With flu season upon us and the opening of flu vaccine clinics, we can expect advertisements, reminders and encouragement to get ourselves and our children vaccinated. We can also expect to hear arguments and explanations from friends, colleagues and family members about why they do not get immunized against influenza.

While the efficacy of the flu vaccine varies from year to year, immunization is our best means for diminishing the average 12,200 flu-related hospitalizations and 3,500 deaths from flu across Canada annually reported by Statistics Canada. The influenza vaccine is widely recognized by health professionals to be a safe and effective way of protecting ourselves and our communities.

So why the reluctance to accept the scientific consensus on vaccines?

We can ask this question about not only influenza vaccine but also childhood vaccines and vaccines for older adults, such as shingles. While the reasons for vaccine hesitancy are many, Canadian media turned the spotlight last week on the precipitous spread of anti-vaccine myths via online forums as a driver of vaccine refusal (see here and here).

But before we blame the sources of misinformation, we might ask why people visit these vaccine-skeptical websites at all. We are all presumably aware of the varied quality of internet information, and the scientific consensus is uncompromising in its messaging of safety and efficacy. Shouldn’t this be enough? Many commentators lament “anti-science” sentiments and “science denialism”; they wonder why the questioning public doesn’t “believe” in science.

But the terms “believers” and “deniers” don’t capture the dispute accurately. Science, when it’s done well, is our most accurate means of understanding the natural world. There is no need for “belief.”

Vaccine skeptics do not reject science per se, but rather challenge the trustworthiness of scientific governance — how research is prioritized and funded, how trials are designed and evidence collected and analyzed, which studies get published, and how scientific evidence is used to inform policy decisions. The critics charge scientific institutions with bias — say, having financial interests that work against the public interest.

Criticisms of the slanted priorities of scientific institutions are far greater than the small numbers of vaccine refusers. Surveys of public attitudes reveal a low trust in medical and government institutions. Policy wonks wring their hands over the death of expertise, as scientists — and more importantly, the scientific consensus — appear to have lost their secure footing as an authoritative source of reliable knowledge.

The science consensus is the collective judgment of the community of scientists in a particular field of study. Consensus statements capture the state of general knowledge within a field, often to inform practice and policy or to educate the public about important matters.

Consensus statements earn their legitimacy through rigorous debate and scrutiny by expert communities of scientists. The methods include the negotiation of conflicting views in academic conference settings and in expert journals, peer review and the replication of findings.

Yet the mechanisms used to ensure the trustworthiness of that information are internal to the scientific community and are therefore largely shielded from public view. The public is expected, even implored, to trust the source.

Most members of the public are willing to do this. Despite being largely unable to judge the contents of the consensus statement and how the consensus was reached, nonexperts choose to trust the consensus as scientifically accurate, and to trust that the information has been conveyed honestly.

When members of the public challenge the consensus view, they do not reject science but, rather, challenge the integrity of the statement. They do not trust the source, and thereby question the content of the consensus statement.

We trust those whom we perceive to have our best interest at heart. If we do not find that in our family physician, who might dismiss vaccine concerns and shut down debate, we turn to family, friends and online communities of like-minded people.

Public trust is gained by meaningful engagement and responsiveness to concerns. Communications must be directed at the actual concerns of parents rather than dismissive commentary, such as “adverse events following immunization are extremely rare.” Parents, after all, want to know if their child will be one of those rare cases.

The common refrain that Big Pharma is corrupting vaccine research (and health research in general) should be a flag for our health care institutions to seriously regulate and curtail those questionable relationships between the health care profession and for-profit industry.

Public institutions must not only be trustworthy, but the public needs to recognize them as such. Otherwise, public health cannot fulfil its mandate to safeguard public health and well-being.

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Vaccine hesitancy is a symptom of poor public trust in scientific institutions. Earning and maintaining the public trust is crucial for fulfilling public health mandates.

Maya J. Goldenberg is a professor in the department of philosophy at the University of Guelph. Her research addresses the fundamental epistemic question “How do we know what to believe?” in health care.

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