Talking About Immunizations Positively and With Purpose
Mar 14, 2014

We often hear the claim that the public is growing increasingly anxious about the safety of childhood vaccinations.  We’re even told that this is leading parents to refrain from getting their children immunized.  waitingroom

But how can do we know this for sure?  

Fortunately, in an effort to understand the public’s vaccine perceptions, social scientists are beginning to look at these questions in the same way that we investigate vaccine safety and efficacy.  Through research.

Last month an interesting report was released entitled Vaccine Risk Perceptions and Ad Hoc Risk Communication: An Empirical Assessment.  It detailed two principal findings:

“First, that vaccine risks are neither a matter of concern for the vast majority of the public nor an issue of contention among recognizable demographic, political, or cultural subgroups; and second, that ad hoc forms of risk communication that assert there is mounting resistance to childhood immunizations themselves pose a risk of creating misimpressions and arousing sensibilities that could culturally polarize the public and diminish motivation to cooperate with universal vaccination programs.”

In other words, the majority of people are not focused on vaccine risks, and by repeatedly stating that there is mounting resistance to vaccines we’re possibly doing more to damage the public’s risk perception than to improve it.

This is an interesting report to consider because it can directly influence the way in which we talk about immunizations.  The findings suggest that government agencies, public health professionals, and other constituents of the public health establishment should evaluate their messaging to

(1) promote the use of valid and appropriately focused empirical methods for investigating vaccine-risk perceptions and formulating responsive risk communication strategies; (2) discourage ad hoc risk communication based on impressionistic or psychometrically invalid alternatives to these methods; (3) publicize the persistently high rates of childhood vaccination and high levels of public support for universal immunization in the U.S.; and (4) correct ad hoc communicators who misrepresent U.S. vaccination coverage and its relationship to the incidence of childhood diseases

So it appears that we should focus on immunization successes and highlight the fact that the overwhelming majority of people do vaccinate and support universal vaccination. However, as we work to continuously improve our already high immunization rates, we focus instead on the small percentage of people who are not vaccinating.

But new research, published in Pediatrics earlier this month, now has people questioning what – if any – immunization messages are effective.  The study, entitled Effective Messages in Vaccine Promotion: A Randomized Trial, suggests that current messages were not effective in changing a parent’s willingness or intent on vaccinating.

In an explanation by Roy Benaroch, MD, offered on the Pediatric Insider blog, we read details about the types of messages that were tested and the seemingly discouraging news that came out of this study.

Web-based surveys were conducted with about 1800 parents in 2011, who were then randomized to receive one of four pro-vaccine interventions.  The four different messages were: 1) information explaining the lack of evidence that MMR causes autism; 2) information about the dangers of vaccine-preventable diseases; 3) images of children who had diseases that could have been prevented with vaccines; or 4) a dramatic narrative about an infant who almost died of measles.

None of these messages, none of them, increased parents willingness or intent to vaccinate. In fact, among parents who were already vaccine-hesitant, these messages boosted vaccine misperceptions. For instance, specific evidence about the lack of a credible MMR-autism link further decreased the intent to vaccinante among the parents who were already the most skeptical prior to the study. And the dramatic story about the child sick with measles increased the perception of MMR side effects among parents who already distrusted the vaccine—even though that story had nothing to do with side effects of any vaccine.”

It was further explained that

“Among parents who have the strongest anti-vaccine views, no approach seemed to soften their stance. Instead, most of these attempts to communicate science-based information backfired—increasing anti-vaccine sentiment, in many cases reinforcing specific wrong beliefs that were not even relevant to the message given.”

While this shouldn’t really come as any big surprise, the response to this study has seemingly exaggerating the concern.  The headlines themselves seemed so alarming.  The AAP’s piece read  “When Pro Vaccine Messages Backfire”,  TIME Healthland reported “Nothing, Not Even Hard Facts, Can Make Anti-Vaxxers Change Their Minds”, and Scientific American’s article was entitled “Antivaccination Parents Dig In Heels Even after Receiving Medical Info“.

In following the various coverage of this report one particular explanation stood out to me.  It was provided by NPR social science correspondent Shankar Vedantam who hit on an important consideration in an excerpt from the transcript below:

GREENE: Shankar, I’m struggling to make sense of this. I mean you have parents who are believing that the vaccines were safer and those parents are less likely to want to get their kids vaccinated?

