with 2.88 percent in public schools.

Which is true enough, but the Nicholas Bakalar, the author of the NYT piece, missed a very key part of the study. It's a part of the study that the writer for Ars Technica, Beth Mole, who wrote about the story didn't miss. Basically, the study did not show that higher educational attainment predicts the likelihood of PBE percentage. Quite the opposite, in fact. The authors, in describing their model predicting change in PBEs over time, report:

Educational attainment did not independently predict 2013 PBEs. More educated populations had slower rates of change in PBE percentages from 2007 to 2013 (P ≤ .01). For example, in the school-level block group model, a 10% increase in the percentage of the population with a college degree was associated with a 0.025% decrease in the annual rate of growth from 2007 to 2013.

In other words, there was a negative correlation between the percentage of the population with a college degree and the rate of PBE growth from 2007 to 2013. Or, as the authors explain:

We found that areas of California with higher household income and proportion White population are associated with higher overall PBE percentages as well as greater increases in PBEs from 2007 to 2013. In contrast to some previous studies, we did not find an independent predictive effect of educational attainment level once we controlled for those characteristics. Although the marginal effects of income and race were modest in magnitude, the overall PBE percentage doubled from 2007 to 2013, and more than 17 000 PBEs were issued in California in 2013.

In other words, although there might be a correlation in the raw data between educational level of the population and percentage of PBEs, it's not an independent predictor. Control for other socioeconomic factors, and it the correlation between education and PBEs goes away. To be honest, I was rather surprised by this result, not so much because I think antivaccinationists are more intelligent, but rather based on my personal experience of constantly hearing antivaccine activists proclaim how educated and intelligent they are I rather expected there to be a correlation. I also rather expected there to be a correlation because more educated people tend to be much better at motivated reasoning; namely constructing arguments and cherry picking data to protect their pre-existing beliefs. Of course, this is just one study, and the authors note that their results don't agree with some previous studies. Even so, I can't help but feel a bit of amusement at how quick Vox was to latch on to this study as confirming his self-image of being oh-so-much more intelligent than everyone else.

Of course, it's hard to take anyone seriously, Mensa or no Mensa, who says such howlingly stupid things as:

The very simple fact of the matter is that vaccines are far, far less important in halting the spread of infectious disease than controlling entry and immigration from non-first world countries. This is obvious, since vaccine rates are still very high in the USA and Western Europe, and yet there is a massive rise in various diseases that is the direct result of global travel and large-scale immigration. The idea that the current vaccine schedule is responsible for the huge decline in deaths from infectious diseases in the 19th century is not merely ahistorical, it requires a combination of ignorance and stupidity. This will become readily apparent before long as most children will continue to be vaccinated but disease rates will continue to rise thanks to the behavior and lifestyles of the New Americans.

Um. No. Overall vaccination rates might be high in the US, but there are pockets of low vaccine uptake in, yes, affluent white suburbs, particularly along the coasts. Guess what? That's where the outbreaks are happening! As for Europe, Vox is clearly rather ignorant if he thinks vaccine rates are so high in Western Europe. Indeed, health officials in Western Europe are envious of us in the US because there are way, way more cases of measles there every year right now. I know Vox thinks it's because of what he views as all those damned dirty apes immigrants flooding Europe, but in reality it's almost entirely due to low MMR uptake.

Meanwhile, Vox is, in his usual brain dead fashion, parroting the myth of the "diseased illegal immigrant." In fact, children from central America have higher vaccine uptake rates than children in, for example, Texas:

Fact check: UNICEF reports that 93 percent of kids in Guatemala, Honduras and El Salvador are vaccinated against measles. That’s better than American kids (92 percent). Furthermore, it’s absurd to claim that the U.S. has eradicated measles while Central America has not. In fact, measles outbreaks have resurged in some American cities. By contrast, according to the World Health Organization, neither Guatemala nor Honduras has had a reported case of measles since 1990.

Truly, Vox Day's stupid, it burns. Same as it ever was.

In the meantime, waht are the implications of this study, which Vox so wildly mischaracterized? One implication is that simply disseminating information will not persuade antivaccine parents, but we've known this for a long time. In this area, what the authors of the study conclude makes a lot of sense:

Some have reasoned from findings that high-PBE communities are better educated that public health strategies should focus on disseminating more scientific data on vaccine safety and the consequences of vaccine preventable illnesses.27 Our results call into question the reported link between high-PBE communities and higher average educational attainment, and other research also points to the need for messages that extend beyond providing vaccine safety data. For example, although there is little doubt that misperceptions of vaccine risks drive vaccine refusals, also important may be beliefs among upper-income, White parents that protective parenting techniques are effective substitutes for immunizations.

If you follow the antivaccine movement as long as I have, you'll soon realize the overwhelming sense of privilege among antivaccine parents. They don't feel any obligation to contribute to herd immunity, while thinking nothing of sponging off of it, hence "Dr. Bob" Sears' famous admonition to "hide in the herd." They also have an exaggerated sense of what parenting alone can accomplish beyond any connection with reality. For example, many of them really do seem to think that just by feeding their children the right foods, engaging them in the "right" activities, providing them with the "right" supplements, and in general having them live the "right" lifestyle, they can render their child virtually immune to harm from infectious disease. (Calling Bill Maher!) Couple that with a belief that "natural" immunity from the disease is better than vaccine-induced immunity (which to them is artificial), and such parents believe that their children's immune systems can handle anything, no vaccines needed, and that measles and chicken pox parties are a great way to give their children that "natural immunity." It's a dangerous delusion. I like to call it immunity by virtue: Live virtuously and you'll be healthy and no microbe will harm you. Unfortunately, microbes don't give a rodent's posterior how virtuous your or your child's lifestyle is.

It's easy to make fun of idiots like Vox Day because, well, he's such an arrogantly ignorant putz, prone to having proposed racist Donald Trump-like ideas years before Donald Trump embraced them. Refuting this ideas that drive antivaccine sentiments is hard because people are inherently resistant to having their deepest held beliefs challenged.