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Tuesday, February 16, 2016

Cover Sheet & Handout for Legislators in Olympia!

Is There Actually A Vaccination Problem in WA?

HB 2009 seeks to eliminate our existing right to take a philosophical exemption to vaccine requirements for school entry.  This discards our right to Informed Consent by threatening the education of our children in order to force vaccine compliance. 

In an emergency, we want our public health bodies to take necessary action. 
We are not currently facing a public health crisis that would warrant such legislation.

(1) Every disease that can be effectively controlled with a vaccine is being effectively controlled with a vaccine. Larger outbreaks of disease come from vaccine failure, not vaccine refusal.
(2) Deceptive statistics are being used to suggest large numbers of parents are refusing all vaccines. This is false. Most children who have a vaccine exemption have skipped or deferred a single vaccine, not all of them.
(3) Diseases which are NOT vaccine-preventable are far more dangerous for the immuno-compromised than those we can vaccinate against. 

The right to Informed Consent and the right to a Free and Appropriate Public Education each stand independently. Rights are not interchangeable. Requiring anyone to choose between any rights sets a dangerous precedent.

We are not facing an emergency that justifies interfering with access to public education.  Such legislation sets a dangerous precedent that makes sense only in the midst of a public health disaster on the scale of the 1918 influenza epidemics. We are not currently in such a disaster, nor are we likely to be in one. Voluntary vaccination is working.

Is HB 2009 warranted or appropriate for Washington State? No. 

Medical Paradigms Matter

Medical paradigms are the basic models that shape how we think about medical questions.    Having a correct paradigm can drive major advances. Having an incorrect paradigm can blind us to mistakes, even serious ones. A dramatic example of this phenomenon can be seen in the history of cholera.

Cholera is a disease that causes death by dehydration, often within 24 hours. In the 1850’s, cholera ravaged London. No one knew what caused it, only that people were dying by the thousands. There were many theories as to the exact cause of cholera, but many of them centered on a single paradigm: miasma. In this paradigm, disease is caused by foul odors.  

Edwin Chadwick, now considered the father of public health, advocated tirelessly for government to take responsibility for public infrastructure to protect the health of society. He wanted to clean the air and rid the city of cholera. So he dumped all the human waste of the city into the Thames river, which also served as the city’s main water supply.

Cholera is waterborne. It is estimated that 15,000 people died.

John Snow was an anesthesiologist and Henry Whitehead was a minister. These two “outsiders” began to explore the issue with fresh eyes - and they presented strong evidence that cholera was waterborne. Now we revere them. But at the time, the establishment disregarded their evidence, calling them idiots and amateurs. As it turns out, they were entirely correct.

Edwin Chadwick was also correct. Government has a moral obligation to support public health, which is why we honor him. He was dedicated to the common good. But his first strategies to support that common good were disastrous, because his premise was flawed. 

Today, we face a similar paradigm problem around the social science of vaccine medicine. The unquestioned paradigm of most vaccine education is that people fall along a continuum from very pro-vaccine to very anti-vaccine, and that people can be moved along this continuum in a predictable way through a combination of education and force. Almost all of our current public health communication is based on this “Continuum Paradigm”. There’s only one problem: it’s not true. 

There have been very few social science studies done on vaccine decision-making, but none of them support the continuum paradigm. Two of these studies are at the back of this packet for your consideration. 

Acting on a false paradigm causes unpredictable results at best.  Sometimes, it costs lives.

The Simplifer/Delegator/Questioner Paradigm

The S/D/Q paradigm is quite different from the Continuum paradigm. Instead of focusing on what people decide, the S/D/Q paradigm focuses on how people decide. The S/D/Q paradigm has not yet been directly tested in clinical trials. However, it does match the data from existing studies about vaccine attitudes. The S/D/Q paradigm has also been implemented with great success on Vashon Island as a way to reduce hostility and improve communication.

