Educational levels of parents have also been implicated as contributing to vaccine hesitancy. A number of studies have reported that parents with less formal education have greater distrust in the medical community and their vaccines, and have less belief in the necessity and efficacy of vaccines256–259. For example, parents with less than a total of 12 years education were more likely to report a lack of information about vaccines, compared to parent with graduate education259. This allows the influence of less reliable sources on parents with limited education. Interestingly, anti-vaccine sentiments can partly be explained by the Dunning-Kruger effect260; being ignorant of one’s own ignorance261. The psychologists Dunning and Kruger found that less intelligent/educated people overestimated their test performance and overall competence262. Importantly, these same subjects lacked the metacognitive capacity to recognize and judge their own lack of competence. Improving their test performance helped them recognize the limitations of their abilities262. In the study from Motta et al., a third of participants responded to know as much or more on the cause of autism than doctors and scientists. This overconfidence is highest among those with low levels of knowledge about autism and is associated with increased support for the role that non-experts play in the policymaking process260. It seems a significant part of vaccine hesitant individuals are ignorant of their own ignorance. Of note, a similar phenomenon was observed in extreme opponents of genetically modified foods263. Anti-vaccinationists also tend towards low cognitive complexity in thinking patterns, flaws in deductive reasoning and a habit of substituting emotional anecdotes for data264. Still, it may not only be a lack of intelligence or education in “vaccine hesitant” parents, but also the lack of theoretical training to incorporate, assess and judge a larger amount of knowledge. Indeed, individuals are generally poor in distinguishing their own knowledge from the knowledge that resides in the community they belong to, resulting in overestimating their own knowledge265. However, vaccine hesitancy is also prevalent in parents with high levels of education266,267. Higher education cultivates epistemic self-reliance or intellectual autonomy; the belief in ones capacity to govern knowledge and constantly question the status quo. Perhaps, the refusal to adhere to a epistemic authority (a physician or scientist for example) by educated individuals is misplaced self-reliance concerning vaccines268,269,[1]. This would argue for the lack of trust in authorities of knowledge and policymakers, a recurrent criticism on present-day vaccination programs.
[1] The idea of the authority on knowledge and its role in intellectual self-reliance and the necessity of conscientious self-reflection is expertly argued by Linda Trinkaus Zagzebski, in “Epistemic Authority: A Theory of Trust, Authority, and Autonomy in Belief” 2012, ISBN-13: 9780199936472
256 Prislin R, Dyer JA, Blakely CH, Johnson CD. Immunization status and sociodemographic characteristics: the mediating role of beliefs, attitudes, and perceived control. Am J Public Health 1998; 88: 1821–1826.
257 Shui IM, Weintraub ES, Gust DA. Parents Concerned About Vaccine Safety: Differences in Race/Ethnicity and Attitudes. Am J Prev Med 2006; 31: 244–251.
258 Gust DA, Woodruff R, Kennedy A, Brown C, Sheedy K, Hibbs B. Parental perceptions surrounding risks and benefits of immunization. Semin Pediatr Infect Dis 2003; 14: 207–212.
259 Gust DA, Kennedy A, Shui I, Smith PJ, Nowak G, Pickering LK. Parent Attitudes Toward Immunizations and Healthcare Providers: The Role of Information. Am J Prev Med 2005; 29: 105–112.
260 Motta M, Callaghan T, Sylvester S. Knowing less but presuming more: Dunning-Kruger effects and the endorsement of anti-vaccine policy attitudes. Soc Sci Med 2018; 211: 274–281.
261 Dunning D. Chapter five – The Dunning–Kruger Effect: On Being Ignorant of One’s Own Ignorance. In: Olson JM, Zanna MPBT-A in ESP (eds). . Academic Press, 2011, pp 247–296.
262 Kruger J, Dunning D. Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J. Pers. Soc. Psychol. 1999; 77: 1121–1134.
263 Fernbach PM, Light N, Scott SE, Inbar Y, Rozin P. Extreme opponents of genetically modified foods know the least but think they know the most. Nat Hum Behav 2019; 3: 251–256.
264 Jacobson RM, Targonski P V, Poland GA. A taxonomy of reasoning flaws in the anti-vaccine movement. Vaccine 2007; 25: 3146–3152.
265 Rabb N, Fernbach PM, Sloman SA. Individual Representation in a Community of Knowledge. Trends Cogn Sci 2019; 23: 891–902.
266 Opel DJ, Taylor JA, Mangione-Smith R, Solomon C, Zhao C, Catz S et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine 2011; 29: 6598–6605.
267 Smith PJ, Chu SY, Barker LE. Children Who Have Received No Vaccines: Who Are They and Where Do They Live? Pediatrics 2004; 114: 187–195.
268 Landmark AMD, Gulbrandsen P, Svennevig J. Whose decision? Negotiating epistemic and deontic rights in medical treatment decisions. J Pragmat 2015; 78: 54–69. 269 Navin M. Values and Vaccine Refusal: Hard Questions in Ethics, Epistemology, and Health Care. Routledge, 2015.
Sjoerd's thoughts on academic vaccine research 