VEDANTAM: Well, I think, David, what Nyhan seems to be finding is that when you’re confronted by information that you don’t like, at a certain level you accept that the information might be true, but it damages your sense of self-esteem. It damages something about your identity. And so what you do is you fight back against the new information. You try and martial other kinds of information that would counter the new information coming in. In the political realm, Nyhan is exploring the possibility that if you boost people’s self-esteem before you give them this disconfirming information, it might help them take in the new information because they don’t feel as threatened as they might have been otherwise.

GREENE: This is a matter of people not wanting to acknowledge that they may have been wrong about something for many years.

VEDANTAM: That’s right. And also that if they were to acknowledge that they have been wrong, it might mean large changes in, not just their behavior, but their sense of who they are and their sense of identity.

These comments remind us of what we already know.  The parents who are already convinced of their anti-vaccine viewpoint will reject our immunization messages, regardless of their content.  And while I’ve learned that there are some people who will insist that vaccines are more dangerous than the diseases they are designed to prevent, it’s only because they tend to engage with pro-vaccine advocates in social media and in the comment section on immunization blogs and news articles.  Most people I talk to don’t even realize that people are purposely avoiding vaccination for their children.  They can’t even fathom why someone would put themselves and others at risk and reject the overwhelming scientific evidence that show the benefit of vaccines to greatly outweigh the minuscule risks.  So, while some view this recent study as a blow to our communication efforts, I consider it a reaffirmation of where we should – and shouldn’t – direct our attention.

In advancing the pro-vaccine message we should not be trying to change the minds of those who hold firm in their decision not to vaccinate.  Rather, we should focus our efforts on reinforcing the decisions made by the majority of people who are vaccinating, while also addressing the questions and concerns of those who express uncertainty about their vaccine decisions.  These are the people who are worried about the number of vaccines their child is scheduled to receive in one visit, or the number they receive overall.  These are the people who attempt to alter the recommended schedule or who selectively vaccinate – picking and choosing which vaccines they feel are most important or necessary based on their own individual criteria or “spacing them out”.  These are the people who have immunization questions but haven’t felt confident about the answers they’ve received.  These are the people that we must not abandon.

workerspowertoprotectIf we are discouraged by studies like the one mentioned above, than we may as well just accept that anyone who is undecided about vaccines will eventually be persuaded by the small but vocal anti-vaccine contingent.  I, for one, am not prepared to allow that to happen.   I believe that our biggest impact will come from personal conversations in which vaccine advocates are willing to respond with great patience and respect to people who are genuinely looking for verifiable evidence to their immunization questions.  This will require a great investment of time and consideration for everyone involved – parents, public health experts and medical professionals.  These encounters may happen just about anywhere; in private, in public, in person or even on social media.  We must seek opportunities to highlight the importance of vaccines and encourage a respectful exchange of information to ensure parents are comfortable and confident in their immunization decisions.  Ultimately, we want everyone to be willing – and able – to adequately express why they have made the important decision to vaccinate.

Our efforts start and end with you.  We would love to hear stories about how you have come to your decision or have helped others in their decision to vaccinate. Maybe it was never a decision you questioned.  Or maybe you were hesitant and came to your decision after something you read, a discussion with a friend, or a conversation with a doctor.  Or maybe you or someone you knew suffered from a vaccine preventable disease. 

Share your stories by emailing us at so that we can share your story to help motivate others to speak up about vaccinations.

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4 responses to “Talking About Immunizations Positively and With Purpose”

  1. Carrie says:

    Because I spent a lot of time leaning toward “natural” parenting, I did question vaccines after my first child was born. I actually started to lean toward NOT vaccinating, until I realized that the places I got my information from were not reputable, were not based in real science, and were severely biased toward “natural” practices, many of which I had found were not working for me or my family. I tend to put a lot of stock in real, scientific evidence, so that probably did a lot to put me in the state of mind FOR vaccines. But the biggest thing for me, honestly, was that if one of my children contracted a vaccine-preventable disease because of MY decision, I couldn’t live with myself. I then spent a lot of time looking into the REAL science behind vaccines and seeing how easily the anti-vaccine mindset was disproved and debunked. I’m thankful that I had an open mind, searching for the REAL truth objectively, and not based on any one particular bias..for example, because I leaned toward many “natural” practices, I didn’t feel that I needed to be anti-vaccine because it follows the ideology. I was able to step outside of any particular “label” and see what was TRULY best, not only for my own family, but also for countless other families who rely on herd immunity to protect their own loved ones.

