Paul Holmes 23 Feb 2015 // 8:39AM GMT
With more than 100 cases of measles reported this year across 14 states—the majority of them traced back to an outbreak at Disneyland in California—the media spotlight is focused on America’s anti-vaccination movement, which must bear the brunt of the blame for the resurgence of a disease once thought to have been eradicated.
Before the introduction of a live measles vaccine in 1963, the average number of measles cases in the US was around 550,000 a year, with about 500 of those resulting in death. That number has declined steeply, and between 2001 and 2011, the median number of measles cases reported per year was just 62.
But last year saw more than 600 cases in the US, and this year is now on track to exceed that number.
It is clear that anti-vaccination concerns are creating a major public health issue, but they also pose a massive communications challenge: many of those who refuse to vaccinate their children are immune to the most obvious methods of persuasion, whether that means presenting them with the facts about vaccination or trying to convince them that their behavior poses a real risk to the wider community.
It is far from clear what kind of messaging can overcome the climate of fear around vaccines, or who can deliver those messages credibly to change behaviors—but it is clear that a new approach is needed.
The Origins of a Health Crisis "Fear, ambivalence and ignorance are powerful obstacles.” The anti-vaccine movement began in earnest in 1998 following the publication in The Lancet of a study by British doctor Andrew Wakefield that suggested a relationship between the measles-mumps-rubella vaccine and autism.
“Suddenly prevention became medical roulette,” says Gil Bashe, who leads the healthcare practice at Makovsky. “In seeking to defend against illnesses like measles, some unfortunate child might draw the short straw of autism. Now there is no lack of information to disprove this decade-old myth, and no lack of authoritative voices urging people to get vaccinated. But fear, ambivalence and ignorance are powerful obstacles.”
As Bashe says, the study that started it all has since been discredited and its data shown to be falsified, and Wakefield has lost his medical license, but the study was seized upon my concerned parents and many continue to believe that Wakefield was the victim of a witch-hunt by the medical establishment—and large pharmaceutical companies in particular.
Jennifer Wayman, managing director of social change at Ogilvy Public Relations, believes that the persistence of vaccination misinformation comes down to “the unfortunate overlap in the timing between when the MMR vaccine is administered and the typical age at which toddlers start showing symptoms of autism. The two often happen at about the same time. So parents get their kids vaccinated and right away they start showing autism symptoms.”
She also sees a connection between anti-vaccination attitudes and “a time when parents are increasingly choosing a natural parenting style: natural childbirth, cloth diapers, breastfeeding, and whole or natural foods. For these parents, the only unnatural thing going into their babies’ bodies are vaccines. And that is concerning and scary.”
For all of these reasons, the anti-vaccination movement has not only persisted in the face of all the scientific information, it has grown. Last year, The Atlantic reported that in some neighborhoods in LA, ground zero for the anti-vaccination movement, the rates of vaccination are as low as in South Sudan.
It’s important to put that in context. Across the United States, the vast majority of parents continue to get their children vaccinated. Says Wendy Lund, CEO of GCI Health: “Communications in support of on-time vaccination have been overwhelmingly effective to this point. Vaccination rates are high.”
Conventional Communication Has Not Helped “Throwing facts and science at people is ineffective. It doesn’t change people’s minds and it can make the problem worse.” While that’s true, even a relatively small percentage of anti-vaccination parents can threaten the “herd immunity” that vaccination has achieved. For herd immunity to protect the entire population, vaccination rates need to be at 90-95 percent, experts say. And it is beginning to fall below that level—in some communities, alarmingly so.
The fact that this is happening despite overwhelming consensus that vaccines are safe is obviously troubling.
“Vaccination has become a very emotional issue on both sides, but the fact remains that vaccines save lives,” says Lund. “The data support this. The dramatic reductions in disease cases can be directly tied to vaccines. The elimination of diseases like polio and smallpox can be directly tied to vaccines. The proof is there.”
But clearly the proof is not convincing to many people. In fact, there are reasons to believe that presenting the facts may be counterproductive.
Brendan Nyhan, a political scientist at Dartmouth College in New Hampshire, published a study in March last year that divided nearly 1,800 parents into groups and presented each with different information, based on material provided on the web by the CDC. One group was told about the lack of evidence about any link between the MMR vaccine and autism. A second group was told of the danger from diseases that the vaccine prevents. Other groups were shown photos of children with measles, mumps, and rubella, or presented with a true story from the CDC website about an infant who almost died of measles.
None of the messages had a positive impact on the parents’ intent to vaccinate, and some were counterproductive. The images of sick children actually increased belief in a link between vaccines and autism, and the story about the child who nearly died heightened concerns about side effects.
“Throwing facts and science at people is ineffective,” Nyhan told BuzzFeed News. “It doesn’t change people’s minds and it can make the problem worse.”
Equally ineffective, one suspects, is the stigmatization of those who hold anti-vaccine beliefs. In one recent article in the Los Angeles Times, these concerned parents were “dolts,” “ill-informed,” and “stupid” people, guilty of “casual ignorance,” whose fears are “worn as a badge of sophisticated nonconformity.”
This is not language designed to make people reflect on their position and reconsider their opposition.
But even the best-intentioned education campaign could have unintended consequences. Diehl, for one, is concerned about the possibility that any mass market campaign to address the concerns of the anti-vaccination movement could backfire. Citing research from Yale University, she says: “Aggressively promoting the benefits of vaccines to people who do vaccinate may raise questions that didn’t exist before.”
But such a campaign may now be inevitable, she acknowledges. “As we face the prospect of more and more outbreaks of vaccine preventable diseases and the news cycles that will inevitably come with them, these mass-audience discussions may be unavoidable. What may be most important is to avoid over-representing the number of people who are denying vaccines. In terms of promoting health behaviors, ‘everyone is doing it’ is more powerful than ‘tsk, tsk, you should do it.’
“If, in the effort to push back on vaccine misinformation, we create a perception that there’s mass resistance to vaccines, it will cause more harm than good.”