Image: Tina Tiller
Image: Tina Tiller

Covid-19October 21, 2021

How to open a positive conversation with your vaccine hesitant friend

Image: Tina Tiller
Image: Tina Tiller

Loving, meaningful and understanding engagement can mean resisting the temptation to bombard with data, writes Dr Elspeth Frascatore, founder of Doctors Stand Up For Vaccination.

Vaccine hesitancy. It’s a phenomenon that has uncomfortably co-existed with vaccines for hundreds of years. Vaccines have been in existence since 17th century China, when Buddhist monks drank snake venom to build resistance to venomous bites. Edward Jenner and Jonas Salk were vaccine pioneers who brought the first smallpox vaccine in 1798 and the polio vaccine in 1955 respectively, eventually resulting in the eradication (or near eradication in the case of polio) of these debilitating diseases from the planet. Vaccines certainly have an impressive portfolio.

However, despite these successes, a flyer currently archived at the National Library of Canada shows the anti-vaccination rhetoric of that time: “the insane ravings of the MAD PRESS” are “aiding and abetting an outrageous crime”. The concluding paragraph states: “though the press and profession cry vaccinate! vaccinate!! vaccinate!!! And the people in thousands follow their blind leaders, I still say, DON’T”. Similar points of view were found all across the globe, even though the history of vaccines is an overwhelmingly positive one. Sadly, some of that sentiment is painfully familiar today.

Indeed, in the 1950s the anti-vaccination rhetoric was so strong that the age-old technique of celebrity endorsement was used, as Elvis smiled happily while receiving his polio vaccine in 1956. Move aside Ashley Bloomfield, the King has entered the building…

Elvis Presley receiving a polio vaccination at CBS studios in New York City, 1956. (Photo by Seymour Wally/NY Daily News Archive via Getty Images)

As I write, 630,000 or so eligible New Zealanders remain unvaccinated. What emotion does that statement prompt for you as you read those words? For some it may be anger or frustration, others helplessness, and others sadness.

Recent protests in Auckland Domain and other parts of the country have shown New Zealand has its own small proportion of the population with a strong, and for some implacable, sentiment against vaccinations. We all probably know someone who is yet to come forward for their vaccination. We may have even argued passionately with complete strangers on the internet about their stance.

However, and this is one of the most important messages we need to learn: we cannot paint everyone with the same brush.

In assuming every one of those 630,000 are the same, we do our people a disservice. Vaccine hesitancy is a continuum. Sure, you will have a very loud minority of “anti-vaxxers” that dominate the field. But for the vast majority of unvaccinated people it is far more complex. These are the people with whom you, as a person who chose to be vaccinated, may be able to have a productive conversation and may be able to make a difference.

In our conversations, we tend to assume that people use facts and cold hard logic to process vaccine information and decide how to act. So, it follows that when we know someone who is yet to be vaccinated, we figure they made that decision based upon a lack of good information. In our efforts to help, we try to fill those holes by bombarding them with information and “myth-busting”. We may produce a flurry of percentages, forward papers to read. We might even tell them they are “wrong”. Take a step back, though, and it’s not hard to see how this may have the opposite effect to that intended: alienation and a hardening of resolve.

In reality, facts and figures can be far from the first thing people use when making a decision. Facts and figures belong to what has been called “the slow brain” or “system 2 thinking”. This is the slow, deliberate part of the brain that works through information and makes deliberate, complex decisions. The vast majority of decisions, however, call on the “fast brain”. This is the quick, instinctive, emotional and more automatic part of the brain: “system 1 thinking”. This part of the brain is trained over the course of a person’s entire life by personal life experiences, by what they hear in conversations, what they read in books, what they see in the media and on the internet. The fast brain of any one human is unique, and equally unchangeable (at least not rapidly) through simple logic. If a person is afraid of dogs because they were bitten as a toddler, you can tell their “slow brain” that “my dog doesn’t bite”, but the “fast brain” fear remains.

It is here, hidden yet influential, that “vaccine hesitancy” can lie. It is understandable, valid, mostly subconscious and its origin and maintenance are completely unique to that person. With that knowledge, it starts to make more sense that a simple presentation of facts is unlikely to help that person.

In those vital conversations you may have with your unvaccinated whānau or friends, you need to understand them and their fears to the core. The experiences that build a person’s “fast brain” may be social, cultural, spiritual, value-driven, historical or political, and are distinctly personal. They may be rooted in their own personal experiences, or the experiences of their whānau or cultural circle. If this person is presented with “facts” that don’t sit comfortably with their innate – or “gut” – feelings, they may “feel wrong” and simply be rejected (“I know you say your dog won’t bite, but I still don’t feel safe”). The person does not have control of their feeling of discomfort – indeed, the value that underlies it is part of their very being, their identity, their true self.

However, once you have an understanding of this complex interplay between “fast and slow” thinking, and understand that a person’s hesitancy is more than could be summarised in a Facebook post or a tweet; when you finally “see” the person and acknowledge their feelings – then, and only then, can those important conversations occur.

Is this easy? Is this a sudden “fix-all” or “light-bulb moment”? No. But from this basis, trust is built. Who a person trusts or finds credible is not the same for everyone. For some, with personal or historical negative experiences, large institutions (such as hospitals, the pharmaceutical industry or indeed the government) can be perceived as highly untrustworthy. These feelings are valid to that individual, and it is for these reasons that a “one size fits all” to vaccine hesitancy simply doesn’t work. Indeed, for many the reiteration of facts and statistics can serve only to isolate people further, making them more resistant and entrenched.

Rather, we, as a country, need to enter into loving, meaningful and understanding conversations. It could be with a doctor, a nurse, a family member or a friend. This may be a journey for both parties – this may not be something that can be solved over a pint of beer. We need to come to know and respect our whānau, friends and patients on a deeper level. What drives you? What are your core values? Once that mutual respect is established, we work together to find the “root values” and problem solve. When a person has uncertainties about specific facts, try to help by explaining as opposed to stating facts, maybe using metaphors or examples whilst trying to understand their world-view. Speak of their hopes and wishes for the future and how being vaccinated may empower them to achieve these, talk about the positive and protective effects being vaccinated may have for their friends and whānau.

A vaccine conversation can be (and should be!) a positive experience, where you connect with someone on a deeper level and leave with a heightened respect for one another.

In a global pandemic, we truly are a “we”. Our actions can impact positively or negatively upon every single other person in our community. We can form a protective bubble, or we can just as easily burst a bubble. This is where we can learn from the concept of kotahitanga, a collective action and unity, to secure the future of Aotearoa. In this era of individualism, if we can begin to think again as a community, one that respects and understands one another’s values and different world views, that protect one another, and that takes the time to reach out a helping hand to a neighbour that is struggling, well, I do believe “it’ll be right”.

Kia kaha Aotearoa.

Elspeth Frascatore is the founder of Doctors Stand Up For Vaccination, a grassroots initiative by the doctors of Aotearoa New Zealand supporting vaccination for Covid-19.

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