The S/D/Q paradigm states that for any given area of health care, an individual will choose one of three strategies:

Simplify:  Create a simple rule about this type of medical care, usually pro or con.

Delegate:  Find a trustworthy authority figure and follow instructions.

Question:  Collect data from a variety of perspectives and take personal responsibility for decisions based on that data.

When discussing vaccines, each of these strategies offers something vital to the larger society.

(1)  Simplifiers, whether pro or con, offer vital protections to society. 
  1. Anti-vaccine Simplifiers raise awareness about vaccine problems. Our first drug safety law, the Biologics Act of 1902, was passed after anti-vaccine Simplifiers raised awareness about a contaminated vaccine batch that killed a number of children.  
  2. Pro-vaccine Simplifiers support everyone’s access to vaccine medicine. The Vaccines for Children program exists because pro-vaccine Simplifiers made sure it got passed and funded.

(2)  Vaccine Delegators reflect the decisions of other people, magnifying the effects enough so that statistically significant conclusions can be drawn.

(3)  Vaccine Questioners promote the best possible use of science by continually asking questions. This allows discoveries that can improve our use of vaccine medicine, and protects us against rigid assumptions.

What is changing (and what is not)?

Many people have observed an apparent trend of increasing vaccine exemption rates and concluded with some alarm that anti-vaccine sentiment is on the rise. This is incorrect and based on both the false Continuum paradigm and deceptive statistics.

There is no increase in anti-vaccine Simplifiers. This is the group that is called anti-vaccine extremists in the old, inaccurate Continuum paradigm. They generally call themselves anti-vaxxers.  This group has held stable at less than 3% of the population for more than 100 years.

There is a large shift from Delegators to Questioners. This shift is not just found in vaccine medicine. We have seen this shift in every area of health care over the last 50 years or so.  There are many reasons for this shift, including general skepticism of authority, changes in the practice of medicine, and the increasing availability of information via the internet.
There is also a huge shift in how we define vaccine exemption. Consider, if you will, a six year old child who is fully vaccinated against rotavirus, diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, chickenpox, Hib, pneumococcus, and hepatitis A. This child even just had his annual flu shot.  Most people would consider this child vaccinated. But according to many statistics, this child is classified as “unvaccinated” because his parents chose to defer the Hepatitis B vaccine until adolescence.

This bizarre definition of “unvaccinated” also means the rate of “unvaccinated” kids will rise every time a new vaccine is introduced. Most kids with vaccine exemptions are vaccinated.  

This gets even more absurd when people start making hysterical claims that the unvaccinated kids are going to bring back polio. In fact, vaccination rates for polio are high. In other words, skipping the chickenpox vaccine will not bring back polio. 

For that matter, nearly the entire adult population would be considered “unvaccinated” if held to the same standards as schoolchildren! Are you “unvaccinated” by these standards?

Contrary to recent hysteria, the measles/mumps/rubella (MMR) vaccine also continues to be a very popular vaccine. Measles is one of the most contagious diseases on earth. If Disneyland had more liberal refund policies, it is possible that the contagious individual would have stayed home and saved us all a lot of time, money, and stress. Regardless, this highly contagious virus was introduced into the best possible environment for transmission, followed by many of the exposed individuals getting on airplanes and flying all over the world. Despite this perfect storm of exposure, less than 200 people got measles. This is what herd immunity looks like.

Delegators & Questioners Need Different Messaging

The false Continuum Paradigm leads to many serious errors when communicating about vaccines. The three different styles respond very differently to information. Using the wrong approach is a waste of resources at best and counterproductive at worst.

Simplifiers can and should be disregarded for the purposes of public health messaging. There aren’t enough of them to alter the patterns of disease transmission and they are not going to change their passionate beliefs because of any public health campaign.

Delegators are swayed by appeals to authority. Large amounts of data tend to make them uncomfortable and overwhelmed.

Questioners dislike and distrust appeals to authority. They prefer large amounts of data, including complex data and ambiguous data.

