Some threats to the social order, such as crime, drugs and terrorism, give rise to ongoing alarms. To understand both the alarms and their persistence, it is useful to draw on two bodies of theory. Moral panic theory addresses alarms about groups or activities that transgress social norms, proposing several characteristic features, but does not explain why a moral panic would persist. Several concepts from studies of scientific controversies, including the lack of impact of new evidence, help to explain how a moral panic might continue indefinitely. To illustrate the combined use of moral panic and controversy theory, the case study of the alarm over unvaccinated children and criticisms of childhood vaccines is used. Persistent panics potentially have several negative consequences, especially for groups targeted as causing a danger.
A moral panic is an alarm in society about a group or activity that is seen as transgressing social boundaries, posing a threat to the moral order. Sociologist Stanley Cohen conceptualised moral panics, using the examples of the Mods and the Rockers in Britain in the 1960s.
Since Cohen’s formulation, many social scientists have studied moral panics, in the process proposing modifications or extensions of the original idea.
In some cases, moral panics may seem relatively harmless, being in retrospect little more than a manifestation of current moral strictures. However, many panics have significant consequences for the stigmatised group, namely the folk devils, and can lead to laws, policies and practices with far-reaching effects.
Of special interest are panics that involve major social mobilisations over a lengthy period, with ongoing impacts. Examples are the war on drugs, the war on crime and the war on terror. In each case the “war” has continued for decades and has had drastic consequences for individuals, groups and entire countries caught up in campaigns of attempted eradication.
In each of these examples, the so-called war has served to define and unify an in-group by vilifying an out-group. The out-groups are variously users of illegal drugs, criminals and terrorists. By stigmatising these groups, the rest of society is sanctified: the danger to the in-group is expelled symbolically, and sometimes sent to prison or death.
Underlying the concept of moral panic is the assumption that a society’s response to folk devils is unreasonable or disproportionate to any danger.
Moral panic theory has most commonly been applied to relatively transient issues, ones that in retrospect seem misguided or even amusing, as revealing more about society than about the folk devil in question. Sustained alarm-based mobilisations, such as the wars on crime, drugs and terrorism, have attracted extensive popular and scholarly attention, but more commonly from the framework of social problems than moral panics.
Cohen’s original formulation of moral panics has been modified and extended in various ways. For example, it has been linked to processes of moral regulation,
The approach here is to analyse a particular long-standing social issue using a moral panic framework to see what insights it can provide. For this purpose, the starting point is close to the original formulation of moral panic theory by Cohen and his interpreters. The issue addressed is vaccination, a highly contentious topic. In the next section, the usual moral panic stages and features are presented and mapped onto the vaccination controversy. After this, the issue of whether alarm about vaccine hesitancy and vaccine critics is proportionate to the danger they pose is addressed. At this point in the analysis, concepts from the study of scientific controversies are introduced and applied to the vaccination debate, helping explain the persistence of the vaccination controversy. In the conclusion, the relevance of this analysis to other issues is outlined.
The focus here will be on childhood vaccines, in particular the ones recommended by governments for all children for the past few decades and that have been the focus of public discussion about vaccination during this time.
Vaccination involves exposing a person to a small dose of an agent, called a vaccine, with the aim of stimulating the immune system so that the person is resistant to exposure to a virus or a bacterium causing a disease. For example, the polio vaccine contains small amounts of modified versions of polio viruses designed to stimulate the immune system but not cause polio.
Vaccines have been developed for a large number of infectious diseases, and many more are in development. Governments recommend that children receive specified vaccines at particular ages, for example, in Australia, hepatitis B vaccine at birth and the combined vaccine for measles, mumps and rubella (MMR) at 12 and 18 months, as well as many other vaccines.
Vaccines are supposed to provide protection against full-blown disease, but sometimes immunity is not sufficiently stimulated, or wears off over time. Furthermore, some people receive little or no benefit from certain vaccines, for instance very young children and people whose immune systems are compromised, for example due to drugs to treat cancer.
An important concept is herd immunity. For infectious agents that spread from person to person, if very few people are susceptible to the agent, then it has difficulty spreading—local outbreaks are more likely to contract over time than to expand—thus providing protection to the community, known as the herd, hence the term
Vaccination is routinely lauded as one of the greatest contributions to public health. It is backed by nearly all governments and health authorities, as well as by nearly all researchers in the area.
Critics of vaccination raise a number of concerns.
The vaccination issue is commonly posed as a conflict between supporters and opponents, between pro-vaxxers and anti-vaxxers. This misrepresents the diversity of views in the area. Many parents want their children to receive most but not all vaccines, or to receive them all spaced out in a schedule different from the recommended one. Some proponents consider all such parents to be anti-vaxxers, so classifying anyone who does not adhere to the recommended vaccination schedule. Also muddying the picture are parents who support vaccination but whose children are not fully vaccinated due to obstacles, for example difficulties in accessing a doctor; such parents outnumber those conscientiously opposed to vaccination. The misleading dichotomisation into pro-vax and anti-vax treats vaccination as a unity, to be supported or opposed in full, and lays the basis for stigmatising critics.
