How do we overcome the mindset of anti-vaccinators, a.k.a. anti-vaxers? I sat down with Adam Strasberg1, a political strategist and ad creator, to discuss how to improve the medical community’s approach to vaccine advocacy. He gave me new perspectives on the issue with insights on behavioral economics, ethnography, and the mindset of the lay person.

  1. Brute force does not work. Drilling more science into the minds of college-educated anti-vaxers does not work and may actually produce contradictory results. Nyhan et al. recently published two articles showing current scientific-based public health communications may actually increase misperceptions or reduce vaccination intention with MMR and influenza vaccine.
     
  2. Emotions matter. Communication is more than just about being on message. Personal stories influence more than the scientific data. Emotions move more than facts. The rise of social networks, blogging and instant internet access on handheld devices has empowered all-comers to tell their stories. Professional degrees are not needed, and are often a hindrance to telling good stories. We, as doctors, need to improve our story-telling techniques. To support the science, we also need to talk about the college freshman we cared for who was left without legs from meningococcal infection or the 6 year old boy who died from the “strangling angel” diphtheria this year in Spain. Stories are emotion delivery vehicles.
  3. Young pediatricians need more experience. Because our vaccines have been so successful, graduating pediatricians today have never seen chicken pox let alone polio or measles. How can they powerfully tell stories about patients they have never cared for? Some effective ways to stir emotion in our trainees beyond lecturing and showing pictures are: 1) Send them abroad. One case of neonatal tetanus or watching a child die from Hib meningitis knowing that the illness was preventable by vaccination will remain etched in their memories for a lifetime. 2) Bring all of your trainees to see the child with exposed muscle following surgery for group A strep necrotizing fasciitis. Remind them that these patients were common before the varicella vaccine. Take them to the pertussis baby on ECMO in the PICU. All trainees should at least see the pertussis cough video. 3) Bring in patients who have recovered from meningococcemia or dealt with HPV and cervical cancer to talk about their experiences. Our trainees understand the science but they will be better vaccine promoters if they also understand the emotions.
  4. Community immunity. Belonging to a community can be a powerful motivator. Everyone wants to be a part of a community. Members of a community feel responsible to help and contribute to their community. Using the phrase “herd immunity” creates the wrong frame for anti-vaxers. A herd follows unthinkingly; most anti-vaxers do not want to be part of a herd. The terminology should be changed to “Community Immunity,” to incite a sense of belonging and purpose.
  5. Mother vaccine spokesperson wanted. We need to reconsider how the medical profession is delivering the message on vaccines. Currently, pro-vaccine spokespersons are experienced male doctors who are revered in the scientific world for their enormous contributions to vaccine science. However, anti-vaxers frequently view them as patriarchs in a social system in which males hold primary power. Anti-vaxers are often young, educated new mothers who want no part of this historically patriarchal society. While there is value in male physicians providing vaccine guidance, the pro-vaccine messages additionally should be articulated in our media sources by women who are mothers as well as doctors. They can more effectively start the discussion with, “I know that you want to do what is best for your children...”
  6. Understand what drives Anti-Vaxers. We continue to speak of vaccination as a public health and science issue, despite the inability of those constructs to influence anti-vaxers. Instead of speaking to parental rights, perhaps we should focus more on protecting innocent children. Instead of promoting science, we should emphasize the naturalness of the vaccination process – it is not a scientific or artificial occurrence, but a natural one, akin to lifting weights to get stronger. We need more research to understand the levers that move anti-vaxers so we can learn to speak with metaphors and constructs that influence them to reconsider their objections. Our children deserve it!

Written by: Pia S. Pannaraj, MD, MPH
Children's Hospital Los Angeles

1 Adam Strasberg is the son of acting teachers. He was raised in the world of actors, theatre and books. With an MFA from NYU Graduate Film School, Adam eschewed the bright lights of Hollywood, instead finding his element fusing his creative talent with his desire for social change inside the world of politics. He is a partner at a marketing consulting firm in Washington, DC. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.