Certain characteristics in the overall population tend to lead to better health outcomes: more education, higher incomes, and more involvement in health care. However, these same characteristics also produce a population that has a relatively high percentage of Questioners.  Current public health messaging is not meeting the needs of this demographic.  Instead, the focus has been on trying to make Questioners act and think like Delegators.  This approach will not work.
Rather than fearing an independent thinking and highly-educated population, we need to capitalize on it. It is time to develop new communication strategies that will meet the needs of both Questioners and Delegators. 

Visual model of the S/D/Q paradigm

Vaccines Simplifiers make up a small portion of the population. More than 90% of the population are either Delegators or Questioners.The ratio of vaccine Delegators to vaccine Questioners will vary based on demographic factors like income, education, and access to health care. The same factors that produce better health outcomes also produce more Questioners.

attach moving pie chart here

Scientific Studies refute the Continuum paradigm

In 2013, a study was done with the objective “to test the effectiveness of messages designed to reduce vaccine misperceptions and increase vaccination rates for measles-mumps-rubella (MMR).” The results were that, “None of the interventions increased parental intent to vaccinate a future child.” The conclusions of the article were that, “Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed.” Full text of the study may be found at

Interestingly enough, this effect is not limited to the United States. A similar study done in the UK had similar results, concluding that “Pro-vaccine messages may be counterproductive among vaccine-hesitant parents.” Full text of the study can be found at

Many similar studies exist. Any time we study the social science of vaccine attitudes, the results are not consistent with the continuum paradigm. By all the standards of science, the continuum paradigm is false. Continuing to build public policy on a false paradigm is unlikely to succeed.

The results of these studies are perfectly explained by the S/D/Q paradigm. While that does not necessarily mean that the S/D/Q paradigm is correct, it does indicate that the S/D/Q paradigm is worthy of further exploration and research. For more information on the S/D/Q
paradigm, please email us at or visit our blog: 

Overall summary
Medical paradigms matter. Taking action based on a false paradigm is risky and can cause unintended consequences. We have growing evidence that the continuum paradigm is false.

Voluntary vaccines continue to be popular. Removing the option of the philosophical exemption infringes on Informed Consent. This is a form coercion that is both unnecessary and may have the paradoxical result of reducing both the popularity of vaccines and confidence in vaccines.  

There is no current health crisis. Every disease that can be effectively controlled with a vaccine is being effectively controlled with a vaccine. Small outbreaks, such as the Disneyland measles outbreak, are to be expected in high-density situations. Large outbreaks, such as the pertussis outbreaks, are the result of vaccine failure, not vaccine refusal. 

Monday, February 8, 2016

Community Conversations Article (Just Published!)

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Unintended Consequences - Learning From History

Right now, we are facing a serious threat to our safety and freedom. As is so often the case, this threat is coming from good people, well-intentioned people who seek only to protect society.  But good intentions aren’t enough.

In the 1860’s, the United States had a serious problem with alcohol. Whether drinking beer, wine, or stronger spirits, the average adult drank the equivalent of two and a half gallons of pure alcohol per year. (2) After decades of preaching against the evils of alcohol, the Temperance movement abandoned education in favor of legal coercion:  the complete ban of alcoholic drinks.  In 1919, the 18th amendment to the constitution was passed, and Prohibition began.

The effects were disastrous. Prohibition gave us organized crime and corrupted every part of the justice system. In 1933, Prohibition was repealed as a failed experiment. Today we’re back to drinking about two and a half gallons of alcohol per person. (3) But now we have AA to help people who wish to stop. We have MADD and SADD to prevent drunk driving. We have laws restricting the sale of alcohol to children. While there is still much progress to be made, we are learning to live with alcohol in a way that limits harm.
Prohibition was a simplistic response to a complex problem that endangered us all and continues to cause problems to this day. Corruption and organized crime are not in anyone’s best interests.  Even those who choose to completely abstain from alcohol are safer in a nation in which alcohol is legal.