In the past two decades, alarm about reluctance to vaccinate and criticism of vaccination has become a frequent theme in countries such as Australia and the US. In 2019, the World Health Organization declared vaccine hesitancy—“the reluctance or refusal to vaccinate despite the availability of vaccines”—to be one of the top ten threats to public health worldwide.
Kenneth Thompson in his book
First, a group or activity is defined as a threat to the community. Children who are not fully vaccinated are seen as a threat to other children. In the US, this threat is used to justify barring unvaccinated children from school. Parents who do not ensure that their children are vaccinated are often seen as responsible for disease outbreaks.
Second, in Thompson’s model, there is a suitable media portrayal of the threat. In Australia and the US, cases of measles are newsworthy, with media reports commonly quoting authorities who comment about the danger and blame “anti-vaxxers” for the danger.
Third, public concern builds rapidly. Vaccination does not fit this feature of moral panics particularly well. Alarm about infectious diseases has been around for decades. There are some periods when concern grew about particular diseases, but concern about vaccine scepticism and hesitancy seems to have developed gradually.
Fourth, opinion leaders and authorities respond. This is certainly the case for vaccination. Opinion leaders, including politicians and health authorities, have raised the alarm about vaccine-preventable diseases. As noted above, governments have taken measures to promote vaccination. The most extreme measures are in some US states, such as California, where religious and conscientious objections to vaccination have been disallowed for the purposes of children attending school.
Fifth, in Thompson’s model, eventually the panic fades away, with or without social changes. In the case of vaccination, the panic is in full swing. Some major changes have been made, and more can be anticipated.
In summary, the moral panic framework applies reasonably well to vaccination, except that concerns about vaccine critics have developed more gradually and been more persistent than the typical panics studied. Vaccination might be classified as a slow-motion panic, or a sustained panic, in contrast to relatively short-lived or localised concerns about Mods, Rockers, satanic rituals, school violence or teenage pregnancy.
Erich Goode and Nachman Ben-Yuhuda provide a somewhat different set of indicators for moral panics: heightened concern over the behaviour of a group; hostility towards the group; general consensus that the threat from the group is real and serious; alarm about the group’s activities being disproportionate to its threat; alarm rising suddenly and then fading away suddenly.
Since the original formulation of moral panic theory, there have been several new developments: the mass media are no longer so dominant; the concept of moral panic has gained currency outside the academy; folk devils can fight back, including by using social media; and entrepreneurs can try to manufacture moral panics for commercial reasons.
In applying the moral panic framework to vaccination, there is an important issue to address: proportionality. Supporters of vaccination can and do argue that unvaccinated children and vaccine critics are actually a serious danger to public health and that strong measures to ensure high levels of vaccination are warranted. In other words, if there is a panic, it is a reasonable response proportionate to the risk.
Addressing the issue of proportionality is challenging because it goes to the heart of vaccination as a scientific controversy, a topic introduced in the next section. On many points there are claims and counterclaims seemingly without end, so reaching a definitive endpoint can seem impossible. Rather than trying to make a conclusive statement about proportionality, all that will be attempted here is to show that a plausible case can be made that a generalised alarm about unvaccinated children and vaccine critics is disproportionate to the danger they pose, and hence that strong measures to ensure high levels of childhood vaccination for all vaccine-preventable illnesses are excessive in relation to the danger they are intended to counter, recognising that any conclusion in this area is bound to be disputed. What constitutes a “strong measure” is a matter of judgement, and can be debated. Barring unvaccinated children from attending school is treated here as a strong measure.
It is important to acknowledge that not being vaccinated for a particular disease can permit harm to a person’s health and, should they contract the disease, they may possibly infect others. In addition, someone who questions vaccination and discourages this person from being vaccinated can be contributing to harm to the person’s health. The question is not whether non-vaccination and vaccine criticism are potentially harmful but rather whether the alarm about them is proportionate to the danger they pose. That is a complex issue for a number of reasons, so it is worthwhile unpacking some of the assumptions often made in discussions about vaccination.
In talking about a panic about vaccination, it is useful to distinguish between two related alarms. The first is alarm, or simply concern, about children who have not been vaccinated. The second is alarm about people who raise concerns about vaccination—vaccine critics—and about people who have concerns, even if not expressed, something called vaccine hesitancy. These two alarms are related in various ways, the most important of which is that vaccine critics may cause others to develop reservations about vaccination.
For the purposes of assessing whether alarms associated with vaccination are unnecessarily great, it is useful to refer to two claims, each corresponding to one of the two related alarms. The first claim is that the panic about children who have not been vaccinated is disproportionate to the danger they pose. The second claim is that the panic about vaccine critics is disproportionate to the danger they pose.
To look at the issue of proportionality, there is yet another complication. Vaccination, as a practice, is not a unitary entity but consists of different vaccines for different diseases. Much of the alarm about unvaccinated children and vaccine critics is undifferentiated: all vaccines are packaged together so far as public discourse is concerned. But when looking at risk and proportionality, it is important to note that the contents of the package are not uniform.
