For a Canadian physician with ostensibly more productive ways to spend my time, I have spent far too many hours following the circus known as the Republican presidential primaries, headlined by the dreadful Donald Trump. Like the majority of Canadians, I have been disgusted by his racism, his bigotry, his arrogance, his disagreeability, his demagoguery, his inability to answer questions with a grain of truth, his hyperbole…etc, etc.
Most of us cannot fathom how Trump can hold any appeal to an electorate. During any of his speeches or press conferences, I will scream at my television, “C’mon Trump supporters! That has to be the last straw! You can’t support him after he says something like that!”
Yet they stand by him. As Trump famously attested, he could stand on 5th Avenue and shoot somebody, and many of his supporters would still vote for him. And he likely isn’t wrong.
This phenomenon was described last week by pundits as Trump’s support having “calcified”. When I heard this term, a light bulb went off for me, and I realized that we have been dealing with this exact phenomenon in medicine for years.
The “calcification” of the anti-vaccine movement.
Many Trump supporters often begin their Trumpism innocently enough. They are frustrated with government, and gravitate to an anti-establishment candidate. But then they are shown evidence that their candidate has serious flaws. And rather than evaluate evidence both for and against their candidate, they view all criticism through the lens that it must be biased against Trump. With more criticism, more delusions of persecution follow. And after a few weeks or months, they are too invested in the idea of Trump to possibly evaluate him objectively.
And then we have anti-vaxxers. Again, many may have developed their anti-vaccine views innocently enough. Parents of children with autism who were desperate for answers. Parents who are wary of pharmaceutical company influence. Parents who are being influenced by noted pseudoscientists who are peddling books, supplements, programs, etc. It is far from shocking that so many people may begin as “vaccine-hesitant”. But at some point, they transition from being “vaccine-hesitant” to being ignorantly against all vaccines. A famous study from 2014 in the Journal of Pediatrics looked at the effect of various educational interventions on parents’ beliefs and attitudes about vaccines. Shockingly, all of the interventions (providing them evidence that MMR doesn’t cause autism, images of children with measles, text information about the dangers of disease, narratives about children with disease) failed to increase the likelihood of vaccine uptake, and some actually DECREASED the parents’ willingness to have their children vaccinated.
For anti-vaxxers, it’s always about the vaccine. “The vaccine causes autism”. Well no, it’s doesn’t. “The vaccine has mercury”. Nope, not any more. “It’s a pharmaceutical conspiracy”. It’s a game of Whack-a-Mole. Make one argument, and another one pops up. It’s not about the evidence, the science, or health. It’s about the vaccine to them, and nothing else.
To Trump supporters, it’s not about the truth, or about policy, or about foreign affairs, or about anything relevant to being president. It’s only about Trump.
(As an aside, “Making America Great Again” is essentially the Trump version of anti-vaxxers “doing things naturally”. It’s a catchy slogan, and elicits a certain positive emotion, but it completely lacks any meaningful substance.)
There’s a reason why Trump has espoused anti-vaccine views throughout this campaign. During a debate in September on national television, he told this story: “People that work for me, just the other day, two years old, beautiful child went to have the vaccine and came back and a week later, got a tremendous fever, got very, very sick, now is autistic”. He knows that there is likely a tremendous overlap between devout anti-vaxxers and his supporters. Both groups value dogma over evidence, emotion over reason.
So what’s the lesson in all of this? Most physicians have accepted that our patients who are staunchly “anti-vaccine” cannot be reasoned with. Providing them evidence and explaining the benefits, is often futile, although most of us will still try. It is the parents who are “vaccine-hesitant” where there remains hope for evidence and science to triumph. And for Trump? I think his opponents will concede that the majority of Trump’s supporters are beyond reasoning with. But thankfully, the majority of Americans are still logical, reasonable, and open to the objective evidence of his complete lack of presidential qualities.