Of all of the parenting topics that turn into all-out war online – breast vs bottle, dummy-gate, circumcision or uncut grapes – the worst of all is surely vaccination. Here the Spinoff Parents’ science writer Dr Jess Berentson-Shaw discusses the importance of talking calmly about vaccination.
In part one and part two of this series on vaccinations in New Zealand, Dr Jess Berentson-Shaw discussed the value of vaccinations to individual children and to all children in society. She covered the small risks and the large protections vaccinations offer and highlighted the critical importance of ‘herd immunity’. If as many people as possible vaccinate their children then all children in a community – including those who cannot be vaccinated and those who miss out because of poverty and deprivation – will have the freedom to grow up healthy.
It can be terribly satisfying to get one over on people who decline vaccinations – to trap them in a hypocritical statement or just get pissed at them. I will be honest and say I have, in my frustration, done this in the past. Then I challenged myself as a scientist and asked – does this approach actually work? What does the evidence tell us about how to talk to people who are concerned or unsure or just plain ‘anti’ vaccination? These are important questions to ask because ultimately the goal here is to ensure all of our children have the opportunity to experience a healthy childhood.
And with that as my aim I realised that perhaps I needed to stop being a smartarse and start being a good science communicator.
What does the research tell us convinces parents of the value of vaccination?
Experts in New Zealand do not think mandating vaccination is what is needed – it is not really the New Zealand way, of live and let live and our respect for diversity. Rather we need high quality effective conversations about immunisation. I will start by looking at how to talk with parents who are unsure, and then discuss how to talk with the so-called “active decliners” of vaccinations.
Five ways to talk to parents who are unsure about vaccination
1. Lets start by looking at when we should we talk about vaccination. Currently we tend to leave the detailed vaccination conversation until the time comes to vaccinate, when a baby is about six weeks old. And that’s a problem. After a baby is born is a stressful time; six weeks is just about enough time to really fuck a new parent up. Parents are juggling multiple massive changes in their lives, sleep deprivation and strong emotions. Talking about the hard stuff now is just really really difficult.
Research indicates that opening two-way discussions prior to birth by well-informed and engaged health professions may help. Women in New Zealand have most contact with their midwives prior to birth. However the workload for midwives at prenatal appointments is huge, so we need to get a bit innovative about delivering this information to pregnant women without overburdening midwives. Is there another community organisation that can do it? Is social media a tool we should be leveraging? What about peer group discussions? Community change campaigns? Should we consider teaching vaccination science in schools?
2. We need to talk about good science in an empathetic way. Parents are right to express interest and concern about any intervention their child receives; it shows a totally appropriate level of engagement with the job of being a parent and caring for your child. A recent survey on immunisation attitudes indicated that about 5% of people surveyed are unsure about vaccinating and another 5% have concerns about vaccine safety. This simply indicates people are engaged with the issues and we should not minimise that engagement. Research suggests that tailoring messages to each individual’s specific concerns may help. This site is a great source of information for people with particular specific concerns. And Sciblogs also has good resources
3. Next issue: fear. Fear-based communications appear not to work, so scary pictures of children with measles and seizures? Just don’t go there. Psychological research tells us that when people see something awful and fear-based we tend to just avoid the issue or shut out information; the stress response is not a great enabler of acceptance of an idea. However, positive stories of children who survived due to vaccination? Great.
4. Encourage good media (or create good media on yourself). Mainstream media in New Zealand needs to be a reliable source of evidence-based vaccination information. This is not a story of two equal sides – classic ‘both sides’ media storytelling techniques are not appropriate or even ethical here. Yes parents have concerns, but the science is not out on this issue. Really it is not. Vaccination offers children in New Zealand enormous freedom that children in developing countries do not have. The risks of vaccination exist, but they are small (and the safety research vigorous), and the benefits are significant in children who are vaccinated. Research is clear that vaccinated children in wealthy countries (like New Zealand) are much less likely to suffer an infectious disease than unvaccinated children.
5. Keep trust and respect front of mind. Parents need to feel supported and trusted because they are decisions makers of their children’s lives. So don’t shut them down, go all authoritarian, or tell them their worries are unfounded. Parents have concerns because they love their children; it is this love we need to activate when showing how very crucial vaccination is. This is too important to get the communication wrong on.
So how about ‘active decliners’? Is there anything we can do?
How to talk with parents who choose not to vaccinate
Here’s the hard truth: It can simply be better to sidestep the conversation with those who are very confident in their anti vaccination beliefs, and focus instead on those who are more open to discussion. If parents believe absolutely in a conspiracy of health professionals and the pharmaceutical industry, or in the false data about autism, for example, then sometimes evidence and argument will just make them double down on their beliefs as they feel ‘got at’.
But it may be possible to acknowledge their concerns about the downsides of the pharmaceutical industry while also highlighting the rigour of vaccination testing. An industry can be more than one thing at once. I am no fan of the behaviour of some parts of the pharmaceutical industry in the US in terms of their political influence, but vaccinations have extraordinarily powerful science behind them and the standard they are held to by the wider scientific and medical community is very high. I can be confident in the science while questioning some of the activities of some big corporations. This is my power as a scientist and a citizen – to take the good for my and my child’s benefit and reject the bad.
Emphasising the societal benefit of vaccinations works when benefits to a parent’s child are also discussed. So the herd immunity arguments count more if parents understand that vaccinations also benefit their individual child. At the heart of most parent’s decisions to not vaccinate is care and love for their child – they believe they are protecting their child, much like those of us who vaccinate believe we are protecting ours. Beliefs matter in using science. If in our discussions we can draw on that care and love, for example our shared desire to give our children a healthy life, we may get closer to the desired behaviour change.
Here’s an example of this type of communication in action. In Western Australia a community of self-identified ‘natural parenting’ advocates had high rates of declining vaccination. In an attempt to increase rates of vaccination a campaign was developed in which role models from within that community who had actually chosen to vaccinate their children were located and asked to talk openly about their choice to vaccinate. The campaign was called ‘I Immunise’ and focused on how vaccination can be part of a natural parenting identity. Specifically, it drew out and communicated why these parents believed vaccination was aligned with their natural parenting value set, which was essentially about taking care of and protecting their children. Some people in the study responded by doubling down on their anti vaccination beliefs (which is to be expected), but about a third of those in the study who had a history of refusal changed their beliefs about the value of vaccination to their children. The research does not offer a definitive solution, but is an interesting and new approach. It highlights that we need to get smarter and more evidence-based about what works in vaccination (and all science) communication.
In a changed world of science and information, we have a lot of work to do. We need a lot more evidence to do that work if we are going to continue to help all parents (not just some) give their children the freedom of a healthy childhood.
Dr Jessica Berentson-Shaw is a mother of two, scientist, writer, and author.