The dynamics of different vaccine-preventable diseases differ considerably. Some are highly contagious, most notably measles, whereas others are less so: tetanus is not contagious at all. Therefore, the collective benefits from widespread vaccination vary considerably from one vaccine to another. Similarly, the individual benefits vary enormously. Without vaccines, some diseases previously infected nearly every child, for example mumps and chickenpox; vaccines prevent most of these illnesses, but with variable personal benefits, since only a few who contract mumps or chickenpox suffer long-lasting harm. On the other hand, without vaccines, some diseases, for example rotavirus and pneumococcal disease, affect only a small proportion of the population. More generally, the harms caused by different diseases vary dramatically from person to person. For example, many people have HPV (human papillomavirus) in their system, but only in a small proportion does this lead to cervical cancer. Then there are the risks from vaccines, which can vary from one to another. Some vaccines lead to vanishingly small numbers of reports of adverse events, whereas many more adverse events are reported for others, such as the HPV vaccine.
Because the patterns of vaccine-preventable diseases vary so considerably, as do the benefits and risks of vaccines for different diseases, it can be argued that there should be separate policies for different vaccines, or at least groups of vaccines that have similar impacts, rather than a single category of “vaccination”. Various analogies can be drawn, for example to transport or sport. The danger from riding a motorbike is, per kilometre, far greater than the danger from travelling by passenger jet, so it makes sense to raise concerns about specific modes of travel rather than transport in general. Similarly, the danger to health from boxing is far greater than the danger from swimming, so it makes sense to raise concerns about specific sports rather than sport in general.
Here, I will distinguish between claim 1-vax, that the alarm about children who are not fully vaccinated is disproportionate to the danger they pose, and claim 1-measles, the alarm that children who are not vaccinated against measles is disproportionate to the danger they pose, and other analogous claims such as 1-polio and 1-rotavirus. Similarly, I will distinguish between claims 2-vax, 2-measles, et al., that the alarm about people who raise concerns about vaccination in general, or about specific vaccines, is disproportionate to the danger they pose.
The argument here is that there is strong evidence for more than one of the specific claims in the 1 category and, ipso facto, for the corresponding claims in the 2 category. There is also evidence for the more general claim 1-vax, but it is not as strong as for some of the specific claims in category 1. Note again that these are claims about disproportionality, not about the benefits of vaccines. It is quite possible for a vaccine to have nett benefits (for individuals and the population) yet for the alarm about unvaccinated children and about vaccine criticism to be excessive compared to the danger they pose.
First consider 1-polio: the claim that alarm about children not being vaccinated against polio is disproportionate to the danger they pose. Not being vaccinated against polio is sufficient for a child to be considered unvaccinated and hence, in the US, unable to attend school without an exemption, and some states allow exemptions only for medical reasons. Also, not being vaccinated against polio is enough for the parents of such a child to be given the label “anti-vax” and otherwise stigmatised. In short, not being vaccinated against polio is enough, in the US at least, for invocation of the full set of measures and attitudes associated with vaccine refusers.
What is the danger? In the US, there have been no cases of polio for two decades. The level of vaccination needed to achieve herd immunity is probably less than 90%.
Second consider 1-tetanus. Not being vaccinated against tetanus is sufficient for a US child to be considered unvaccinated. Herd immunity is irrelevant because tetanus is not contagious. Hence the alarm about children who are not vaccinated against tetanus is excessive compared to the danger—certainly the danger to others.
Third consider 1-mumps. Prior to the availability of a vaccine, mumps was “a nuisance widely considered so harmless it was a frequent butt of jokes.”
So, next consider 1-vax, the claim that the alarm about unvaccinated children is disproportionate to the danger they pose. This claim can be considered an amalgam of the claims for each vaccine in the schedule. A child who has received only three of the four doses of the inactivated polio vaccine recommended in the US, while receiving all other vaccines, is considered unvaccinated. Alarm about the danger posed by this child is, if 1-polio is accepted, disproportionate. To rebut 1-vax, it is necessary to show that some unvaccinated children pose such a danger that public alarm is warranted. To consider this issue, it is useful to look at four risk comparisons: deaths, collective benefits, economic costs and resurgence. Of various possible comparators, here alcohol is used most commonly because reducing alcohol consumption has both individual and collective benefits.
The first risk comparison concerns deaths. The number of deaths from vaccine-preventable childhood diseases is extremely low compared to those from many other causes. For example, the number of deaths per year of US children from measles is close to zero, and there are very few childhood deaths from other infectious diseases.