There are well-intentioned people who believe that the only way to save society from disease is to force vaccination on each and every person, child and adult alike. But like Prohibition, this is simplistic and dangerous. It’s also based on several pervasive myths.

Myth 1:  There is an increasing fad of refusing all vaccines that, left unchecked, will eliminate the benefits of herd immunity and cause outbreaks of dangerous diseases.  

What a terrifying idea. Who wouldn’t support forced vaccinations if the only alternative was epidemics? But this myth is not true.

Reality:  There is neither a downward trend nor a future likelihood of mass vaccine refusal.  Vaccination rates are actually holding steady or increasing for most vaccines.

So what about all these unvaccinated children we hear about in the news? They’re mostly vaccinated! Consider a group of ten kindergarteners which contains one child who skipped the chickenpox vaccine, one child who deferred a Hepatitis B vaccine, and one child who has received only 4 of the 5 pertussis vaccinations. That group of children is marked in the statistics as 30% unvaccinated. This is absurd. In fact, these children represent only 6 missed vaccines out of 390 vaccines administered which equals an “unvaccinated” rate of .01%. This group is 99.99% vaccinated and herd immunity is strong! 

Myth 2:  Forcing people to use a beneficial medical intervention could not possibly cause harm.

Reality:  Direct force is a dangerous tool that often has unexpected negative side effects.  

Prohibition was not intended to strengthen the Mafia, but it did. Even if vaccines had no risks whatsoever, the risks of undermining Informed Consent vastly exceed any potential benefits. Especially given that a group reported to be 30% unvaccinated can actually be 99.99% vaccinated. 

Myth 3:  We are in the middle of a public health crisis that can be resolved with higher vaccination levels.

Reality:  Every disease that can be effectively controlled with an existing vaccine is being effectively controlled with an existing vaccine. 

Even with 100 percent vaccination levels, measles outbreaks are inevitable if a contagious individual goes to a crowded place like Disneyland or New York City. Even perfect herd immunity does not prevent these kind of outbreaks, it just keeps them small. Large outbreaks of diseases like pertussis and influenza result from vaccine failure, not vaccine refusal (1). 

So, let’s talk about Informed Consent.

When you meet with your doctor, your doctor will make various health recommendations. You may choose to follow or decline those recommendations and you may ask to discuss other options. But you don’t need your doctor’s permission to make those decisions. That’s what Informed Consent means.  

It’s a violation of Informed Consent for your doctor to obtain your compliance through threats.  It’s an equal violation for your school, employer, or government to do so. Attacking your education, your employment, your custody of your children, and your housing are all forms of coercion that infringe upon your right to Informed Consent.

Informed Consent means you have the right to say “yes” or “no” to a medical recommendation without fear of punishment for either answer. Vaccine medicine is powerful and has the potential for great good. Coercion does not. Let us learn from the mistakes of the past. Let’s keep our vaccines available, affordable, and voluntary.

             (baboon study)
(alcohol consumption 1850-1983)
             (alcohol consumption 1935-2010)

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world.  This article was co-created by Karen Crisalli Winter and March Twisdale.   BLOG:   Email:

Act Now - Protect Informed Consent (here's how!)

Hello all! 

My most recent article (co-written with Karen Crisalli Winter) has just been published and we’re sharing it here. It serves to illuminate both the thoroughly inaccurate method of tracking vaccine compliance and the very real dangers inherent to any law that denies citizens their right to Informed Consent. Remember, bad laws that end up in the Supreme Court (and are judged unconstitutional) often could have been stopped in the legislature by an active and engaged citizenry. Now is the time to pay attention and speak with your representatives.

State regulatory agencies & some state medical associations share a heavy bias in favor of Government Medical Mandates. The mis-information campaign that has been created through flawed analysis or outright “gerry-mandering” of data is deeply unsettling. And yes, your rights as a patient are under threat.

