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Throwback Thursday: An Evidence-Based Guide for Convincing Parents to Vaccinate

Throwback Thursday is a series we sometimes do at Skepchick wherein we re-post old Skepchick pieces that have updates, are relevant again, or that we just really want to re-share. The U.S. is currently in the midst of the worst measles outbreak in decades, likely because there are pockets in places like California where many parents are choosing not to vaccinate their children. I’ve seen a lot of people arguing on social media about how best to convince parents to vaccinate and thought it might be a good idea if I wrote a post about it. Then I remembered that I already wrote a post on that exact topic back in 2013. Everything I wrote back then is still relevant today and is reposted below with a some small edits along with a new intro. The original post was published at Skepchick on Nov 21, 2013. 

For years I’ve been following anti-vaccine blogs and sometimes even attending (and getting kicked out of) anti-vaccine events. I don’t do this to torture myself but because I’m interested in how such unscientific anti-vaccine messaging has made inroads within the popular culture and specifically in how we can use messaging ourselves to change the minds of parents who are considering not vaccinating their children. In recent years a lot of research has come out showing that providing anti-vaccine parents with facts about vaccines may actually make them more entrenched in their anti-vaccine views. This can be an unsettling fact to those of us worried about the herd immunity of our communities.

But, do not despair because there are evidence-based methods to persuading parents to vaccinate. Many of these tips comes from the results of a marketing research study done by Women Thinking, Inc and published here on Skepchick back in 2013. The study looked into the most effective types of messaging for convincing parents to vaccinate their children. I’ve combined many of the results of that survey along with other research in cognitive psychology and behavioral economics to put together a list of tips to use when trying to convince your friends and family that vaccinating their children is the best way to protect them against infectious diseases.

Before I start, I want to mention some caveats. These tips are meant to help sway a parent who is worried about vaccinating but still open to the idea. They are not meant to be used in attempting to convince a parent who is staunchly anti-vaccine that all their beliefs about vaccines are wrong. You are still welcome to try to debate them, of course, but you’ll likely be disappointed with the results. Luckily people with extreme anti-vaccine views make up a very, very small portion of the population. Most of the people lowering herd immunity to dangerous levels in certain communities are not actually anti-vaccine proponents; They are just parents who have fears about vaccines and are not sure what decision to make, so they go with the easiest one which is to not vaccinate. These tips can be used to help convince those parents that their fears regarding vaccines are unfounded.

Don’t assume that she is stupid for questioning the safety of vaccines.

The results of the WTinc study showed that parents, even those who are distrustful of vaccines, understand that vaccines are effective in preventing infectious diseases and that their children are at a heightened risk of contracting these diseases if they are not vaccinated. They also understand that the risks of bad side effects from vaccines are low. Essentially every parent is doing a cost-benefit analysis, comparing the low-risk of their child catching an infectious disease if not vaccinated to the low-risk of their child getting a vaccine injury. It’s important to keep in mind that this decision can be a difficult one and the fact that the chance of a bad vaccine injury is much less likely than catching an infectious disease is not obvious to everyone. Not knowing this does not make someone stupid or ignorant. It just makes them not a vaccine researcher, like 99.999% of the population of the planet, including, most likely, you. Carefully considering the decisions you make about your children’s health and safety doesn’t make you a bad parent; It makes you a smart one. Treat her that way and you won’t come across as being patronizing, something that could really sully the message you are trying to get across.

Emphasize the safety of vaccines, but be honest about the risks.

The WTinc survey results showed that parents tend to have a pretty good grasp on the benefits of vaccinating, but are fuzzy on the associated risks. The anti-vaccine movement has been fairly successful at spreading the myth that vaccines are not very well studied and have all sorts of dangerous toxins and chemicals in them. These were some of the strongest arguments against vaccinating that WTinc found in our study. Lucky for us though, we have the facts on our side. Do not lie and say that vaccines are 100% safe or have no negative side effects because it is untrue and most likely the person you’re talking to is smart enough to see through a lie like that. Focus instead on the fact that  vaccines are some of the most well-studied drugs out there. Tell your vaccine-doubter about how the CDC is meticulous in tracking vaccine side effects through the VAERS database and how they follow-up by compensating parents of children with vaccine injuries via the Vaccine Court. Emphasize how much knowledge researchers have about vaccines and their associated risks and how this has led to very safe vaccines and a system in place to help those who do end up with a vaccine injury. Lastly, make sure to mention that serious vaccine injuries are vanishingly rare, especially when compared with the risk of catching an infectious disease.

