Vaccine messages can backfire

The Pediatric Insider

© 2014 Roy Benaroch, MD

Vaccine coverage rates, overall, remain very strong in the USA. Well over 90% of kids are well-vaccinated, and the rates of vaccine-preventable diseases remains very low. Newer vaccines have proven especially safe and effective, including immunizations against severe diarrheal illness and cancers of the cervix and throat. In many ways, we are staying ahead in our battle against vaccine-preventable disease.

Yet: there are still pockets of intense resistance to vaccines, resistance that’s based on fear and lies and a willingness of anti-vaccine propagandists to say anything to decrease public confidence in vaccinations, doctors, scientists, and the parents who vaccinate their children. We’ll call these folks the “pro-disease lobby.”

In my practice, almost all families get all of their kid’s vaccines. We talk about what they’re for, we talk about the expected side effects (most babies have none, a small minority have some fussiness or fever), and we make sure parents know how to handle those and when to call if anything worrisome happens. We give out Vaccine Information Statements, which also list potential side effects, trivial and serious. Then we get the babies and children protected.

There are some families who have sincere questions, and those get extra time to get their questions answered, respectfully and patiently.

Then there are those 100% devoted to the pro-disease lobby. They don’t want questions answered—at least not by their pediatrician, not when the internet tells them what they want to hear. Frankly, I don’t even know why they come see me. If they think I’m evil or stupid or thoroughly misguided, why would they trust me with any aspect of child care?

Is there any way to convince these families that vaccines are a good idea? A new study, published today, looked at different vaccine messages: which ones work, which ones help, which ones hurt. The results are discouraging. Web-based surveys were conducted with about 1800 parents in 2011, who were then randomized to receive one of four pro-vaccine interventions.  The four different messages were: 1) information explaining the lack of evidence that MMR causes autism; 2) information about the dangers of vaccine-preventable diseases; 3) images of children who had diseases that could have been prevented with vaccines; or 4) a dramatic narrative about an infant who almost died of measles.

None of these messages, none of them, increased parents willingness or intent to vaccinate. In fact, among parents who were already vaccine-hesitant, these messages boosted vaccine misperceptions. For instance, specific evidence about the lack of a credible MMR-autism link further decreased the intent to vaccine among the parents who were already the most skeptical prior to the study. And the dramatic story about the child sick with measles increased the perception of MMR side effects among parents who already distrusted the vaccine—even though that story had nothing to do with side effects of any vaccine.

Among parents who have the strongest anti-vaccine views, no approach seemed to soften their stance. Instead, most of these attempts to communicate science-based information backfired—increasing anti-vaccine sentiment, in many cases reinforcing specific wrong beliefs that were not even relevant to the message given.

This jibes with my own experience, and what pediatricians say around the water cooler (more likely, honestly, the coffee maker.) The true anti-vaccine, pro-disease parent is essentially in a cult, with fixed delusional beliefs far outside reality. Talking with them only increases their anger and hardens their stance. People do not like to believe that they’re possibly wrong, and would rather listen to viewpoints that agree with their own, even at the cost of their own health. That’s too bad, because their children suffer, and our children suffer too.

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14 Comments on “Vaccine messages can backfire”

  1. CATT Says:

    Of course, like any belief system it works both ways. I have met and read posts from both sides of the camp; that are congenial or vicious. I do believe one thing; that everyone should be allowed to make their own informed decision. For those of us of the minority that have adverse reactions to vaccines and Pharmaceutical drugs, our personal wishes should be addressed without ridicule or intimidation. After all don’t the inserts, on meds, clearly state that there can be adverse reactions? That’s because of us “Opposite People.” That is a term my doctor has coined; a much nicer and more respectful term than “Pro-disease.”

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  2. I wonder what would happen if these parents were more inconvenienced by their decisions? Right now it’s just a signature or two and nothing more. However, if public school districts in places with outbreaks of something like pertussis decided to only allow unvaccinated students to attend schools where the vaccination rates were high enough to keep outbreaks unlikely, then I’m guessing they might have a harder choice. There tend to be pockets of people who don’t vaccinate. Probably should spread them out a bit even if that means their kids have to get on a bus and go across town to a different school.

