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IMMUNISATION experts say a one-size-fits-all approach to immunisation campaigns is unlikely to be effective for parents with entrenched antivaccination views, who need a more targeted approach.
Professor Jonathan Carapetis, director of the Telethon Institute for Child Health Research, said simply translating a traditional “facts and figures” approach to immunisation campaigns could further entrench the views of parents who are firmly anti-immunisation.
“Human behaviour is a very complex thing”, Professor Carapetis said, citing drink driving and smoking as examples of behaviour that people continue with despite the known risks.
“Administering a product to a child in the hope that it will prevent them getting a nasty disease that they might not get anyway is inherently a complex decision-making process for a parent, and that means simplistic approaches to changing those opinions and that behaviour are not likely to work.”
Professor Carapetis was commenting on US research that identified a “backfire effect” in attempts to correct misinformation about links between vaccines and autism to parents with entrenched antivaccination attitudes. (1)
In a two-wave survey of 1759 parents of children aged 17 years or younger, published in Pediatrics, researchers found that the effectiveness of pro-vaccine messages varied depending on existing parental attitudes to vaccination.
“Corrective information about the disproven vaccine-autism link significantly reduced misperceptions, but also reduced intention to vaccinate among parents with the least favorable vaccine attitudes”, the researchers wrote.
Associate Professor Julie Leask, of the University of Sydney’s School of Public Health, said that with about 92% of 2-year-old children fully immunised, Australia’s immunisation rates were reasonably high and stable. (2)
However, she and Professor Carapetis said concerns remained about the timeliness of vaccines and the persistence of low vaccine uptakes in some areas in Australia. (3)
Professor Carapetis said there was a need to target those areas and support GPs to provide effective information to parents who were not having their children vaccinated.
“The biggest struggle in our system is that people need time for those discussions”, Professor Carapetis said.
Professor Leask said the National Centre for Immunisation Research and Surveillance was developing communication tools to help primary care providers in approaching these “sometimes tricky” conversations with parents about vaccines and it had also developed an MMR decision-aid to assist parents. (4)
She said when talking to parents who were firmly opposed to vaccination, health care professionals needed to be wary of the “backfire effect” as described in the Pediatrics research.
“If you have a parent in front of you who is clearly not going to vaccinate, then it is fruitless to engage in a game of scientific ping-pong which can degenerate into an argument and further entrench the parent’s view”, she said, adding that it may lead to a patient not returning to the practice.
Professor Leask said it was important to keep the bridges of communication open with these parents.
“We suggest a very specific approach for parents who are clearly firmly going to refuse vaccination and it’s around maintaining some relationship of trust so there’s that open door for the future should they change their mind”, she said.
A few key questions could help health professionals to gauge a parent’s attitudes to vaccination, she said.
“It’s about getting an accurate picture of where the parents are at so you can treat them accordingly. If they are totally vaccine-refusing, a brief discussion, leaving the door open for the future [is appropriate]. If they are vaccine-hesitant, it may take a bit more time, and … offering another appointment and suggesting that [the parent] … has a look at some good-quality online resources, like the decision aid.”
Professor Leask said Australia did not have a national standardised system for providing risk–benefit information for parents before a baby was vaccinated. “There are certainly some fantastic efforts going on in different jurisdictions, but we could probably be a lot more coordinated as a nation in that regard.”
Professor Leask has applied for funding from research agencies for a project to support vaccine communication in primary care.
1. Pediatrics 2014; Online 3 March
2. Medicare 2013; ACIR statistics
3. AMA 2013; Low vax rates raise disease risk
4. NCIRS 2013; MMR decision aid
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A superb documentary by Genepool Productions aired on SBS last May 2013 may still be viewed on the SBS-online app. Every argument’s loophole was elegantly addressed. I highly recommend it for all health professionals. It addresses every possible issue that might be raised by a doubting parent. It provides succinct and clear evidence on every count.
I suspect that any vacillation or hesitation on the GPs part is immediately read as doubt. Being fore-armed with very specific answers to every nuanced argument is empowering – and more convincing. Yes, inflexible mindsets will be impossible to bend. But knowing you’ve done everything humanly possible will allay that feeling of helplessness. And you may just tip an uncertain parent over to the side of sanity.
