Monday, March 3, 2014

Telling Anti-Vax Parents They're Wrong Only Makes Them More Anti-Vax

By Karen Ernst

Today, a study in the Journal of Pediatrics seemed to point out that what pro-vaxxers are trying to do is all wrong.  It might seem to suggest that debunking vaccine-autism myths, explaining relative risks of disease, and demonstrating the effects of vaccine-preventable disease is ineffective.  

The study tried to influence parents’ decisions about vaccines using four strategies, all utilizing online resources: correcting misinformation about the MMR-autism myth, giving information about the risks from vaccine-preventable diseases, presenting first-person narratives about children who had contracted VPDs, giving visuals of those risks. After being presented with one of these four strategies, parents were surveyed about how much more likely they were to choose an MMR for their children.  The information used came from the CDC, although the source of the information was not given to the parents surveyed.  The parents participating in this study came to the study with a wide variety of beliefs about vaccines, and almost none of them left with their beliefs being changed.

In short, the Pediatrics study found, in summary, that:

1. Showing ardently anti-vaccine parents proof that vaccines don’t cause autism only made them less likely to vaccinate.

2. Explaining the risks of vaccine-preventable diseases does not increase the chances that parents would agree to the MMR in the future.

3. Showing parents visuals about disease risk or giving them stories about children suffering from vaccine-preventable diseases did not make them more likely to vaccinate their children.

Those findings seem pretty damning for the pro-vaccine message, but I think we should take heart.  There is so much this study didn’t cover, and so much we can do that would work. Here are my thoughts on the findings:

1. Anti-vaccine parents have a broad range of concerns about vaccines beyond the vaccine-autism myth. Hitting one discussion point only irritates their sense of “they don’t get us.” The study might also fail to nudge ardently anti-vaccine parents because there is no human component, and the targeted parents have no opportunity to feel that someone took the time to genuinely hear out their concerns and address them in a personalized way.

2. Emphasizing risks often feels to parents like “fear-mongering,” and parents who refuse vaccines might feel that they are able to continue refusing vaccines since they live in communities with high vaccination rates where the risk of their child actually contracting a vaccine-preventable disease is low.  Just the other day on our Voices for Vaccines Facebook page, one mother commented, “I do not vaccinate, but would definitely consider it if traveling overseas.”  Anti-vaccine parents believe that their risk for contracting diseases is greater where those diseases are endemic, and trying to convince them that their children are at risk for complications from diseases they are unlikely to catch at home is problematic.

Conversely, anti-vaccine parents are likely to disbelieve in herd immunity. As Amy Parker’s mother once did, anti-vaccine parents often rely on organic foods and healthy living to protect their children from diseases that are often airborne and highly contagious. Those of us providing the cover of herd immunity to their children only make it easier for them to continue to delude themselves into believing that their lifestyle is the deciding factor. And because allowing children to become ill to prove our point is wrong in every sense of the word, it’s simply unlikely that anti-vaccine parents will change their minds due to fear of risk from disease.

In reality, what these anti-vaccine parents are doing is increasing the risk that these diseases will come back and that someone will suffer from a serious complication.  The parent who already vaccinates does so not only out of concern about serious complications, but also because they want to prevent illness in their children. But only ardent pro-vaccine parents are typically also passionate about the power of protecting her whole community.  However, maybe we can use pride in protecting the community not as a way to motivate parents to vaccinate but to motivate vaccinating parents to take pride in their actions and speak up about them.

3. Images and stories about children in peril because of disease only makes parents look for other dangers.  I call this the “Law and Order: SVU” effect, named so because after I have watched episodes of this show where children were in peril, I tend to see dangers for my children everywhere--beyond the scope of the subject of the episode.  

The researchers call this the “danger-priming effect.”  Priming parents for danger doesn’t make them more likely to take the solution you are offering, according to this theory.  It makes them more likely to look for dangers everywhere, including in that syringe you are holding out to them.

4. This study was limited in what it could reasonably do to ease fears about immunization because it was online and impersonal. There’s simply no way to quantify all of those conversations that occur on the playground among parents or around the Thanksgiving table or even between friends on Facebook.  

Parent-to-parent communication is entirely different than the communication in this study.  Think about what we know about ardently anti-vaccine parents:  They are more likely to believe conspiracy theories and thus less likely to believe officially sanctioned scientific evidence.  They are more likely to have a social network guiding them toward vaccine refusal, and providing them positive social reinforcement for their decisions.  The cold, impersonal online survey has no chance for success in the mind of a parent whose decisions are socially reinforced and are based on a distrust of official stances.

So what can we, as pro-vaccine lay-advocates, do? Are we likely to make parents less likely to vaccinate through our advocacy?  

I do not believe so.  In fact, I think lay-advocates--everyday parents and citizens--are key. Recent research shows that normalizing immunization works.  So let’s do that. Let’s let people know that we happily vaccinate our children because we understand the science behind it is clear and because we value our children’s health.

And vaccinating is normal.  Well over 90% of parents vaccinate on-time. If anti-vaccine parents feel that their position is being reinforced by their social network, then we as parents are not doing our job to protect our children and their friends. If every parent with fully vaccinated children simply stated that their children were vaccinated on-time, there would be a groundswell. The voices of these parents would drown out the fear-mongering and lies of the anti-vaccine movement, and concerned parents would feel more confident to join our ranks.

In other words--speak up. It just might work.