The second risk comparison concerns collective benefits. Proponents of vaccination continually highlight the importance of herd immunity, by which high levels of individual immunity to a disease protect those who cannot be immunised. However, the same sort of collective benefit would result from lower levels of drinking: as well as benefits to drinkers themselves, there would be benefits to others in the form of less domestic violence and fewer traffic accidents. A community of teetotallers would provide collective health benefits. Governments have introduced some measures to reduce the dangers, for example random breath testing. However, the level of alarm about alcohol is far less than that about vaccine-preventable disease. There are news stories about a few cases of measles
The third risk comparison concerns economic costs. Illnesses often result in loss of income or interruption to schooling. It can reasonably be argued that high levels of vaccination for a particular disease, even if the disease caused no deaths or disability, could result in considerable cost savings, thus benefiting the community through lowered expenditures. However, do cost savings provide a suitable rationale for a continual alarm about unvaccinated children and vaccine critics? There would be cost savings from a reduction in alcohol consumption, soft drink consumption, and various other changes in diet and behaviour, but failure to make such changes, while increasing costs to the community, seldom lead to alarms. Another possible comparison is with exercise: lack of exercise contributes to ill health, yet there is little in the way of a continual alarm about individuals who do not exercise and the costs they impose on the community through their greater levels of ill health.
The fourth risk comparison concerns resurgence of disease. It is important to address the argument that rates of vaccination-preventable diseases are low today precisely because vaccines are successful. If this is the case, then alarm about possible declines in vaccination rates, and about the influence of vaccine critics, might be warranted, namely proportionate to the danger. This is analogous to arguing that alarm about declining investment in fire prevention, such as fire engines and fire drills, is warranted even though the damage due to fires is fairly small, because the damage might increase.
How can this argument be addressed? One possibility is to compare rates of disease and death due to vaccination-preventable diseases in countries with and without high levels of vaccination. The challenge is finding comparator countries that are otherwise similar, and this is likely only for diseases where governments in some countries recommend vaccination whereas those in other countries do not. Furthermore, to the extent that recommendations vary according to the circumstances, as they should, including varying assessments of risks, benefits, costs and priorities, this sort of comparison will not be very informative. Another possibility is to examine rates of disease and death in the same country before and after introduction of mass vaccination for specific diseases. If the rates of disease before mass vaccination were large and seen as unacceptable, then it can reasonably be argued that concern about declining rates of vaccination today, and about vaccine critics, is warranted.
There is yet another complication. In before-and-after-mass-vaccination comparisons, should the measure be the number of cases of disease, the economic cost of disease or the number of cases of disability and death? If someone has the flu or mumps or chickenpox and recovers, is this of sufficient import to raise an alarm?
Vaccination proponents regularly cite the massive death toll from influenza in the aftermath of World War I, the high levels of deaths from measles and diphtheria a century ago, and the human cost of polio before vaccinations. However, a possible resurgence of infectious diseases does not provide a rationale for present vaccination policies. For highly infectious diseases such as measles and pertussis, the death rate prior to mass vaccination in countries such as Australia and the US was not all that great compared to today’s major causes of death.
The scare about mass death from infectious diseases sometimes is about a new virus, such as swine flu or bird flu. But current vaccines (pre-Covid) are unlikely to provide protection against a new virus
This examination of the rationales shows that there is a lack of strong evidence warranting alarms about unvaccinated children and vaccine critics. This is especially true when children are considered unvaccinated because, although receiving some or most vaccines, they have not received all of them, or not within the recommended time frame. In other words, they are partially vaccinated or have had their vaccines spaced out, but are categorised as unvaccinated and considered a cause for alarm, as evidenced by policies banning them from attending school. The possibility of a resurgence of an infectious disease does not offer a sensible rationale for creating alarm about the relatively small number of children who have not received some or all recommended vaccines.
It is reasonable to have a concern about infectious disease and to take measures to prevent illness and death. Furthermore, it is plausible that the nett benefits of widespread vaccination, in terms of health and cost, are significant. The point here is that the alarm about unvaccinated children and criticism of vaccines is disproportionate to the danger when comparisons are made with other causes of preventable death and disease.
In summary, there is strong evidence for claims 1-polio, 1-tetanus and 1-mumps, namely that alarms about children unvaccinated against these diseases are disproportionate to the dangers they pose; there is similar evidence for many other claims in the 1 category. This evidence is also strong for claims 2-polio et al., namely that alarms about critics of vaccines for these particular diseases are disproportionate to the dangers they, the critics, pose. As for claims 1-vax and 2-vax, there is also more general evidence, via risk comparisons, regarding deaths, collective benefits, economic costs and resurgence, though this evidence is not as strong as for many of the specific claims such as 1-polio and 2-polio. In addition, claims 1-vax and 2-vax can be thought of as an amalgamation of various specific claims, such as 1-polio and 2-polio, for which there is strong evidence, indicating that the alarm about anyone who is not fully vaccinated or who criticises any vaccine is far too sweeping, incorporating as it does a disparate collection of partially unvaccinated individuals. Although by the assessment here, the evidence is strong, it is neither definitive nor uncontested. It is to be expected that vaccination proponents will argue that concerns about less-than-fully-vaccinated children and vaccine critics are fully justified. Note again that the argument here is about a public alarm, not about the benefits of vaccination. It is quite possible to conclude that measures to promote vaccination are beneficial to individuals and society, while at the same time the alarm about unvaccinated children and vaccine critics is disproportionate to the danger they pose.
