How communications can combat vaccines hesitancy
Are vaccines unsafe?
Paul Offit is a doctor who advocates for vaccines. In an interview with the Guardian, he recalled meeting a mother who decided not to vaccinate her infant son against influenza.
The little boy was taken to hospital and went through a progression of increasingly invasive care as the flu took its toll and his condition worsened. “The mother watched her child die in slow motion, like falling off a cliff slowly. It was very hard.”
After the boy’s death, Dr Offit asked the mother if she would be willing to talk to other parents about the importance of vaccination as a way to prevent further tragedy. She politely declined, saying that she still thinks she made the right choice – that the vaccine would have been more harmful.
This mother’s persistence of belief reflects a growing misconception in some parts of the world that vaccines are unsafe. The results have had real-world consequences because they are eroding herd immunity; measles cases have now hit a 20-year high in Europe.
In the US, there has been a surge in outbreaks of mumps, pertussis and other diseases, plus a reduced uptake of the HPV vaccination. Last year was the worst flu season in at least four decades, resulting in around 80,000 deaths.
In recognition of how dangerous this situation is, the WHO has listed vaccines hesitancy as one of the top ten threats to global health in 2019.
What on earth is going on?
Vaccines hesitancy is complicated
Polarising views are coming from the industry and the likes of President Trump (who repeated claims that vaccines and autism are linked), so it’s understandable that many people are sitting somewhere in-between.
If deniers and acceptors are at the extreme ends, there is a large group in the middle that refuses some vaccines or is hesitant to get vaccinated. You could call them ‘fence sitters’.
They have varying degrees of hesitancy about vaccinations. They have diverse, often very personal reasons for feeling this way – for example, they may have felt unwell after a previous vaccination or are concerned about the ingredients of vaccines.
While anti-vaxxers are seemingly well-informed, ‘fence sitters’ are perhaps less well-read, less able to recognise authority and easily swayed by arguments that look legitimate or that pulls at their heart strings – particularly when it’s about children’s suffering.
They may be parents in Europe who have the privilege to say no to vaccines because they don’t live in a developing country where vaccine-preventable diseases are much more visible.
They may distrust elites and experts who they believe are in the pocket of Big Pharma. This coincides with record-high trust inequality between the more informed public and far more sceptical general public.
They might feel overwhelmed by facts and figures and would rather switch off than enter into this toxic debate. They will not respond to logical, numbers-based arguments, particularly if they feel talked-down to.
Why are anti-vaxxers gaining ground?
Social media plays a big role in spreading misinformation about vaccines. Sites like Facebook provide a place where people who share the same opinion can easily gather to create an echo chamber of similar ideas.
Both sides seem to be squaring up for a fight. Doctors find it intolerable that people could reject vaccines – to them, it’s like refusing to put on your seatbelt in an airplane because you don’t believe that airplanes can crash.
Extreme anti-vaxxers may believe that their child contracted autism from MMR or that vaccines contain human cells taken from abortions. Some believe that vaccines contain harmful chemicals, or that there are better alternatives out there. Many believe vaccines are just a shill for pharma companies to make money. There is no changing their minds; they’ve dug their heels in and no amount of data or expert opinion will shift them. Remember the mother of Paul Offit’s unvaccinated patient? Faced with her son’s death, she remained convinced of her beliefs, a position unimaginable to most people.
Beyond merely discussing their concerns, anti-vaxxers are now mobilising to attack pro-vaccination figures and produce targeted campaigns to influence ‘fence sitters’ to refuse vaccines. They think that they are right and that the industry is evil. Why? Why is it so difficult to change their minds?
The response from the scientific community is often to publish more and more stats about how important vaccines are to world health. And they are: mass vaccination is one of the world’s greatest public health triumphs. Celebrating this is important and the industry has pledged to not rest until vaccine-preventable diseases are a thing of the past.
But in the case of anti-vaxxers, this falls on deaf ears. If people don’t trust the source of the information, it doesn’t matter how much data is published to challenge their beliefs. This has left the field wide open for fanatics to keep perpetuating myths about vaccines.
We need a better-quality conversation about risk
Pro-vaxxers are saying that vaccinations are 100% safe; anti-vaxxers are saying that it’s 100% safe not to vaccinate.
Neither side is right.
We can’t fight this emotional battle with weapons of logic; we need to meet in the middle. We need a better-quality conversation about risk.
We need to acknowledge that nothing is without risk; taking paracetamol is generally safe but not risk-free. Acknowledging risk may be a difficult thing for pharmaceutical companies to do, but right now neither side will concede an inch of ground, so the debate is going nowhere – or worse, we’re regressing to a place where vaccine-preventable diseases are on the rise.
And while vaccine supporters might think it’s madness not to vaccinate, ‘fence sitters’ are caught in the middle; they’re overwhelmed by diametrically opposing views and terrified of putting their children at risk.
Parents who do vaccinate need the confidence to justify that decision to themselves and others – in other words, not to feel ashamed, under attack or as if they’re bad parents for vaccinating their children. Even the WHO staff have been given guidance on how to speak with anti-vaxxers. Parents have nothing in their arsenal.
Something everyone has in common is that we all want the best for our families – we all want our children to be happy and safe.
The scientific community might think it’s outrageous to acknowledge anti-vaccine arguments, but we need to show willingness to have a conversation. We need a way of talking about risk that’s constructive and respectful.
It’s much riskier to say no
If vaccines deniers are influencing people who are hesitant about vaccines, the same open forums can be used to spread accurate information on the value of vaccines.
But for every argument that pro-vaxxers put forward, anti-vaxxers have an answer prepared. Instead of pitting the two sides against each other, communications can play a role in re-framing the debate to focus on risk instead.
To reframe the terms of this debate, we need to demonstrate the very real risk that this poses to individuals and their families in their own communities without resorting to repeating scientific facts which are easily dismissed as ‘fake news’.
For example: you may think that vaccine-preventable diseases have been eradicated, but they still cause millions of deaths every year. If you live in a developed country in Europe, they may not be a part of your everyday life, but these diseases are only under control if we stay vigilant and continue to vaccinate.
Let’s reframe the terms of this debate
Communications could be a powerful means to combat vaccines hesitancy by helping people think differently about the risks involved.
Instead of focusing on facts, let’s acknowledge how scary it is to think that your child may be at risk. In a brilliant article for Nature Heidi J. Larson called it an “emotional contagion, digitally enabled” that’s dangerously eroding people’s trust in vaccines.
So let’s acknowledge those fears and encourage people to think carefully about it. If the misinformation is coming directly from the White House, it’s no wonder there’s confusion.
We should avoid shocking or upsetting language or imagery and focus instead on clever, emotional messages. Vaccines hesitancy is a deadly issue, so it’s important not to make light of it or belittle the audience in any way.
It’s a chance to reiterate that the scientific community cares not only about individual children but children plural, and particularly those in the most marginalised groups, who are most likely to fall ill.
We should acknowledge that anti-vax parents were once children too – children who perhaps benefited from the immunisations that they now seek to deny their families.
It’s a chance to point out the incredible breakthroughs that have been made in smallpox, polio, HIV and HPV. The potential for positive impacts from future breakthroughs is immeasurable.
It’s a chance to give pro-vaccines families the tools to speak openly with detractors about the ‘greatest story never told’ – one in which a child is vaccinated against preventable diseases and grows up to live a long and healthy life.
We feel strongly about how communications of this kind can protect public health. Interested in carrying on this conversation? We’d be keen to hear your thoughts on how the pharma and healthcare industry should tackle this global issue. Get in touch today.