I am a pediatrician. Here is what I learned about why people do not trust vaccines.

From the measles epidemic in Williamsburg and Rockland County, New York, to a case of whooping cough in the capitals of Texas Capitol and Kentucky, the public opposition to "the plague festivals" by the governor of Kentucky is omnipresent. The stories are indeed alarming, with the upsurge of vaccine-preventable diseases and epidemics, such as in Williamsburg and Rockland County, highlighting the very real threat and public health challenge vaccination rate.

These stories are also alarming in another way – the one about responses to vaccine refusal. Rockland County officials have declared the state of emergency and banned unvaccinated children under age 18 from accessing many public spaces. New York City has ordered mandatory measles vaccination in four postcodes in Brooklyn. In a recent case in Arizona, armed police officers abducted a sick child and his siblings from his parents' home in the middle of the night, because the unvaccinated child's doctor feared he was suffering from meningitis.

The rationale and the need for interventions in Williamsburg, Rockland County, and Arizona, and many others, can be argued in terms of public health policy and practice. But the picture that emerges from these stories and the steady stream of editorials in various media indicates how questionable this question has become. Faced with an anti-vaxxer movement of conspiracy theories at the Pizzagate, social media manipulations and campaigns supported by Russian trolls, the media, the medical establishment, local authorities and even the l? law enforcement are unleashed against those who do not vaccinate their children.

Before I go further, I must say one thing: I am a pediatrician. I support vaccines. They are safe and effective. They prevent the real disease. Anyone who can be vaccinated should be. There are those who try, by using false and misleading information, to convince people to fear vaccines. These people are at best misguided and at worst malicious.

But my experience tells me that we may not be dealing with this public health problem the right way. At the very least, we should take a moment to ask ourselves exactly what is happening here.

As a pediatrician who regularly cares for healthy children, I always meet parents who are reluctant to get vaccinated. Applying for vaccinations is part of the routine of most checkups and other medical checkups. The reasons for not vaccinating vary from one parent to the other, as is their resolve not to vaccinate.

Some parents remain concerned about alleged links to autism, although the original studies that claimed to prove this link were retracted and debated years ago. Other parents worry about introducing into their children unnatural products or manufactured by pharmaceutical companies. Some fear that vaccines will replace, and thus weaken, the immune system of their children. Other people worry about side effects. All these misconceptions go against the facts, or at least misinterpret them. But I would say that if we put dogma aside, they are really not so irrational.

Let's look at some standard anti-vaccination arguments. First of all, the supposed link autism. A 1998 study by British physician Andrew Wakefield, originally published in The Lancet, one of the world's leading medical journals, was supposed to demonstrate a relationship between measles, mumps and rubella vaccine and increased rates of autism in the children who received it. The data was finally revealed unscientific, the study was retracted and Wakefield lost his medical license. But the idea imposed itself in the imagination of the public.

So any parent who shares this concern with me will hear something like this answer: "This study was a fraud, a sham. We now know that this is not true. Vaccines do not cause autism. This is fine, but it should be noted that the same medical facility repeatedly told parents that vaccines do not cause autism, has already been the subject of a study published in a prestigious newspaper. Is it any wonder some people at least do not know what to believe?

Why not want to introduce chemicals into your child's body? Is there a consumer of organic food – or a person who "goes organic" once they have a child, as many of my friends did – who can quickly reject that instinct?

And distrust of the pharmaceutical industry? The Vioxx scandal and the opioid crisis that has hurt millions of people in America and beyond have been a direct result of the deception and misinformation perpetrated against the public by for-profit drug companies (Merck and Purdue Pharma, respectively).

Of course, vaccinating children does not diminish their immunity; it improves it. But it's true that an infection like chickenpox, which I had as a child, will immunize you. And we are learning more and more, when it comes to food allergies or diseases such as asthma, that exposure to irritants and allergens in the environment can contribute to strengthen the immune system and prevent disease. People who believe that exposing children to the disease may help strengthen their immunity might draw erroneous conclusions, but they did not invent the concept from scratch.

The side effects of the vaccine, although rare, are real. You have to understand the probability and the risks of do not vaccinate to make an informed decision that assesses risks versus benefits. It only takes a scary real story to deter a protective parent already afraid of getting vaccinated.

It is essential to realize one thing: parents who are hesitant about vaccination do not try to harm their children. A parent who takes his child to seek medical care expresses concern for his well-being, even if he is opposed to vaccination. In addition, parents who openly say to their doctor that they do not plan to vaccinate are showing great courage in admitting their attitude towards vaccination. They are generally well aware of the stigma and disapproval that this may create for a health care provider. It is good to give them credit without endorsing their decision. This could open a conversation space and an opportunity to achieve a better result.

Forbidding children in public spaces and sending armed police to their homes, however, creates very little space for conversation. To take a less extreme example, crushing people with statistics and phrases such as "evidence-based" and "risk-benefit" probably does not create much room for conversation either.

So what's going on here? The world is inundated with information, misinformation, stories, diaries and opposing forces, some malicious, others simply ignorant. Yes, people are prey to it. But we also know more than ever how the world works, which means we know that bad things are really happening. Institutions and entities that we were supposed to trust betrayed us. Let us remember that the entire planet is literally in a state of existential crisis and that those who have the power to do as much as possible are blatantly denying it. (That does not mean that a planet destroyed by climate change is one where vaccines would probably not be very useful.)

People react to this reality and express their reluctance to automatically trust the figures of authority. Refusing to vaccinate, or asking questions before agreeing to do so, is in a way a rational response to a period of profound confusion. In the medical establishment, we take our good intentions for granted, and we are struggling with this state of affairs. We believe ourselves good and expect others that they automatically believe the same.

The assumption that doctors work in the best interest of patients may be increasingly needed, at least occasionally. I think it creates major discomfort for doctors and I say it because I have felt it myself many times. "Why will not they listen to me?", Launches the internal monologue. "I'm right, I know!" But the issues of parents, patients, society and the media are the new normal that we must accept and embrace.

There is no quick way out of this moment of hesitation to the vaccine. Public health authorities will do what they must. People must be protected, after all. But I suspect that these efforts will not carry much if they do not go in the direction of a real commitment, on a human scale. I am talking about asking simple questions without any judgment, opening discussion spaces, getting out of our defensive positions and giving up some of our misconceptions.

When everyone shouts at each other, the best way to be heard is to simply talk calmly, from one human being to the other.

Samuel Freeman is a pediatrician in Montreal and a member of the Northern and Aboriginal Children's Health Program at the Montreal Children's Hospital.

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