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PUBLIC health advocates have long been frustrated at how hard it is to persuade vaccine-hesitant parents of the safety and benefits of immunisation.
One study published last year found educational interventions with parents could actually make them less likely to vaccinate their children.
The randomised controlled trial looked at four interventions: explaining the lack of scientific evidence for a causal link between the measles–mumps–rubella vaccine and autism; providing written information on the dangers of the diseases prevented by that vaccine; showing images of children affected by the diseases; and telling the dramatic story of a child who almost died from measles.
None of those four strategies increased parents’ intention to vaccinate, and the last two actually increased parental belief in the dangerous side-effects, not of the diseases, but of the vaccines that prevent them.
So why are anti-vaccine messages so persuasive and so resistant to scientific evidence?
A study of nearly 500 anti-vaccination websites presented at last week’s American Public Health Association annual meeting set out to examine those questions.
Around two-thirds of the sites linked vaccines to autism, and about 40% raised concerns about brain damage or injury. Just over a quarter argued vaccines were ineffective and a similar proportion argued they weakened the child’s immune system.
Techniques used to promote the anti-vaccine views included “expert” opinion, pseudo-scientific evidence (like this example), anecdotes about alleged vaccine-related injury, and the fostering of mistrust in relation to those recommending vaccination.
Government was the most common target of mistrust (79% of sites), followed by health care professionals (42%). Reasons for mistrust included the belief that authorities lacked concern for people’s wellbeing (82%), were ignorant of vaccine dangers (78%), or were motivated only by profit or power (70%).
One site, allegedly written by a medical professional, says: “Vaccines are immoral when they are forced upon an innocent and ignorant public by an insane system of ‘public health’ and pediatricians who are often in total denial of the negative effects of their own actions”.
Widespread claims that government and health care practitioners were liars, ill informed or engaged in a conspiracy were particularly disturbing, the researchers argued, given these are the people and organisations we rely on to deliver quality messages on immunisation.
If those sources aren’t trusted, there is little chance their messages are going to get through.
One solution, the researchers suggest, might be to associate the pro-vaccination message with other beliefs held by vaccine-hesitant parents. Many of the anti-vaccine sites also promoted healthy behaviours such as good nutrition and breastfeeding, for example, a possible common ground for public health advocates.
It might also be possible to get the message out through organisations or people these parents do trust — parents’ groups, perhaps, or health food stores.
Perhaps, most crucially, many of the sites use ideas about freedom and individual choice to bolster their arguments, prompting these researchers to suggest immunisation advocates should be careful not to use language that implied any restriction of individual freedom — which might raise questions about the federal government's “no jab, no pay” policy.
The researchers argue that there might even be a way to convince parents that vaccination, far from impinging on their child’s freedom, actually enhances it.
Jane McCredie is a Sydney-based science and medicine writer.
“Malaria, hepatitis C, HIV are three diseases that do not have vaccines. They certainly have not disappeared.” Indeed. It’s not ALL about nutrition and sanitation after all. The comment from “hadenoughofignorance” (a highly ironic pseudonym) goes to show how pervasive the anti-vax movement is on the internet – they can find their way to any site discussing vaccination. For other non-medical readers, it’s worth noting that it’s highly unlikely that a child would have a seizure immediately after a vaccine unless they were already epileptic – as the febrile response would not have time to have occurred. It’s also worth noting that the vast majority of febrile convulsions occur in response to ordinary viral illnesses – we see them every day in medical practice.
Hadenoughofignorance…Was it your ‘personally normal child’? It would need to be, you must have been there to see what you describe happen. Otherwise you cannot credibly cite the event. Don’t cite other people – hearsay evidence is always suspect. And if the response was that rapid, it may be the event of needling the skin that caused the reaction you described. [If it was your child, I am sorry for you, but your should tell us the full story, including the medical management of the exigency. This was an ‘outlier’ event.]I consider human vaccines undergo far more stringent testing than do animal vaccines. Anyway, how can one compare animal ‘reactions’ to human ‘reactions’ to the point of claiming they are identical – being the ‘exact same reactions’? You cannot ask animals how they feel. Animal skin cannot be seen, it is commonly hidden by fir. What are the ‘reactions’ you are writing about?Native ‘viral’ varicella virus, during primary chicken pox infection, incorporate themselves into human sensory neurons of spinal ganglia, becoming ‘latent’. That persisting latent infection protects adults from the far more severe – not uncommonly life-threatening – adult form of primary chicken pox. The functioning of the competent immune system is complex. It must have some biological memory of the ’noxious agent’ to be able to present a prompt defence against its reappearance.
Malaria, hepatitis C, HIV are three diseases that do not have vaccines. They certainly have not disappeared.
When your perfectly normal child starts seizing and goes into respiratory distress within seconds of a vaccination and the doctor says “its not related” causes the mistrust. Veterinary science documents vaccine reactions in animals, yet when those exact same reactions are seen in people there is “no correlation” Ma study done between vaccinated and unvaccinated dogs showed the vaccinated dogs developed autoantibodies to many of their own biochemicals, autoimmune disease ! Yet doctors will deny the same thing happening in people, The New England Journal of Medicine reported it is possible to isolate the rubella virus from the arthritic joints of children vaccinated against rubella, research in 2000 confirmed polyarthritis in dogs was linked to the combined vaccine given to them. Fibrosarcoma is the most common vaccine associated sarcoma in cats, yet in people the cause is “unclear”. Most anti vax were pro vax who now have damaged/dead children with “no known cause” considering the 100’s of thousands of “correlations” to continue denying it is criminal. Those people will not be blackmailed into vaccinating again.The people that think its the unvaccinated spreading diseases are lacking common sense and maybe they should check out the FDA site more often and see the press releases stating recently vaccinated individuals can become carriers. You say “Psuedo science” yet the thousands of studies proving vaccines arent safe are mostly .gov websites, but as I understand it psuedo science means, “study not paid for by those who will make the most money from them”. What happened to all the diseases that had no vaccines? Miraculously disappeared.