All of us are called upon to ensure that our legislators receive accurate information should HB 2009 come to a house vote. Legislators are people, like you and me, who have only so many hours in the day. As such, they depend upon us to bring new and important information to their attention. We cannot scold them for poor voting choices, if we do not also step up to raise their awareness. 

How to approach your representative successfully:
Please be respectful and clear in your communication. Choose one issue that matters to you most. OR...if you are fluent on several aspects of this issue, ask your representative (or your Rep’s aide) what is the most important question he/she has? 

Remember to ask, “What is your #1 question about this issue?” 
Do not ask about their #1 concern or fear. 

Why? Because you want your representative to think. That’s right...we’re trying to replace a “belief or assumption” that they have likely formed over the past few years of intense, country-wide propaganda...with independent thought. When they say, “This is my #1 fear,” then we are put into the unenviable position of explaining to them why they are WRONG. How their fear is NOT valid. We are thrust into the role of DENYING their concern. How well does that work in any relationship? 

We want them to solicit our opinion. Seek our advice. Ask us for answers. Because then, we’re giving them what they want and what we want at the same time. Imagine a Representative who says, “Well, let me think...okay, here’s the main question I have about vaccines in WA state. What are we supposed to do about pertussis and immune compromised kids in the schools?” 

Ooooh...doesn’t that just sound NICE? They’ve given you a problem that, if you can solve it, will meet their need. YOU get to be the good guy or gal! 

Your reply might be, “That is a great question! (compliment) Because, honestly, you’re right. (confirmation) We all want Washington to be a safe and healthy place to live. (plant seed) And, what I’d like to share with you today (limit yourself to only one answer) is an NIH/FDA Baboon Study which was released in November of 2013. This well-received and un-contradicted study finally helped the CDC and others within the vaccine medicine scientific community confirm that the upswing of Pertussis cases in the past decade - despite higher vaccine rates for pertussis than ever before in American history - was being caused by a flaw in the vaccine. Not one batch, either. The vaccine, at it’s highest and best, actually serves to ONLY reduce symptoms in those who get sick...making them unaware that they are sick at all. Meanwhile, they are still spreading the bacterium readily to their immuno-compromised friend at school. Clearly, as a tool for reducing the spread of pertussis, a vaccine that has been proven to mask symptoms is insufficient. And the argument for mandating this vaccine (or withholding a child’s education) falls flat. (pause here, in case they want to ask for the link to the study, etc.) 

(Then, on the way out, give them something to vote FOR):

Of course, we all want to use legislation to improve public health when possible, and something that does help improve public health is people staying home when they are sick. So, you could support HB 1356 which supports sick leave for all employees in WA State. (this is an empowered message to leave them with, rather than simply leaving them deflated and believing there’s nothing they can do)

Friday, December 4, 2015


It occurred to me today, that...


“To sweep across the state, one day at a time, contacting all Representatives & Senators in WA State about my research into the importance of maintaining the Informed Consent Ethic, the reality that Medical Science Evolves, the Dangers inherent in all medical interventions, and the Importance of NOT over-estimating Vaccine Medicine Efficacy or the Infallibility of professionals within the Medical Field.”



Is what?

Saturday, October 24, 2015

Why Pro-Vaccine Advocates NEED Vaccine Exemptions

A Community Conversation About Health and Responsibility: Vaccines and Beyond

Informed Consent: Why Fully-Vaccinated Citizens Need Vaccine Exemptions

When you go to the doctor, you may take the right to informed consent for granted. The doctor makes a recommendation, which usually includes information about the risks and benefits of that recommendation. You may choose to follow that recommendation, ask more questions or decide to do more research before making a decision. Perhaps you choose to seek a second opinion. In the end, you may refuse the doctor's recommendation. These are all your rights under informed consent.

Imagine, for a moment, going to a doctor for medical advice regarding a procedure. The doctor gives a recommendation which you listen to respectfully. Before you have a chance to make up your own mind, the doctor casually mentions, "Oh, by the way." "If you don't agree to my recommendation, you will be kicked out of school and/or fired from your job. This medical procedure is mandatory in the state of Washington. But as long as you're willing to give up education and employment, feel free to make your own decision."