Pulling together these strands, persistent moral panics are likely to have these features: A group or set of ideas defined as a threat to the community Widespread condemnation of the group or ideas Attacks on the group or ideas by some politicians and media Alarm disproportionate to the danger.
However, there is more to the vaccination issue than these features. To get a handle on other features, it is useful to turn to studies of scientific controversies.
Polarisation refers to the coalescence of partisan positions into two opposing camps. This is most obvious in the language used: pro-vax and anti-vax. In polarised controversies, partisans deploy standard sets of evidence and argument, and make no concessions to opponents. Public scientific controversies typically involve disagreements about risks, benefits, ethics and decision-making. On all four of these areas, partisans always line up together. Proponents of vaccination say the benefits are large, the risks are minuscule, seeking high levels of community protection through herd immunity is the ethical option, and decisions should be made by health authorities informed by experts. Critics of vaccination say the benefits are overrated, the risks are greater than normally acknowledged, that informed and uncoerced choice is the ethical option, and decisions should be made by individuals and parents. Proponents and critics often talk past each other, not addressing issues and arguments presented by their opponents.
The significance of this sort of polarisation is that intermediate positions are marginalised. No one prominent in the vaccination debate says the benefits are large and the risks small, yet there should be no encouragement to vaccinate. Nor does anyone say the benefits are overrated and the risks understated, yet the nett benefit warrants strong pressures for vaccination. Anyone of stature who adopts such an intermediate position will have aspects of their stands trumpeted by opponents and be shunned by their erstwhile allies: there are enormous pressures to join one side or the other, or to drop out of the debate. An example is Robert Sears (“Dr Bob”), a US doctor who has recommended modification of vaccination schedules.
In many public scientific controversies, there are groups with an interest—a stake—in supporting a position. They do not need to be lead players, but their presence provides a continuing controversy driver. In the case of vaccination, pharmaceutical companies that manufacture and sell vaccines have the most obvious vested interest. The companies have not played a strong overt role in the vaccination debate but, at least according to critics, their influence on research and testing of vaccines can be influential.
The medical profession also has a stake in vaccination, because for decades it has lauded vaccination as one of the greatest ever contributions to public health. It would be embarrassing to admit that some vaccines are unnecessary, that the vaccination schedule is too full, or that the adverse effects of some vaccines outweigh their benefits.
Sociologists use the term “moral entrepreneurs” to refer to groups that promote concern, or panic, about a social issue.
One of the striking features of long-lasting scientific controversies is that new evidence seems to have little impact.
Another feature of many public scientific controversies is the sidelining of alternatives. In many cases, there are different ways to achieve the goals of campaigners, but these are subordinated to winning against opponents.
The goal of both supporters and critics of vaccination is to protect and improve health, especially children’s health. This is often forgotten in the heated condemnations of the other side. The focus of the confrontation is vaccination, but there are other ways to promote health, including ways to improve immunity to disease. Research has shown the value of good diet, exercise, mindfulness and sleep in improving immunity.
From this perspective, vaccine critics are convenient scapegoats, justifying an alarm about vaccine hesitancy and diverting attention from other paths for improving health. This brings controversy analysis in touch with moral panic analysis: the scapegoats are the folk devils.
Studies of scientific controversies thus suggest four additional features of persistent panics. The full set of features thus becomes: A group or set of ideas defined as a threat to the community Widespread condemnation of the group or ideas Attacks or criticisms of the group or ideas by some politicians and media Alarm disproportionate to the danger Polarisation of partisan positions into two opposing camps Groups with a stake in subduing opposition Failure of new evidence to affect partisan positions Marginalisation of alternatives.
In a persistent panic in which the alarm is disproportionate to the danger, there is an opportunity cost involved: excessive attention is given to a smaller danger, while larger dangers are relatively neglected. There is unfairness for groups targeted as sources of or responsibility for the danger. They, as the folk devils, are condemned and may be subject to harassment and discrimination.
In the usual formulation of moral panics, social changes result, and this includes new laws or selective enforcement of previously neglected laws. The new or newly enforced laws may represent institutionalised unfairness. They are also a key part of what makes a panic persistent: a return to the status quo ante requires changes to laws or enforcement practices.
These facets can be seen in the panic in the vaccination arena. As already noted, the alarm over vaccine criticism and hesitancy leads to relative neglect of other options for boosting immunity and for dealing with preventable causes of ill health. There have been extensive attacks on vaccine critics. In Australia, this has included abusive online commentary, complaints to government agencies, censorship of talks,
There is an injustice involved in measures that are more punitive than necessary to address the likely harm averted. In Australia, parents whose children are not fully vaccinated are denied a portion of welfare benefits they would ordinarily receive. Most parents subject to these penalties are not opposed to vaccination, but have failed to have their children fully vaccinated for practical reasons, for example distance from doctors.