Talk about the importance of vaccinating children on schedule.

The WTinc study found that one of the preferred choices among parents who couldn’t make up their mind about vaccines was to do a delayed vaccine schedule wherein they waited until their children were much older than is recommended before taking them to get their vaccines. When we tested the salience of anti-vaccine messaging with these parents, we found they were very convinced by the argument that a young infant is too small and weak for their little bodies to handle the toxins in vaccines and that it would be better to wait until they are older before giving it to them. It’s easy to see why this argument is so convincing because it seems to make intuitive sense.

If you are facing a parent that holds beliefs like this, you can use this same argument in defense of vaccines. In fact, when an infant is small and weak is when they are most at risk of getting very sick and even dying if they contract an infectious disease. The vaccine helps protect them when they are at their weakest. By waiting until they are older to give them a vaccine, you are leaving them unprotected at their weakest moment. It is when they are young that they especially need the vaccines to protect them until their bodies grow stronger and better able to combat diseases. Tell all this to your vaccine-questioning parent with special emphasis on the importance of sticking to the CDC vaccination schedule.

Use active-language and metaphors to make vaccinating the default decision and not vaccinating an active (and risky) decision.

In the Women Thinking, inc study, the most convincing argument we found for vaccinating was to compare vaccines to a car seat. It is well-accepted within parenting culture that the default action is to put your young child in a car seat. A parent who doesn’t do this is one that is going against the norm and is making an active decision to not use a car seat and put their children at risk. We want parents to think about vaccines in the same way.

The Status Quo Bias is a well-known and much-studied cognitive bias within behavioral economics that says that when having trouble making a difficult decision, a person is more likely to go with the default because it’s easier. When thinking about vaccines, it’s easy for some parents who are having trouble making a decision to default to not vaccinating. By instead comparing vaccines to an action that is consider a default parenting action, such as car seats, it twists the decision to vaccinate into the default position, with choosing to opt-out becoming an active and potentially risky choice. When talking to parents about vaccines make sure to use active verbs such as “opt-out” or “choose to forego” when discussing the choice to not vaccinate.

 Emphasize that most parents are vaccinating their children. 

Although parents who reject vaccines have been becoming more common, it remains a small minority of parents who are choosing to opt-out of vaccines altogether. Though we did not study this particular type of messaging in the WTinc survey, research in behavioral economics and cognitive psychology shows that people tend to be more likely to do something if they believe most other people are doing it. For example, hotel guests are more likely to opt-out of daily towel cleaning if they first read a sign telling them that most other hotel guests opt-out and constituents are more likely to vote in the next election when told that lots of other people are planning to vote. This same type of messaging can be used in convincing parents to vaccinate their children.

Cite research on vaccination rates. The closer-to-home the stats you can find, the better. Where I live in Chicago, the Chicago Tribune reported in 2011 that vaccination rates in Chicago schools were typically around 98%. There were many private schools that had rates under 90%, but even there it is important to remember that 9 in 10 parents were still choosing to vaccinate. Let the parent you are speaking with know that most of the other parents in their area are vaccinating their children. Emphasize that vaccinating is the norm. This also helps play into the message mentioned earlier that vaccinating is the default decision and opting-out is an active decision that goes against the norm and leaves their children unprotected.

Don’t talk about Andrew Wakefield.

