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A (slightly) new approach to talking about vaccination

If you’re fairly active in the online parenting world, you’ll have observed that the V-word often brings people down into three firm camps:

1. Hardcore pro-vaccination people
2. Hardcore anti-vaccination people
3. “Whatever you feel is right is best”, no conflict people

Now, I find the first group very frustrating because they are some of the most vocal people in the health advocacy world, but they are often guilty of ridiculing, insulting, attacking, and offending the second group, and even often the third group. Facebook pages like Refutations to Anti-Vaccination Memes, Science Babe, IFLS, Things Anti Vaxxers SayI Fucking Hate Pseudoscience, among many others post some very good pro-science material…but then post some pretty terrible things about anti-vaxxers, often using words like “idiot”, “moron”, “stupid”, or “imbecile.” Not so positive! The comments are even worse. Vaccination is not related to being any of those things.

The second group is frustrating for reasons that are probably obvious to anyone reading this blog.

The third group…that’s who worries me.

One of the big reasons that people care so much about vaccination is that it’s a public health issue. It’s not as simple as “my child my choice,” because, no, really it’s “my child, I choose for everyone else.” The very way that routine immunisation works means that we’re in it together and that those of us who can vaccinate must, for the sake of those who can’t. That means that it’s in all of our interests to, basically, convert people. If we can talk to and about those people in the right way we stand the best chance of educating the most people possible and improving everyone’s health.

The problem is that it’s really hard to change people’s minds on topics like this. A study from 2014 has found that even trying creates a “backfire effect” and can actually strengthen non-evidence-based views. Described in great detail in this Mother Jones article, it used a pool of test candidates who held negative views toward the MMR vaccine and tested them with four different messages to see which were effect at counteracting those views.

1. “Autism correction”: a blast of science disproving false beliefs and giving evidence
2. “Disease risks”: detailing how terrible the vaccine-preventable diseases are
3. “Disease narrative”: true case study of a frightening example of one experience with the disease
4. “Disease images”: gory pictures of what the diseases actually look like

Messages 3 and 4 not only did not sway participants toward vaccination but actually made them less likely to vaccinate. The second message didn’t really have any effect. The first one had some effect, though ultimately people didn’t necessarily change their minds on MMR vaccination, they just learned the facts. I think that’s where the hope lies.

That ties in with this article from Vox about how to debunk false beliefs without having them backfire. It’s a great article and really worth reading! It’s a transcript of a discussion between the author and a psychologist from the University of Bristol who coauthored The Debunking Handbook, which I definitely want to read now.

He says:

The moment you get into situations that are emotionally charged, that are political, that are things that affect people’s fundamental beliefs — then you’ve got a serious problem. Because what might happen is that they’re going to dig in their heels and become more convinced of the information that is actually false. There are so-called backfire effects that can occur, and then the initial belief becomes more entrenched.

Sounds like vaccination debates, doesn’t it?

When asked about how to deal with a person who holds views that aren’t evidence-based this is what he advises:

There’s a couple of things I can suggest. The first thing is to make people affirm their beliefs. Affirm that they’re not idiots, that they’re not dumb, that they’re not crazy — that they don’t feel attacked. And then try to present the information in a way that’s less conflicting with [their] worldview.

That for me says it all. Those pages I mentioned above, they are loud and they speak for those of us who really care about this issue but they are achieving the opposite effect of what we want. They are polarising and damning, and even when they’re fine the commenters can be terrible. What we need is for more people to choose vaccination, not more people digging their heels in and going to the other side because they’re more welcoming.

So I propose a new way of looking at this:

We don’t attack. We don’t call names, we don’t rise to it. No matter how frustrating it is we turn the other cheek, and good lord it is frustrating. If we encounter someone intractable and we have to walk away, then we walk away so as to not turn off all the people reading who are on the fence. We have a clear and targeted message. We need to not be authoritarian in any way or we end up with situations like this. To do this I propose that for this purpose people fit into six different categories. People who:

1. vaccinate because science, aka vocal advocates
2. vaccinate because they accept it’s the right or mainstream or standard thing to do
3. do selective vaccinations and are nervous about those
4. are quite scared and abstain because they don’t know who to believe
5. actively oppose vaccination and won’t be swayed
6. actively pro-disease and infection.

Group 1, it’s preaching to the choir, we don’t need to worry about them other than that they’re communicating our shared cause in an effective way.

Group 2, can be given info to back up what they’ve already chosen so that they can be more vocal and confident in their own communication.

Groups 5 and 6, we need to write them off. We won’t convert them.

Groups 3 and 4, that’s where the opportunity is. Those are the people who we can calmly and patiently guide, and we learn new things in the process. We never let them see us attack or mock or call names or they don’t listen to what we have to say. We can address their concerns and match those with good information. This fantastic article for example runs through a whole series of anti-vaccination myths and provides the correct information, with a follow up of even more here. The US CDC page gives exhaustive citations and you can harvest studies from there. There are countless evidence-based blogs that do provide actual, quality citations, though you have to be very careful of pseudoscience pages that will give rafts of studies that once you look at them you realise are nothing to do with the issues at hand.

We have to remember that choices about vaccination are not a reflection of intellect or ability, or even formal education. Parents want to do what is best for their kids, the problem is that some are listening to the wrong information and the louder we shout, the less trustworthy and believable we are.

I’m going to steal a term from Katha Pollitt of the pro-choice movement: the “muddled middle.” If we can target this “muddled middle” who is unsure and do so in a reassuring, factual way, we can gain some ground toward increasing vaccination numbers. Not because they’re forced to, not because they’re browbeaten into it, but because they want to do it, which will in turn turn them into more voices for vaccines, which benefits all of us.

What do you think?

2 Responses to “A (slightly) new approach to talking about vaccination”

  1. Jeanne says:

    6. actively pro-disease and infection ????
    Do you really believe that’s why people don’t vaccinate?

    • nature nurture parenting says:

      You might have missed the rest of the post, namely, the other reasons people don’t vaccinate – they’re concerned about risks, they’ve been treated badly by the medical establishment, they’re hesitant about the science, and so on. The entire point is that there are only a few, the most extreme end, who are so committed to their kids getting diseases. They’re not the ones to address because their reasons for not vaccinating are not normal or rational in any way.

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