There have been many studies of crime, drug problems, terrorism and other issues in which there is a long-lasting alarm about dangers to society. To better understand the processes involved in such “persistent panics,” two bodies of theory are drawn upon, using the issue of the alarm over vaccination hesitancy and vaccine critics as an illustration.
Moral panic theory provides a useful framework for understanding how a group or practice can be identified as a threat to the moral order, stigmatised and targeted with adverse actions. The alleged threat serves to unify the community in opposition, drawing on us–them dynamics. However, most moral panic analyses have been of alarms that subside in a matter of months or a few years. This leaves unexplained the phenomenon of persistent panics, ones that continue for decades.
The study of scientific controversies offers several concepts that help explain persistence: polarisation, the role of groups with vested interests, the failure of new evidence to affect partisan positions, and the marginalisation of alternatives. These help to explain why some public scientific controversies, such as those over pesticides and fluoridation, continue largely unchanged over many decades. On the other hand, controversy researchers have less often addressed the phenomenon of alarm over challenges to dominant scientific views, something better addressed by moral panic theory.
To illustrate the value of combining moral panic theory with controversy studies, the case study of vaccination is useful. The dominant view is that vaccination is beneficial and should be encouraged. But this isn’t all: in some countries for at least the past two decades, parents whose children are not fully vaccinated have become stigmatised, and public criticism of vaccination has been seen as a cause for alarm.
The response to vaccine critics and vaccination hesitancy shows several features of a moral panic, including identification of folk devils (the source of danger to the moral order), media amplification of the threat, responses by authorities, and alarm disproportionate to the danger.
The vaccination issue is also a scientific controversy, suggesting the value of drawing on insights from controversy studies. Like many other public scientific controversies, in the public debate over vaccination the two main sides are highly polarised: there is little space or encouragement for intermediate positions. There are groups involved with vested interests in vaccination, enabling a continuation of the debate irrespective of any new evidence. Finally, the prominence of the debate overshadows other options for improving children’s immunity and health.
The framework of moral panics can also be applied to the approach used by vaccine critics, which can involve trying to create an alarm about vaccine injuries and stigmatising of public health officials and other vaccination proponents. Vaccine critics have far fewer resources—money, jobs, authoritative endorsements, policies, infrastructure—than proponents, which can help to explain why the critics’ efforts have not created a panic except within restricted circles. If we imagine a different world in which alarm about vaccines is and remains greater than alarm about vaccine-preventable diseases, it is plausible that the same features of persistent panics would apply except with a different set of folk devils.
The combination of moral panic theory and controversy studies offers a way to understand persistent panics of various sorts, including panics over crime, drugs and terrorism. In each of these issues, there are stigmatised groups typical of the folk devils in moral panic theory: criminals, drug dealers and terrorists. These issues also show characteristics of public scientific controversies, for example the failure of new evidence to have any significant impact on continuation of the controversy. Therefore, it is safe to predict that these panics will not go away soon. Campaigners who are concerned about the injustices involved in “wars” on crime, drug and terror need to accept that logic and evidence are unlikely to make much difference, and to address the driving forces behind these persistent panics.
That said, addressing driving forces is a massive challenge, and even agreeing about what these driving forces are is likely to be difficult. All that can be done here is to note that a key feature of persistent panics is othering, including the stigmatisation of opponents, the folk devils. The categorisation of certain groups as enemies helps to foster solidarity within the in-group, with the consequence that there is an incentive to maintain an alarm. One counter to this process is fostering dialogue. For example, rather than stigmatising unvaccinated individuals and vaccine critics, engaging in respectful conversations may have more potential.
Thanks to Jason Delborne, Julia LeMonde, Sarah Monod de Froideville, Stephen Holden, and especially two anonymous reviewers for many valuable comments and suggestions.
Stanley Cohen,
For an overview of moral panic analyses, see Sarah Wright Monod,
In the preface to the third edition of his book, Cohen notes the importance of disproportionality to assessing a phenomenon as a moral panic.
Representative publications include Nils Christie,
Sean P. Hier, Dan Lett, Kevin Walby and André Smith, “Beyond folk devil resistance: Linking moral panic and moral regulation,”
Avi Brisman and Nigel South, “New ‘folk devils,’ denials and climate change: Applying the work of Stanley Cohen to green criminology and environmental harm,”
Amanda Rohloff,
Jennifer Carlson, “Moral panic, moral breach: Bernhard Goetz, George Zimmerman, and racialized news reporting in contested cases of self-defense,”
To refer to childhood vaccines is a convenient shorthand given that some vaccines are recommended for adults as well as children, notably the flu vaccine. The focus is on vaccines recommended for all or nearly all people, thus excluding ones, such as anthrax or yellow fever vaccines, usually reserved only for those who might be exposed to specific infectious agents.
Young children are not in a position to make informed decisions about vaccination; decisions about childhood vaccines are most commonly made by their parents. This raises important ethical issues, but these are not central to the analysis here drawing on moral panic theory and controversy studies.