The supposed connection between vaccines and autism remains important in the minds of many parents when it comes to the decision on vaccinating. In the WTinc study, we found that even though most of the vaccine-unsure parents didn’t necessarily agree with the statement that vaccines cause autism, they didn’t disagree with it either. It was seen as more of a controversial statement that may or may not be true. When speaking with your friends or family that are worried about vaccines, Autism is a topic that is likely to come up. Let them know that there has been a lot of research looking into the relationship between Autism and vaccines and it has been found to not be related.

What you don’t want to do is to give the entire history of Andrew Wakefield’s fraudulent research into the MMR vaccine and autism. The problem is that denying something can actually make you seem guiltier in the eyes of the person you are speaking to. The more you deny something, the guiltier you tend to look, regardless of whether facts are on your side.  For proof of this phenomenon, here’s Nixon:

When Nixon says his now infamous line “I am not a crook,” the only thing on anyone’s mind when hearing it is “that guy sounds like a crook.” In this case, Nixon really was a crook, but even if he were not, he still would have sounded guilty when saying that line. It doesn’t matter whether you are right or not, the more emphatically you deny something the guiltier you come across. In cases like Autism and vaccines this becomes a Catch 22. Vaccines don’t cause autism, but saying that tends to make people think that vaccines do cause autism, because if it didn’t then why deny it?

The WTinc study tested this theory by analyzing the influence of telling parents the story of Andrew Wakefield’s fraud. It turned out that this was by far the most unconvincing argument that we could come up with for convincing parents to vaccinate, and yet it is an argument often used by skeptics when trying to talk parents out of listening to the anti-vaccine movement.

When talking with a parent, you’re going to have to deny that vaccines cause autism, but just try not to dwell too long on this point. Don’t tell the entire history of Andrew Wakefield and the anti-vaccine movement. Just explain that vaccines absolutely 100% don’t cause autism and move on.

Don’t talk about Jenny McCarthy.

I know it’s really tempting to tell your vaccine-doubting parent all about how wrong Jenny McCarthy and the anti-vaccine movement are, but it really is best not to mention it at all unless it is specifically brought up by the parent you are speaking with. There are a couple reasons for this. The first is that focusing on people rather than vaccine safety can make it seem like an argument between personalities rather than one between facts and plays into the idea that vaccines safety is an unknown and controversial issue. Second, remember what I said earlier about how the popularity of an idea legitimizes it? By talking about an entire group of people, including influential and famous people, who buy into anti-vaccine beliefs, all you are doing is serving to make their point of view seem legitimate. It is best to avoid talking about them altogether. If you are specifically asked about it, let the parent know that the anti-vaccine movement is a small fringe movement that almost no one takes seriously.

Talk more about individual people and less about government agencies.

The WTinc study showed that a lot of the vaccine suspicion was tied up in distrust of official government agencies, drug companies, and the medical establishment. Focusing too much on official information from the CDC could engender doubts about vaccine safety. Try to put the focus more on individuals rather than government agencies. For example, when talking about how CDC sets vaccine schedule guidelines, talk about how researchers studied vaccines for many years to determine the safest schedule for administering vaccines that provides optimal protection for children and decreases the chance of any side effects. This puts the focus more on the researchers rather than the organization, which humanizes it.

Don’t be afraid of anecdotes.

Skeptics are so fond of repeating over and over again that anecdotes are not evidence that it has actually led to a hyperskepticism that seems afraid of ever mentioning an anecdote. Anecdotes may not be evidence, but they are important for painting a picture of reality and making an obscure concept easier to digest. If you are a parent, make sure to tell the person you are trying to convince that you vaccinated your children and have been happy with that decision. Of all the evidence you could give about vaccines, this could be the most convincing.

Even if you don’t have children of your own to use as an example, don’t be afraid of using anecdotes from others. Tell stories about parents who did not vaccinate their children and ended up regretting it after their children contracted a disease. Talk about people you know who are not able to get vaccinated for medical reasons and how they rely on the vaccination of those around them for protection. Don’t be afraid to tell these stories. Just because you talked about the evidence doesn’t mean you can’t also mention some stories about individual people you know or have read about in order to insert a little bit of heart and humanity into your argument.

Listen to her concerns and don’t push too hard. 

