Editor’s Note: Rahul Parikh is a physician and writer in the SF Bay Area. The views expressed here are those of the author. View more opinion articles on CNN.
On a recent day in my pediatric practice, I met a bouncing toddler and her parents. They, like my wife and I, are both working professionals. We shared the struggles of modern parenting – getting our kids to bed on time, then ready in the morning so we can get them to childcare or school and ourselves to work, and then starting it all over again the next day.
After some Q&A and an exam, I began to review the child’s vaccine schedule. She was behind. Her parents told me they had done this deliberately because they had concerns about vaccines.
I let them know that we in medicine have a lot of experience with vaccines and that they’ve saved countless lives – that the schedule and number of vaccines at each visit were meant to keep their daughter healthy. I told them this year’s measles outbreak – the worst in over a quarter of a century – was an example of what might happen if we continue to let kids go unvaccinated or under-vaccinated.
They responded by saying they weren’t anti-vaccine, but they didn’t think they needed to move along on the schedule the medical community was recommending. Our time ran short and they left without a clear plan as to when they would catch their daughter up on her shots.
The parents of that toddler aren’t part of the “antivax” group waging a continuous war against progress and enlightenment.
Rather, these were what the medical community calls Vaccine Hesitant Parents (VHPs): a middle ground of caring, pragmatic parents who don’t reject vaccines outright, but worry about them. Some worry because of something they’ve heard from other parents or because they read an account of a vaccine-damaged child online. Some may be dizzy from one too many Google searches that land on confusing and contradictory figures on the value and safety of vaccines.
Not against vaccines, but hesitant
It’s perhaps easier to be influenced by these fears than the thought of what could happen if kids aren’t vaccinated: the neurological consequences of measles; paralysis and suffocation from polio; the damage to brain and limbs from meningococcal disease. The World Health Organization identifies Vaccine Hesitancy as a top 10 threat to global health, where it shares a place alongside climate change, Ebola, and antibiotic resistance, among others.
It’s crucial for us as doctors to work harder to persuade VHPs that the recommended regimen of vaccines is what will keep their children safe. If we want to keep our children and communities healthy, we must help VHPs understand the importance of immunization. To do this, we have to get to them earlier and use the power of conversation and emotional argument, along with science.
For physicians, the opportunity to influence VHPs starts in the exam room, hospital or health system we practice in. Traditionally, the vaccination conversation starts at an infant’s first checkup, around two weeks of age. But many parents begin contemplating vaccines during pregnancy or immediately after childbirth. If health care providers were to broach the topic then, it would offer an earlier chance to influence parents with some new approaches.
A 2017 study by the American Academy of Pediatrics found that pregnant women who were given access to online social network tools were more likely to choose vaccination and immunize their kids on time when compared to subjects who were not. In another study published in the journal Vaccine in 2018, postpartum mothers were engaged in “motivational interviewing,” during which the interviewer explores a patient’s feelings, readiness and confidence in vaccinating. These mothers showed a greater intent to vaccinate their infant and a greater rate of vaccination than control subjects. Both approaches, a social network and motivational interviewing, are practical, scalable and cost-effective ideas worth spreading.
Word-of-mouth: where anti-vaxxers excel
We also need to expand our reach outside of the exam room to utilize word-of-mouth, both in real and online communities. This is an area where anti-vaxxers have had great success. While the medical community has taken a top-down approach using expertise and data as our tools, anti-vaxxers started at the grassroots level — communities, schools, and social media — to spread their messages horizontally to other parents, using stories and images of children they allege are vaccine-injured victims. Their stories aim right at the heart. As opposed to the medical community, which is committed to protecting patient privacy and staying true to science, anti-vaxxers have free rein to say and do what they want, including bending and breaking facts to fit their narrative.
Several years ago, two Minnesota mothers, who run a blog and a website, challenged doctors and health professionals to combine their clinical knowledge with their power as advocates – and, like anti-vaxxers, the power of stories. Writing in a medical journal, they told us plainly, “We are not vaccine experts, providers, scientists, or public health professionals. We are just parents who care about immunization and the health of our communities, and feel passionate about combating anti-vaccine messages — and we know of many more parents like us who would like to help. It’s time for providers and others in the medical and public health community to realize they have partners waiting in the wings. With stories and science, this is a partnership that can make a real difference.”
No doubt they’re right. A template for such a campaign can be found in the fight to spread information about the health risks of tobacco. The images, words and messages that communicate the dangers of smoking have are visceral in nature, meant to trigger fear, horror, anger and even disgust at what smoking can do to the human body. Though “negative” in tone, these messages are backed by scientific truth.
It’s unclear to me whether doctors, public health and policy leaders have used this tactic yet, as we don’t know the conversations that are had in exam rooms. But much of the credible information online – what can be found on the Center for Disease Control’s website, for instance – doesn’t hold up against the stories of a parent’s testimonial about the dangers of vaccines.
The power of sharing real-life horror stories
We need to change direction and share the real-life horror stories of what can happen when we fail to vaccinate our children – certainly on social media. In a 2015 study of vaccine messages on Pinterest, a majority of the pinned items related to vaccines were decidedly anti-vaccine. Pinterest and Twitter have recently taken steps to mitigate anti-vaccine messages on their networks, while Facebook has done the same by rolling out educational pop-up windows that appear on vaccine-related groups and pages, or in searches for vaccine-related content and hashtags.
Pounding the pavement and speaking eye to eye with VHPs may be one approach to spreading the correct facts. One potential forum is at school. Children in Utah County, Utah, ranked sixth nationally for the total number of entering kindergarteners that were under-vaccinated in the 2016-2017 school year. This is where researchers looked at whether college undergraduates (not yet parents) could be swayed to rethink their views of vaccines and found that nearly 7 in 10 vaccine hesitant students who had a conversation with the victim of a disease changed their minds.
Every community has storytellers – from religious leaders to family members and friends. And let’s not forget kids. It’s worth considering how they could change hearts and minds where they live. Recently, a 17-year old high schooler went to Congress and revealed how he became a rebel with a cause by defying his vaccine-hesitant mother and getting shots on his own.
“It’s with love and respect that I disagree with my mom,” he said.
He also corroborated the importance of story in changing minds.
“People resonate better with stories. A large portion of the anti-vaccine information that my mom has provided me is on an anecdotal level. She would reaffirm her position because she would say that ‘she knows people’ and ‘heard stories,’” he told the committee. The medical community’s job is to arm them with the right mix of stories and science.
Most analyses of different approaches to persuade vaccine-hesitant parents to immunize is still new, and don’t point in any single conclusive direction. Still, what’s amazing is the breadth of effort – in medicine, social psychology, behavioral economics, marketing, law, and on – to change the conversation.
One side relies on the same, tired, tactics while the other is trying to constantly learn and adapt. I feel pretty confident that in the long run, I’m on the right side and it won’t be long before I’ll be able to change the minds of that bouncing toddler’s loving parents.