Covid is used here as shorthand for COVID-19, which in turn is shorthand for coronavirus disease of 2019, the disease caused by the virus labelled SARS-CoV-2.
Australian Government, Department of Health.
Scientists continue to analyse matters concerning herd immunity; there are many complications. For an introduction, see Ben Ashby and Alex Best, “Herd immunity,”
The case for vaccination is presented, for example, in F. E. Andre, R. Booy, H. L. Bock, J. Clemens, S. K. Datta, T. J. John, B. W. Lee, S. Lolekha, H. Peltola, T. A. Ruff, et al., “Vaccination greatly reduces disease, disability, death and inequity worldwide,”
See for example Mateja Cernic,
On the shortcomings of the concepts of “anti-vaxxer” and “antivaccine movement”, see Gabriela Capurro, Josh Greenberg, Eve Dubé and Michelle Driedger, “Measles, moral regulation and the social construction of risk: Media narratives of ‘anti-vaxxers’ and the 2015 Disneyland outbreak,”
World Health Organization, “Ten threats to global health in 2019,” 2019,
Kenneth Thompson,
For example, Steven Reinberg, “Low vaccination rates and Disney measles outbreak,”
For example, Jeremy Laurance, “Andrew Wakefield’s MMR vaccine theory has been discredited for years, but he just won’t go away,”
For example, Autumn Johnson, “Anti-vaxxers to blame for Disneyland measles outbreak, report concludes,”
Erich Goode and Nachman Ben-Yuhuda,
Angela McRobbie and Sarah L. Thornton, “Rethinking ‘moral panic’ for multi-mediated social worlds,”
A number of philosophers have argued the case for compulsory vaccination: Jessica Flanigan, “A defense of compulsory vaccination,”
See figures reported in Lucija Tomljenovic and Christopher A. Shaw, “Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odds?”
Paul E. M. Fine, “Herd immunity: History, theory, practice,”
There is a complication: tetanus vaccination is normally part of the DTP (diphtheria, tetanus and pertussis) triple vaccine, so in practice it is unlikely that a child would receive vaccines for diphtheria and pertussis but not tetanus. Parents who want to pick and choose vaccines for their children may have limited options. However, this does not change the logic of the 1-tetanus claim.
Elena Conis,
Ibid., 81: “… as the seventies progressed,
It is possible to argue that the danger from unvaccinated children and vaccine critics warrants alarm, and that the problem is that there is not sufficient alarm about other dangers, such as those from alcohol. Economists deal with comparative risks by, for example, calculating the cost of preventing one death through various measures, for example installing handrails or mandating airbags in cars. Setting aside the value judgements involved in such calculations, this does not solve the problem of determining whether alarm about a risk should be considered warranted, exaggerated or insufficient: perhaps greater or lesser alarms would be appropriate for a whole suite of risks. Few moral panic analyses address this general issue, seemingly setting the criteria for disproportionality by observing discrepancies from attitudes and policies concerning commonly accepted risks. That is the path taken here.
Some assessments of mortality take into account the number of years of life forgone, so that the death of a child involves the loss of more years of potential life than the death of an adult, especially the death of an elderly person. This would mean that the deaths of children from infectious diseases would weigh more heavily than the deaths of adults from, say, cirrhosis of the liver. Another complication is that some children die from domestic violence, much of it perpetrated by alcoholic parents. In addition, children of alcoholics are more likely to become alcoholics themselves and to suffer foetal alcohol syndrome, which can greatly reduce life expectancy. Given these complexities, no attempt is made here to make comparisons that take into account years of life forgone. It is useful to reiterate that the argument here is about alarms, not deaths or years of life.
Goodarz Danaei, Eric L. Ding, Dariush Mozaffarian, Ben Taylor, Jürgen Rehm, Christopher J. L. Murray and Majid Ezzati, “The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors,”
Frank H. Beard, Brynley P. Hull, Julie Leask, Aditi Dey and Peter B. McIntyre, “Trends and patterns in vaccination objection, Australia, 2002–2013,”
Stephen S Holden, “Who speaks for ‘we’ speaks not for ‘me’—the vaccination debate,”
Advertisements for alcoholic drinks are not permitted in some media and venues, and sales to children are restricted. Taxes on alcoholic drinks are an important economic disincentive. These and other measures intended to reduce alcohol consumption are important. There are alarms about particular behaviours by drinkers, notably driving and domestic violence, but the stigma attached to these behaviours seldom carries over to “social drinkers”. In comparison, the stigma attached to being less than fully vaccinated and criticising vaccines applies to all, not just those with problematic behaviours such as meeting with others while knowingly being infected.
Morgan Krakow, “A tourist infected with measles visited Disneyland and other Southern California hot spots in mid-August,”
In the US in the 1950s, about 450 measles deaths were reported annually: Walter A. Orenstein et al., “Measles elimination in the United States,”
To the extent that flu aggravates the effects of Covid, and to the extent that flu vaccines protect against the flu, it might make sense to promote flu vaccination to reduce the burden of Covid. The same could be said of anything that improves health, including exercise, good diet and avoidance of toxins.