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  3. […] Vaccine Stubborn […]

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  4. CATT Says:

    Emily, when there is an outbreak, the nonvaccinated are sent home. It’s already being done.

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  5. SMT Says:

    There wouldn’t be an outbreak if everyone vaccinated…….

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  6. People who have a legitimate medical reason to not vaccinate are not a problem for anyone. Our standards for legitimate might be different though. Sometimes the reasons for refusing to vaccinate sound like just fancy “I don’t want to’s.”

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  7. CATT Says:

    “There wouldn’t be an outbreak if everyone vaccinated…” Not true. There are those of us who have contracted disease from the vaccine. That is what contraindications are all about and why many do not go along with the prescribed program.

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  8. SMT Says:

    There would MUCH LESS of a chance of an outbreak is everyone vaccinated. We count on herd immunity to protect us, we lose that when everyone isn’t vaccinated. Which is why we are now seeing measle outbreaks in parts of the country.

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  9. Sarah Says:

    My pediatrician’s website used to state pretty unequivocally that vaccine refusers (for non-medically-legit reasons) were invited to take their business elsewhere. (I suspect that they still do this, just on an individual basis.) I wonder what, if any, effect this might have on those borderline pro-disease people. What might be the result if many/most docs took the same hard line?

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  10. […] an explanation by Roy Benaroch, MD, offered on the Pediatric Insider blog, we read details about the types of messages that were tested and the seemingly […]

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  11. lilady Says:

    Orac, has a new post up about Dr. Bob Sears and his Facebook rant about measles outbreaks…and he linked to your post about Dr. Bob and his “alternate vaccine schedule”.

    http://scienceblogs.com/insolence/2014/03/19/after-all-this-time-dr-bob-sears-finally-tips-his-hand-on-vaccines-part-iv/

    Dr. Bob has a huge list (hundreds) of “vaccine friendly doctors” on his website. Parents of prospective patients, should inquire about the vaccine policy before they bring their children to any practitioner. (That’s just my opinion, btw, which is based on my tenure as a public health nurse clinician-epidemiologist at a large suburban County Health Department-Division of Communicable Diseases Control, who actually investigated individual cases, clusters and outbreaks of vaccine-preventable-diseases).

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  12. Dr. Roy Says:

    Thanks for heads-up, lilady, that was satisfying to see. I don’t get nearly the traffic as Orac, but I like to do my little part for science. And (you’ll appreciate this) I just got a thing from Twitter– Dr. Jay Gordon himself. antivaccine pediatrician to the stars, now follows this blog’s tweets. Not sure exactly what to think of that…

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  13. lilady Says:

    Dr. Roy, Dr. Jay’s “tweets” about measles outbreaks, are the subject of this The Poxes blog post:

    http://thepoxesblog.wordpress.com/2014/03/21/when-another-doctor-stops-behaving-like-one/

    I “don’t do Twitter”, but you could send Dr. Jay a message for me. Tell him I miss my chew toy on Respectful Insolence and the Science Based Medicine blogs. 🙂

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  14. lilady Says:

    Another “heads up” for you. Dr. Jay Gordon sent out a letter to the parents of children in his practice, about the multiple measles outbreaks in California…and his “opinion” about MMR vaccine. (Surprise, surprise, he doesn’t urge those parents to get their children vaccinated).

    The Shot of Prevention blog has published a copy of that letter and is urging people to “Tweet” Dr. Jay about his anti-MMR-vaccine stance:

    http://shotofprevention.com/2014/03/31/say-nowaydrjay-dont-bring-measles-back/

    Dr. Jay also has posted comments on Dr. David Gorski’s Science Based Medicine, which analyzes the new CDC ASD prevalence report:

    http://www.sciencebasedmedicine.org/autism-prevalence-now-estimated-to-be-one-in-68-and-the-antivaccine-movement-goes-wild/#comment-207066

    According to the current MMWR (March 22, 2014), there are 89 confirmed cases of measles, including the four new cases reported during the previous week, by the California Department of Public Health.

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