Would you be okay with this? Even if you absolutely agreed with the doctor's medical opinion and planned to follow the recommendation, would you be comfortable being subjected to this kind of coercion?

History tells us repeatedly that patient involvement in their own health decisions is vital for safe and effective health care. When coercion becomes part of health care, people get hurt. Even if that coercion is well-intended.

Freedom of speech protects us all, but only if we defend it universally. For instance, we don't get to pick and choose whose speech is acceptable enough to be worth protecting. That freedom is protected for all of us. To protect your own rights, you must protect the rights of others, even if you strongly disagree with them. Even if you think they're dangerous idiots. Rights are rights.

The right of informed consent also protects us all. To retain this right, we must all defend it, in every area of healthcare. Allowing a profit-driven industry with known conflicts of interest to decide which areas of medicine and which patient groups deserve the benefits of informed consent is a naive and dangerous proposition.

In 2015, a very small handful of representatives in Olympia crafted & tried to pass HB 2009. This bill was designed to eliminate our right to file a Philosophical/Personal Vaccine Exemption on behalf of our families and our children. It was designed to coerce parents into compliance by threatening their child's access to childcare and public/private education.

The corporate pharmaceutical companies are using powerful marketing techniques to undermine the right of informed consent. Their messages suggest that informed consent is a public health risk and that only mandates can save us all from the scourge of disease. This is fear-mongering. Such legislation will undermine public health while it increases corporate pharmaceutical corporate profit. Any medication or drug (as vaccines are classified according to the CDC) that can be made universally mandatory guarantees a universal consumer base for the manufacturer and a predictable profit. This is even more so if the manufacturer is protected from liability for any harm that drug may cause.

In 2015, corporate pharmaceutical lobbyists spent more than $2 million on changing California vaccine laws.* Laws were passed that remove the right of informed consent for both children and adults. Vaccination is now required for all school children including homeschoolers who meet in a classroom environment. Children who are missing even one vaccine are only allowed to be educated in isolation at home or in independent study programs that involve no classroom contact. In addition, no adult in California may work in any form of childcare or preschool without proof of vaccination and this includes parent co-ops. If any money is exchanged to pay for a program, vaccines are required for both paid staff and volunteers.  *Source: Sacramento Bee

It is important to note that the California measles outbreak did not spread through schools. It happened because someone who was contagious with measles went to Disneyland where they still have a strict "no-refund, no exchange" policy for any reason...including active, contagious measles. Oddly, no legislation to mandate refund or exchange policies for businesses has been introduced into the CA legislature.

In 2015, we succeeded in defending our right to informed consent in Washington, but in 2016, we expect a much harder fight in Olympia. And so, we are preparing in advance!
Please join us the effort to protect informed consent. Here's how you can help:

1.  Review some of the posts on this blog. Expand your viewpoint and information base. Our legislators need to hear some new information, not repetitions of the same tired themes.

2.  Contact legislators in Olympia. When doing so, think strategically. In Olympia, there are those who are committed to their viewpoint and nothing you say will sway them. So, don't waste your time. Instead, reach out to those voting members of our legislature who may care a great deal but just don't know much or those who appear to be on the fence. Remember that they have the right to ask questions and there are many great viewpoints we can offer them.

3.  Talk to both your legislators and your friends about the complexity of this issue and the importance of informed consent to them and their loved ones. No matter what the news and lobbyists tell you, coercion is bad medicine and poor public health policy. 

“A Community Conversation About Health and Responsibility: Vaccines and Beyond” is an ongoing series written by two close friends with a passion for improving community cohesion and building respectful relationships in a diverse world. This article was co-created by Karen Crisalli Winter and March Twisdale. 
Learn more at our BLOG:  

Contact us to get more involved:  

Monday, June 1, 2015

S/D/Q Paradigm is in the mail to WA State legislators!