When I enter a discussion with an immunisation “non-believer”, I’m always struck by the sheer determination not to listen or consider. The stark logic of my brother’s excessively pragmatic appraisal of the dilemma haunts me: “it’s simply a form of natural selection”. I wish I could be more like him sometimes, because the problem does often seem intractable. How do we help those who are utterly determined not to be helped or guided or advised? Nevertheless, we mustn’t given up. Just the idea of a child suffering unnecessarily because of obstinent ignorance is ample motivation to keep trying…
I believe the public press have a role to play in changing harmful attitudes such as held by the anti-vaxers. I also believe that rather than debating the facts or data surrounding vaccination, we should be trying to persuade these people to think in a different way. I wrote a letter to the local press in Coffs Harbour but unfortunately it did not get published. I suspect that we need to correct perspectives rather than knowledge now that there is so much “data” available – persuasion rather than “re-education”.
Some issues I raised in my letter to the press were that the world is rid of the dreadful disease of smallpox that in the past killed so many people, and is almost free of the horrific disease of polio that killed or paralysed so many children in every country. Australia and other countries have abolished the lifelong tragedy of blindness, deafness and mental retardation due to congenital rubella.
We have conquered these scourges even though we have absolutely no treatment for them. We have achieved this by virtue of immunisation.
We are bedevilled in Australia by a small but vocal group of people, especially in some rural areas, who do not seem to be able to get their thinking straight resulting in outbreaks of death, disability and disease due to whooping cough that could have been prevented by immunisation.
How and why does this happen? I believe that these people are guilty of a failure of straight thinking in the same way as religious fanatics, leading to obsessive and/or paranoid ideas about the dangers of immunisation.
Let’s hope that as time goes on there will be fewer people guilty of failing to think straight and we can work together to reduce unnecessary damage, death, disability and disease.
I live in an area of high vaccine refusal. It’s frustrating to say the least. I’ve had official complaints made against me for recommending vaccines to parents. I have learned a few things about vaccine refusers, their thinking and their perception of risk. Just a few random points:
Despite trusting relationships as a rural GP/ED doc, I’ve never once changed someone’s mind about vaccinating.
Logic doesn’t enter into the argument. Most vaccine-refusing parents have no idea how the immune system or vaccines work, and they don’t care. Their minds are made up.
There is a high prevalence of parents who think babies are too young to get so many vaccines and make what they think are reasonable decisions to delay vaccination, say until one or five years of age. Again, logic is of no use against peoples’ gut reactions again sticking needles and foreign substances in their kids’ legs.
“I got the flu shot but got the flu anyway”. I try to point out common cold vs flu…pointless again.
People have the perception that the diseases are “normal” in childhood and pose little risk to their kids. Even if rarely someone dies from them, they think the risk of getting an infection is very low.
It has become cool and fashionable not to vaccinate. In fact, I’d bet there’s a high correlation between parents who use “amber teething necklaces” and parents who don’t vaccinate.
If an unvaccinated kid steps on a rusty nail the parents are in like a shot to get immunoglobulin and vaccine…of course all paid for by the healthcare system.
They think I’m a pharmacetical industry brainwashed flunky
Rational discussion will not sway “True Believers” or synagogues, churchs and mosques would all be empty.
It is certainly true that no amount of information will convert the true anti-vax zealots – because they have motivations that are not amenable to rational discussion. The purpose of education and effective communication, however, is for the greater number of fence-sitters – those who are open to hearing the facts, and can be mislead by anti-vax misinformation unless it is corrected. I have seen direct evidence of this effect, which is encouraging. IN this context, it is essential that media stories do not report ”false balance” – a specialist immunologist, epidemiologist or paediatrician should not more be set up to debate the local anti-vaxer than an aeronautical engineer should have to ”debate” the local model aircraft enthusiast. Balance occurs when there is a legitimate division of opinion within an informed group. This is not the case in vaccination.
Using a logical argument against irrational belief is pointless. There is more evidence for vaccination than gravity, and I dont see any of the anti-vaxers trying to fly. I also do not think treating these people as benign or promoting their belief systems (consciencious objection?? what’s conscientious about it???) as ok or non-main stream is corrrect. Being against vaccination is anti-societal, raises risk of serious disease and those responsible should collectively be held to account. There shoud be measures in place to remove the consent of parents (which can already occur re blood product denial etc) and act in the best health options of the child and have them vaccinated.