It is possible that criticism of childhood vaccines can lead to greater vaccine hesitancy so that when a new agent arrives on the scene—as in the case of the new coronavirus—there is greater vaccine hesitancy concerning vaccines for the new disease. On the other hand, if members of the public become sceptical about some childhood vaccines because they seem unnecessary or pose an undue risk of adverse reactions, they may carry this scepticism over to new vaccines for a much more deadly disease. In other words, those who believe the alarm about childhood vaccines is excessive may not respond with alacrity to more urgent alarm bells. How to assess the role of these factors is not obvious.
H. Tristram Engelhardt, Jr. and Arthur L. Caplan, eds.,
Harry M. Collins,
Despite the name, these “scientific controversies” are not just about science, but typically involve differences in views about ethics, economics, dissent and decision-making. These seemingly “non-scientific” aspects of the controversy interact with knowledge claims so that, for example, judgements about scientific findings are influenced by ethical factors and research agendas are influenced by governments and corporations with a stake in the controversy, which means that “the science” can be less than comprehensive and objective. On scientific research agendas being shaped, see, for example, David J. Hess,
From a sociological perspective, to call a dispute a scientific controversy does not entail a judgement about the validity of the arguments. A controversy can exist even when the overwhelming weight of expert scientific opinion lies on one side; indeed, this is a common configuration. Accordingly, to refer to vaccination as being controversial does not imply that the sides are equally balanced in credibility, influence or anything else.
Floriana Gargiulo, Florian Cafiero, Paul Guille-Escuret, Valérie Seror and Jeremy Ward, “Asymmetric participation of defenders and critics of vaccines to debates on French-speaking Twitter,”
Robert W. Sears,
Paul A. Offit and Charlotte A. Moser, “The problem with Dr Bob’s alternative vaccine schedule,”
For example, Peter Aaby has done research showing that DTP (diphtheria, tetanus and pertussis triple vaccine) increases the mortality rate in poor countries, but this has not affected vaccination recommendations. See Peter C. Gøtzsche,
See for example Howard S. Becker, “Moral entrepreneurs: The creation and enforcement of deviant categories,” in
Stuart Blume,
That a controversy lasts for decades despite ongoing research can be taken as indicating that new evidence has little effect, at least on the persistence of the controversy. It is extremely rare for a partisan in such a controversy to significantly change their viewpoint, again suggesting that evidence is not sufficient to bring the controversy to a close. One of the few partisans to change sides after reviewing evidence is John Colquhoun, “New evidence on fluoridation,”
In the fluoridation controversy, proponents trumpet studies showing large reductions in tooth decay but rarely mention critiques of the benefits of fluoridation (e.g., Mark Diesendorf, “The mystery of declining tooth decay,”
G. S. Goldman and P. G. King, “Review of the United States universal varicella vaccination program: Herpes zoster incidence rates, cost-effectiveness, and vaccine efficacy based primarily on the Antelope Valley Varicella Active Surveillance Project data,”
Richard J. Davidson et al., “Alterations in brain and immune function produced by mindfulness meditation,”
Jennifer A. Reich,
There are important public health campaigns promoting exercise, good diet and sleep. The point here is that these areas are seldom mentioned in public commentary by vaccination proponents.
It is possible to justify censorship, depending on the circumstances. Neil Levy, “No-platforming and higher-order evidence, or anti-anti-no-platforming,”
However, there are complications in applying Levy’s ideas to the vaccination issue, in which no single person is an expert on all facets of the issue. Levy gives the example of an epidemiologist having opinions about vaccination. However, an epidemiologist is not, solely by virtue of epidemiological expertise, an expert on vaccination policy or on individual vaccination choice. Expertise in relation to such issues is better understood as a collective accomplishment. It may be just as problematical to allow an epidemiologist to comment on vaccination policy as for an economist, psychologist or ethicist.
Another consideration is that some speakers seek to be no-platformed (i.e., to provoke attempts to block their speeches) so they can be seen as victims and attract greater interest and support for their ideas. This has been called censorship backfire.
Levy writes “But audiences seem warranted in assuming that reputable media organisations and other institutions filter out unrepresentative individuals unless they are genuinely exceptional in their expertise” (496). There are too many counterexamples to make this assumption across the board. Edward S. Herman,
Frank H. Beard, Brynley P. Hull, Julie Leask, Aditi Dey and Peter B. McIntyre, “Trends and patterns in vaccination objection, Australia, 2002–2013,”
Julie Leask and Kerrie Wiley, Submission 327 to the Senate Community Affairs Legislation Committee regarding the Social Services Legislation Amendment (No Jab, No Pay) Bill 2015.
There are many studies seeking to explain questioning of the consensus scientific view about climate change, but few studies probing into why this is such a preoccupation.
Julie Leask, Paul Kinnersley, Cath Jackson, Francine Cheater, Helen Bedford and Greg Rowles, “Communicating with parents about vaccination: A framework for health professionals,”