Hello all!

Karen and I are headed back to Olympia on Wednesday, June 10th (homeschooled kids in tow) for another day of conversations with WA state elected officials. In addition to those we spoke with on St. Patrick's Day, we've mailed the following description of the S/D/Q Paradigm to every member of the House Health Care & Wellness Committee and also the Senate Health Committee.

If you share with us your reason for wanting Washington State to stand up for Informed Consent, we will carry it to Olympia for you! [email:]

If your doctor has dismissed your or your child's adverse reaction, despite your clear description of the events, please share your experience. The assumption that the "medical exemption" is sufficient (because all doctors will respond appropriately and protect children at risk) is a dangerous one that puts too high of a burden upon medical professionals who average only 16 minutes per patient in the USA.

Please enjoy, consider, and share the SDQ Paradigm with your friends & family. It invites thought!

The S/D/Q Paradigm:
Simplifier/Delgator/Questioner:  A new paradigm for talking about vaccines

It has always been an unquestioned assumption that people fall on a continuum from “pro-vaccine” to “anti-vaccine”. Until quite recently, it has also been an unquestioned assumption that people could be moved along this continuum through education. However, recent studies are calling these assumptions into question. Multiple studies have found that pro-vaccine messaging has the paradoxical effect of decreasing confidence in vaccines among the so-called “vaccine hesitant” parents. Two such studies are referenced here:

This has caused some to conclude that the so-called “vaccine hesitant” are stupid, uneducated, or  anti-science.  However, this is not consistent with demographic data, which identifies so-called “vaccine hesitant” parents as having a significantly higher level of education than “vaccine compliant” parents.

We suggest there is a fundamental flaw in all of these studies: vaccine choices do not fall on a single continuum. Instead, we have seen evidence to suggest that how people decide is the crucial issue in need of exploration and understanding. With twenty-five years of observation under our combined belts, we have observed and defined three basic decision-making styles: Simplifier, Delegator, and Questioner. All three are valid, offer value to the community, and deserve our respect.

Simplifiers make decisions by simplifying a complex subject into a few basic rules. These are the folks who will say “All vaccines are safe” or “All vaccines are dangerous.” This is the only group where pro-vaccine and anti-vaccine are accurate labels. There aren’t a lot of these folks, but they are the ones you are most likely to meet at a public meeting when the issue of vaccine medicine is on the table. Simplifiers serve an important purpose in our democracy. At their best, Simplifiers are powerful advocates. Pro-vaccine Simplifiers create an environment that supports everyone’s access to vaccine medicine. As many public health strategies depend upon broad societal use of vaccine medicine, this is great for public health. However, society also benefits from the voices of anti-vaccine Simplifiers who publicize problems with vaccine medicine. This helps to guarantee the safety of the vaccine supply.  For example, our first drug safety law, the Biologics Act of 1902, was passed after Anti-vaccine Simplifiers raised awareness about a contaminated vaccine batch that killed a number of children.

Delegators are quite different. They make decisions by selecting an expert they find trustworthy and following their instructions. Delegators may do a great deal of research on selecting that expert, or none at all. While many Delegators choose to trust government-sanctioned entities, such as the CDC, or accept the advice of their chosen family doctor; others choose a friend, relative, book, celebrity, or religious leader as their expert. Either way, their vaccine choices reflect the opinion of their chosen expert. Since most government and medical experts align themselves with the CDC, most Delegators follow the CDC schedule.

Questioners tend to feel solely responsible for their final decision. Therefore, they focus on data collection, analysis, and all possible options. This research introduces them to the variety of information that science offers on the subject of vaccine medicine. Questioners develop a high level of comfort with ambiguity and the complexity of both vaccine science and the human immune system. Yes, Questioners often seek out experts as sources of information, but they shoulder the burden of making the final decision willingly, as a necessary cost of medical freedom. Their final decisions vary dramatically, with some Questioners seeking out vaccines that are not yet on the schedule, some Questioners choosing the CDC schedule, some Questioners choosing a custom vaccine schedule, and a few rare Questioners declining all vaccine medicine entirely.

