The failure of vaccine messages

Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease.

Yet: there are still pockets of intense resistance to vaccines, resistance that’s based on fear and lies and a willingness of anti-vaccine propagandists to say anything to decrease public confidence in vaccinations, doctors, scientists, and the parents who vaccinate their children. We’ll call these folks the “pro-disease lobby.”

In my practice, almost all families get all of their kid’s vaccines. We talk about what they’re for, we talk about the expected side effects (most babies have none, a small minority have some fussiness or fever), and we make sure parents know how to handle those and when to call if anything worrisome happens. We give out vaccine information statements, which also list potential side effects, trivial and serious. Then we get the babies and children protected.

There are some families who have sincere questions, and those get extra time to get their questions answered, respectfully and patiently.

Then there are those 100% devoted to the pro-disease lobby. They don’t want questions answered — at least not by their pediatrician, not when the Internet tells them what they want to hear. Frankly, I don’t even know why they come see me. If they think I’m evil or stupid or thoroughly misguided, why would they trust me with any aspect of child care?

Is there any way to convince these families that vaccines are a good idea? A new study looked at different vaccine messages: which ones work, which ones help, which ones hurt. The results are discouraging. 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 vaccine 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.

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.

This jibes with my own experience, and what pediatricians say around the water cooler (more likely, honestly, the coffee maker). The true anti-vaccine, pro-disease parent is essentially in a cult, with fixed delusional beliefs far outside reality. Talking with them only increases their anger and hardens their stance. People do not like to believe that they’re possibly wrong, and would rather listen to viewpoints that agree with their own, even at the cost of their own health. That’s too bad, because their children suffer, and our children suffer too.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • goonerdoc

    This should generate some vehement “discussion” from the pro-disease lobby, which always devolves rather quickly. I’ll make the popcorn.

  • PrimaryCareDoc

    This has been my experience, too. Unfortunately, the internet and forums give the pro-disease lobby a perfect echo chamber. One of the worst I’ve encountered is mothering.com, which actually deletes and bans people for posting anything pro-vaccine in certain forums.

  • http://www.ronsmithmd.com/ Ron Smith

    Hi, Roy.

    Good article. I thought I might add a fews tidbits that I’ve discovered over the years.

    I come from the days of seeing 4 to 6 kids a month with temperatures of 102 to 104 following the original DTP vaccine of three decades ago. The much improved vaccine production methods that have reduce that same number to within a whole year have of course been the reason that most subsequent vaccines were much more innocuous from their inception.

    It took some time for those production improvements. The Hib vaccine is staggering in its success as a result. I used to see two children a year with H. influenza meningitis prior to its introduction. I have seen none since. Still the length of time that it took to improve the side effects of the DTP coupled with horror stories that may or may not have been associated with the vaccine took its toll in the opinion of new parents.

    Then came the Wakefield study published by Lancet more than a dozen years ago and which was recently repudiated by that journal. It was a dozen years too late and the Lancet bears some measure of responsibility in my opinion for the prolonged propagation of a terrible misinformation which only served to harden public opinion of some, and promoted serious vaccine discussions in many.

    So what should we as Pediatricians and Pediatric allied health care persons expect? Parents have good reason to be suspicious.

    I think we should very much stop condemnation of parents who decide not to vaccinate. I’m very much a proponent of vaccinations, don’t get me wrong. But this is a *free* country, and I understand the arguments about one persons negative health affecting others around them. If we think the ultimate best thing to remove this choice from parents by lawful mandate, then we can start spelling ‘America’ in Cyrillic.

    Now I do want to convince my parents that vaccinations are a good thing. And I know all the arguments to the point that my wife nudges me when I start spouting them in my sleep.

    But parents, especially those who cherish our freedoms, may not even be pushing back as directly as you might think against the vaccines themselves. Why do I think that?

    What changes my parents minds about foregoing vaccines is not my arguments. Its my relationship with them. Look, we have to take off the white coats figuratively and literally here. Most of these parents, though not all, are generally ones who care deeply about their children. They come to me for their well care and they listen to every word that I say.

    Somehow I connect with them in a way that makes them comfortable and then later come to value my opinions not only about vaccines, but other things. I would estimate that about three-fourths of the time, they eventually come to change their anti-vaccine views as I begin to teach them and gain their confidence.

    They come to know that I respect them. That makes them want to respect me. As the relationship grows, then they can come to a place where they will hear and be receptive to the message. (But maybe its just the fact that I’ve been practicing as long as most of my parents have been alive, and not that at all!)

    Anyway, I continue to give them the best information that I know and see them as I see my oldest daughter and son-in-law who are trying to raise our four grandchildren the best that they can. I get excited about their families and I respect them when they have different opinions about various child-rearing issues. Heck I might even learn something when I listen!

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

  • Dorit Reiss

    I think you’re right about the hard core anti-vaccine parents – but our goal should be, shouldn’t it, to reach the fence sitters before they get pulled in by the misinformation. I think our focus should be on how to have those discussions.

    • Vito Alexander Pavlovic

      Dorit, there are way too many vaccine injured children out there, that’s the problem, a problem you can’t rectify with all your promoting of vaccines, what we have now is word of mouth by the vaccine injured, witnessing vaccine injury, and the denial of vaccine injury going against vaccines, all big pharma has to push vaccines is fear mongering,(not working), hiring shills to defend vaccines(really not working) as is obvious by the recent study, safe and effective(definitely not working).

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