Chris – are you not able to access the placebo-controlled trials for your patients? I can happily direct you to references if you need – including the useful and comprehensive guide The Science of Immunisation – at https://www.science.org.au/immunisation. The real paternalism is coming from the organised and deceptive anti-vaxers, including (unfortunately) some registered chiropractors, who sell simplistic messages and fear.
Listening is a good skill, but promoting pseudo-science and selling simplistric anti-vax messages are not.
Perhaps we could do some randomized placebo controlled trials… You know the ones we are supposed to believe in….. Perhaps we could educate our profession a bit more about the anti-Vaxers concerns. I always found listening first much more helpful than closing my ears to peoples concerns. I thought we were done with paternalism…
Like it or not, the antivax kids of Oz are relatively safe, as the “herd” is mainly immune and therefore usually won’t transmit the diseases.
Unfortunately, due to “generational memory loss” there will always have to be publicised tragedies to remind us of the dangers of antivax.
Our praiseworthy colleagues working in 3rd world clinics might help a lot by sending pics of people suffering vaccine-preventable diseases.
As has been suggested above, we enforce many other preventative health strategies by sanctions, including seat belt laws, motorcycle helmet laws, stopping at traffic lights etc. This is so mainstream that we do not now bother arguing the science and the statistics with helmet- or seat belt-refusers, we simply take away their driver’s license and with it the right to use public roads. Nobody argues about “fairness” eg ability to get to and from work, you do the wrong thing, you lose the privilege and we really don’t care what you believe. Smoking is also banned in various public spaces as we know that the health and rights of surrounding people are put under threat. Same applies, your beliefs are your own indulgence, but if you threaten the rights of the public, expect them to sanction you.
By contrast “No jab no play” is not even a punishment as these other examples merit, it is entirely defensible in terms of protecting other children from high risk children. The rights of the protected children override those of the wantonly neglectful parent. Similarly, restriction of State welfare donations to parents who deliberately do not vaccinate is an appropriate sanction given the children affected are more likely to be consumers of State public health care money in the long run. Again the rights of the compliant and those of the taxpayers are relevant.
The quoted study seems to suggest that there is only so much science you can push on a misguided person before they push back and become paranoid. There needs to be both a carrot and a stick, or we will continue to allow the antivax conspiracy theorists to endanger everyone else.
Immunization is a vital part of improving the morbidity and mortality rates in our country, thus improving quality of life of the baby, and the QOLYS as the baby grows up.
We forget that this is why we do immuize, and we need to make parents understand that by denying a baby / child the right to be immunized, that QOL is diminished or lost in cases of death from infection.
I also think, that the parents need to sign a refusal to follow medical advice but get them to read out the problems that may arise from refusal to immunise the baby “they love so much”, and we need to include things like pneumonia, deafness, sterility and, of course, death. Most will think twice to sign such document.
Once a problem arises in unimmunised child, then the consequences need to be explained, but perhaps public health determination to deliver Court rulings on deaths via COroner’s Inquests etc may need to be highlighted.
In the end, parents are given the responsibility of looking after the child, and if they are not prepared to do this to their best ability then, perhaps, we need to do more than just take the ‘money away’. Perhaps the issue is requiring Guardianship decisions, almost like the issue of any other treatment refusal.
I find vaccines and vaccination common language, and so let us move to the more correct terminology as professionals of immunization. I think it behoves us and all staff members in medical practices to ‘walk the talk’, thus ensuring that we are all immunised according to the Australian standards, as we find many members of the health professions do not follow the guidelines themselves.
Some social conventions are adhered to by all. We all wear clothes in public. We all stop at red lights. What is it about vaccinations that trigger such opposition. We know that logical reasoned argument is not an effective tool for behaviour change. How could a casino make money if it was? The messsage probably has to stop coming from the doctor. The doctor is who you turn to in a crisis – the very act of walking in the door means you have consented to take advice. To advise people who are not sick on preventative choices is always hard
As Oscar Wilde said “It is always a silly thing to give advice, but to give good advice is absolutely fatal”
Perhaps here is where we need to turn to case studies and depend upon role models in whatever form that may take….
Unfortunately social media has given the anti vaccination lobby a platform to spread its views—I frequently see these pop up on Facebook- and the misinformation is scandalous.
The modern generation did not grow up with the scourges of smallpox, diphtheria and polio—They need to look in an old graveyard at the headstones of small children dying of these diseases, now almost eradicated in Western countries by vaccination.
There is a lovely old photo published recently in the Adelaide Advertiser showing a long queue of mothers and children waiting to get the polio vaccine in the 1950’s; they didn’t need any persuading, they were seeing the ravages of the disease every day.
When I was a child, all babies were vacinated against smallpox – no ifs or buts. It was a painful vaccination and all of us oldies have the scar on our upper arm to prove it. BUT smallpox has been irradicated!
I had my children vaccinated, not just to prevent them getting measles etc, but in the hope that if everyone did it we might eventually get rid of these horrible diseases. Allowing children to contract measles to “build up their immunity”is risky, as evident by my permanent hearing loss.