Contrary to popular media hype, we would like to suggest that there is not a huge surge in “anti-vaxxers.”  Anti-vaccine Simplifiers are a tiny percentage of the population, as are pro-vaccine Simplifiers. These percentages have remained steady for more than a hundred years, and they’re not likely to change anytime soon. While they are a powerful force politically, Simplifiers can and should be disregarded for the purposes of public health messaging. There aren’t enough of them to alter the patterns of disease transmission and they are not going to change their passionate beliefs because of any public health campaign.

There is, however, a huge generational shift from Delegators to Questioners. Sixty years ago, patients rarely questioned doctors. Delegation was expected and made sense when the average citizen was lucky to have a high school diploma. Questioners were found mostly within professional scientific circles. With Questioners nearly as rare as Simplifiers, public health messaging was aimed exclusively at Delegators.  Appeals to authority were extremely effective, especially if paired with scare tactics about the hazards of disease and the danger of not trusting your doctor. Vaccines mandates were seen as just another form of expert advice.

These strategies still work very well for Delegators. However, these days up to 40% of parents are Questioners, especially in highly educated areas. The strategies that worked through the 1970’s don’t work now.

When you present Delegator-oriented messaging to Questioners, they are offended by the idea of simply obeying a doctor (even if they like the doctor) and suspicious of scare tactics. Unlike Delegators, Questioners want to be given lots of information. They are reassured by data, not frightened by it, and they accept ambiguity as normal in a field of medical science. They prefer honest uncertainty to oversimplification. We also find that Questioners reject the legitimacy of medical mandates, which is why heavy-handed legislation consistently meets with strong, morally-rooted objections. Even if a Questioner would have voluntarily chosen the behavior that is being mandated, they will stand up for their right to make that decision without coercion in any form.

In short, there is not an increase in anti-vaccine sentiment. There is a shift in how people make decisions about health care. Current public health messaging has failed to take this shift into account, creating (in some areas) alarmingly low vaccination rates. Old strategies of scare tactics, appeals to authority, and mandates will not succeed. These tactics are outdated and counterproductive.

So, what do we do? Rather than fearing independent thinking and a highly-educated population, we need to capitalize on it! It is time to develop new communication strategies that will meet the needs of both Questioners and Delegators. The main difficulty comes from the fact that Delegators become more confident when urged to trust an expert, but less confident when given lots of data. Questioners, meanwhile, become distrustful when urged to follow expert advice, but more confident when given lots of data. On the plus side, both Questioners and Delegators readily self-select messages that work for them. Given that advertisers routinely target niche markets with great success, it shouldn’t be too difficult to gently steer people towards the kind of messaging that will enable us to talk about the evolving subject of vaccine medicine in a rational and productive way.

To do this, however, we will need strong leadership from Olympia and - to gain the respect of Questioners - this means our state must make an absolute commitment to the medical ethic of Informed Consent.

The S/D/Q paradigm warrants further study as a valuable tool for public health.

For more information on the S/D/Q paradigm, please email us at or visit our blog:  

Our first article on the S/D/Q paradigm can be found at

Friday, April 10, 2015

Assumptions VS Reality

When it comes to Vaccine Medicine, people tend to think that their perspective is the "reality" and that those who disagree with them are making "erroneous assumptions." What if everyone is both right and wrong about this?

The issue of "science-ism" (which we'll talk about more later) is important to understand. In a nutshell, "science-ism" is what happens with a person begins to relate to "science" as people often relate to religion. Blind faith, trust in authority figures, belief that concrete & unquestionable answers have been attainted...all of which is the EXACT OPPOSITE of what science really is. Right?

So, in the spirit of "always questioning everything" and "making observations," here is a list of thoughts that challenge the status quo. Which is what science excels at...