Remember what I said about Nixon and denial? The same goes in terms of aggressiveness in putting across your argument. You must be confident and sincere in your statements to be persuasive, but push too hard or belittle her concerns and it could come across as being aggressive and put the person you are speaking with on the defensive. Keep in mind that this isn’t a debate. You are speaking with someone who is questioning vaccines precisely because she wants to do what is best for her child.  Put forward the best argument you can and then back-off and listen. It’s possible she’ll choose to vaccinate her children or she may do a delayed schedule or not vaccinate at all. Regardless of her decision, be respectful of her even if you disagree. You can let her know you disagree, but do so in a way that doesn’t imply that she is stupid or crazy for making the decision she did. Perhaps she will change her mind in time, but drawing a line in the sand could make her feel isolated and push her to the other extreme into the arms of the anti-vaccinationists.

Lastly, I want to address those who after reading this feel that these persuasion techniques are manipulative or even unethical. I’ve come across resistance to these ideas within skeptical circles before. It seems that because skeptics tend to be obsessed with rationality and facts, the idea of using persuasion techniques seems to be anti-skeptic. There is an idea that all you need to do is present facts and a person seeing it will change their mind and embrace science and rationality. This ignores the fact that we are not rationality robots. We make decisions on facts and emotions. We all do this: skeptics and believers. Right now the anti-vaccine movement does an amazing job at tapping into emotions like anxiety and fear. This is perhaps, more than anything, the reason why they have become so successful at turning parents away from vaccines. As someone who has seen Jenny McCarthy speak live, I can attest to her charismatic power at spinning a great tale that tugs at the heart strings and makes you want to open up to her. By responding to these tactics with merely a list facts, we will convince a lot of people, but we’ll miss a lot of people too. We need to mix it up. We need to stick to facts while adding in a bit of heart. We need to think not only about what we are saying but how we say it. By packaging a pro-vaccine message with a little color we might be able to make it a little more appealing to parents who are considering the decision on vaccinating their children.

 

Jamie Bernstein

Jamie Bernstein

Jamie is a data, stats, policy and economics nerd who sometimes pretends she is a photographer. You can usually find her at skeptic events in Chicago or on Twitter or Flickr. She also blogs about music at Notes From Chicago Music Underground.

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2 Comments

  1. February 5, 2015 at 6:25 pm —

    Thank you for this. My son and his girlfriend have started talking about a baby in a couple of years. I know she’s antivax but I don’t to what level. I’m hoping I can just get her to open up and tell my what she thinks and why she thinks it. I think I’ve got the facts down pretty good (plus citations!). You give a lot of good information up above. I’ll need to think on it. I just hope she hasn’t gone to far down the rabbit hole on this.

    And also. A criticism. I really don’t like the way you state “Don’t lie about vaccines being 100% safe”. First, the “Don’t lie” part. That just bugs me. Hadn’t planned on lying at all.

    And then the context. I read a lot of provax stuff. All over the web. I’ve never seen anybody state that. Hey, it’s a big internet so somebody probably did. But I’ve never seen it and I’m pretty wide read.

    But I have seen the antivaxxers show up on a message thread and claim it. And it is always patiently explained to the troll that nobody claims that. There are side effects, swelling, redness blah blah blah. And then another thread and another troll claiming it.

    So. It bugged me and I thought I would point out why.

    • February 15, 2015 at 4:41 pm —

      Sorry, I would have replied sooner but for some reason didn’t get a notification of your comment like I usually do. Anyways, the reason I mentioned the “don’t say vaccines are 100% safe” thing was because a couple years ago when I originally wrote that I did see that mentioned in a hand-out made by the pro-vaccine organization I was affiliated with at the time. I think the language used was that “vaccines are perfectly safe” which isn’t completely true since, as you mentioned, there are side effects that need to be looked out for and in some cases (such as when the child has an egg allergy) vaccines can be quite dangerous. I didn’t know how widespread the claim that vaccines were 100% safe was, but I figured it was something worth mentioning in my piece.

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