Think of people who don’t vaccinate, and the first thing that comes to mind might be Jenny McCarthy, blond and belligerent, waging battle on TV news. Perhaps it’s the organic shopping, yoga-mat-toting moms who live in your nearest upscale urban enclave. Or maybe it’s HBO pundit Bill Maher, smugly informing former Republican senator Bill Frist that although he is a consummate leftie on most issues, when it comes to vaccines, “why would you let [the government] stick a disease into your arm?”

“Anti-vaxxers,” as they are often referred, are an easy group to stereotype and a difficult group to humor. In most thinking circles, they are cast as “the other”; people either too stupid to understand the science behind vaccination, or too selfish to care about the impact of their choices on those around them.

But vaccine skeptics aren’t as different from their critics as we might like to think. And their rise in number over the past decade has less to do with stupidity, or even selfishness, than it does with beliefs about knowledge, trust, and freedom of choice that are pervasive throughout our culture, whether you choose to vaccinate your kids or not.

Dr. Jennifer Reich, a sociologist at the University of Colorado Denver, has been researching the anti-vaccination movement since 2007, seeking to understand the processes by which people come to reject vaccines. Over the past seven years, she has conducted in-depth interviews with parents who refuse mainstream vaccine recommendations, along with doctors, alternative healers, and public policymakers.

Not all of the parents Reich spoke with were “anti-vaxxers” in the sense that we typically think of the term; only a small minority identified as activists in the Jenny McCarthy mold, campaigning other parents not to vaccinate or advocating for policy change. Nor did they necessarily abstain from vaccination completely.

Rather, what united them was a sense that vaccines were up for negotiation: to be administered or rejected depending on the convictions of the parent and the needs of the child. Reich’s interviewees saw themselves as critical consumers of information. They engaged with doctors not as authorities to be obeyed, but as another data point to be evaluated, embraced, or discarded. They continually assessed risk: How likely was it that their child would be exposed to Disease A? What would be the consequences if they contracted Disease B?

Often, the rationales they used to make these assessments were dubious. One mother told Reich that she hadn’t felt the need to vaccinate her infant daughter because she provided “the immunization from [her] breast milk,” while another explained that she had chosen not to vaccinate because she’d “loaded up on all the vitamins and protein powders” during her pregnancy. Another said that she would vaccinate her sons against mumps before they were teenagers to avoid putting their fertility at risk, but if she had a daughter, she would vaccinate her against rubella. She did not, Reich notes, “reference how [her] unvaccinated children present risk to others’ reproduction should they expose them to disease”—and nor did any of the other parents Reich interviewed.  

These parents shared a sense that avoiding infection was an individual responsibility, which could be successfully navigated via practices such as feeding their children organic food, monitoring who they spent time with, and raising them to be responsible decision makers.

These rationales, Reich argues, form part of a framework she calls “neoliberal mothering.” But while the underlying logic is certainly neoliberal, it is present in more than just parenting, and extends far beyond the borders of the anti-vaccination movement.

It is not just anti-vaxxers, after all, who take pride in their ability to critically evaluate information, who do background research instead of trusting their doctor’s advice on faith, or who are skeptical of the motivations of government, pharmaceutical companies, or big business. Nor is it only anti-vaxxers who believe that every individual is unique, and that policies should be adapted to fit those idiosyncrasies, rather than applied one-size-fits-all. (As one mother Reich interview explained it in relation to vaccines: “Everyone has a different immune system. For some people, it may take three shots. [Others get] immunity that first time.”)

In an era of high individualism, ideas like these aren’t outliers or aberrations. They are hallmarks of the liberal middle-classes—the kind of people, say, who might read The New Republic online. And I’ll be honest: they sound an awful lot like me.

Like most people I know, I am pro-vaccine. For me, vaccination is a matter of civic duty; something you do not just to reduce risk of disease for the people you love most, but to reduce the risk to everyone around you. But like the vaccine skeptics Reich interviewed, I too am arrogant about my ability to evaluate information. I too view authority figures as no less fallible than I am, and balk at anything that reads as unnecessary bureaucracy. I approach most “rules” as the beginning of a discussion, rather than the end of it. I put the word “rules” in quotation marks. I may not like the conclusions anti-vaxxers come to, but I do feel an uncomfortable resonance with some of the reasoning by which they reach them.

At its heart, the anti-vaccination movement isn’t a product of ignorance, selfishness, or even fear (as essayist Eula Biss argues in her celebrated recent book, On Immunity: An Innoculation)—although each of these play their part. It is the logical fallout of a society in which knowledge is relative, institutions are fallible, and the individual reigns supreme. In such an environment, the real surprise isn’t that there are people who doubt vaccines. It is that most of us don’t doubt them, even when every social force around us is urging us to do otherwise.

All of which begs the question of how we might better respond to anti-vaxxers. One solution might be to rebuild the trust between individuals and medical institutions. It is well established that parents who choose not to vaccinate their children are a privileged group, but the deep suspicion that lies at the heart of vaccine refusal reflects their distance from power, not just their proximity to it. It stems from the same impulse that leads people to believe that the U.S. government creates fake ISIS videos as propaganda tools, or that media barons dictate stories to their journalists over the phone. If parents want to “do their research” before deciding whether or not to vaccinate their children (or engage in any other medical intervention), doctors can help them to do just that: by engaging them in conversations about how scientific research works, taking their concerns seriously, and directing them towards the multitude of peer-reviewed research in favor of vaccines.

Some doctors have also floated the option of more personalized vaccine schedules, tailored to each child’s immune system by measuring the number of antibodies for a disease already in the blood before administering booster shots. But such personalization would be expensive, Reich points out, and unlikely to be made available to children across the socioeconomic spectrum. Besides, she told me over email, we need to ask ourselves why “individualization is seen as superior, even when it is less empirically based. … So what about personalization feels better, even if it may not actually yield better outcomes?” Then there’s the question of exactly how “individual” each child’s body really is when it comes to the question of how they can best be protected from infectious disease.

Which brings us to a third intervention we could make—to our collective psyche. Not all of the beliefs that fuel vaccine skepticism are undesirable by definition. I want to live in a society in which people have the tools and education to question the information they are given, and which public policy is flexible enough to accommodate the needs of the individual. But I also recognize that when it comes to matters of science or specific public policy, most of us are not experts in the most of the subjects we encounter. And no matter how many websites (or journal articles) we read, we are unlikely to understand vaccines as well as the people who create and administer them. We should question power, absolutely, but we also need to trust it when the evidence supports it.

Whatever approach we choose, one thing is for certain: Dismissing vaccine skeptics as crazies or idiots won’t solve the growing public health problem their choices present. To do that we need to go deeper; to examine not only the ways in which they are plainly wrong, but the beliefs they hold that are more equivocal—and the unwitting role we might all be playing in allowing those ideologies to thrive.