  2. Lawrence says:

    @Carrie – congratulations!

  3. I’ve read this report. I’ve engaged in conversations with Yale Professor Dr. Dan Kahan about calling the anti-vaxx group “anti-science” is counterproductive. I hear all that.

    But I don’t accept it. It’s like in politics. One side, we know who they are, keeps saying Obama was born in Kenya and is a communist muslim. The other side, who is much more rational and intelligent, says, “awwww, that’s so cute. Look at those insane people. No one will listen to them.” But other insane people do listen to them.

    Only around 5-10% of American children aren’t full vaccinated. So that means that most of us are intelligent, rational human beings who want to keep our children safe and alive. What am I going to say to that small minority who thinks that vaccines are dangerous? Am I going to say, “awww, how cute. They deny all science, but let’s not offend them, because you know, they’re so cute.”

    Forget that. (And those who know me, know that I didn’t actually say forget that.)

    As Sam Harris once wrote,

    “Water is two parts hydrogen and one part oxygen. What if someone says, “Well, that’s not how I choose to think about water.”? All we can do is appeal to scientific values. And if he doesn’t share those values, the conversation is over. If someone doesn’t value evidence, what evidence are you going to provide to prove they should value it? If someone doesn’t value logic, what logical argument could you provide to show the importance of logic?”

    These antivaccination cultists think that water is 2 parts GMO pure magic derived from homeopathic solutions, and 1 part GMO free air extracted from virgin forests of the Australian outback. In other words, they invent stuff. And their mouthpieces, like Mercola, Humphries, Adams and others too numerous to count, are simply liars. And loud screaming liars.

    So, this website, which I follow as closely as my own, can be as civil, polite, and embracing as it can. But there have to be others, who mock, ridicule, and laugh at, with the least amount of civility possible, the stupidity and corrupt beliefs of the antivaccination lunatics.

    Do we really think that those anti-vaxx idiots on Facebook or at the Age of Autism really care if we’re polite? Do you think they have an open mind (let alone an open neuron)? Do you think they actually understand simple statistics that show over and over and over that vaccines save lives? Seriously, do you really think? I don’t. So I will mock them. Someone should.

    I also mock creationists, global warming deniers, and anti-GMO lunatics. I am equal opportunity on this point.

    Still, I’m glad you guys are the nice guys. I’d have to drink heavily, along with substantial medicating, to be as nice as you all. I think I might have drink just thinking about being that nice.

  4. Christine Vara says:

    Skeptical Raptor, I actually agree that we can not allow the anti-vax, anti-science mouth pieces to go unchecked. And I appreciate the work of people like yourself who embrace this challenge (even if it is sometimes done at the expense of your liver 🙂 ). However I can’t help but recognize that there are plenty of parents who are not familiar with the topic of immunizations but are still passionate about doing what is right for their children. When they start to ask questions, questions that most vaccine advocates would consider slightly ignorant or basic, it would be helpful if there were a safe and welcoming place for them to turn to. For instance I’ve been involved in private forums where parents are free to question vaccines and in time they learn from the complete nd patient responses of the knowledgeable participants. Our Vaccinate Your Baby Facebook page started out like that. But as it drew attention from more and more people, many pro vaxers were consumed with refuting the ridiculous claims that anti vaxers would use to disrupt the dialogue. But as you explain, we can’t simply ignore their lies but must use scientific evidence to refute them. It is not an easy issue to address, but I agree there is need for all these various ways to communicate a similar message. We just need to ensure that we continue to be responsive to the questioning parent and direct as much, if not more, attention to helping them understand the benefits of vaccines as we do arguing with those who will never change their minds. The way I see it, our arguments are really for the benefit of those who silently watch and wonder. We correct the lies so that others will see them for what they are. And you, my friend, do that so well. Thanks for reading and for sharing your valuable insight.

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