First, it’s important to mention that vaccination rates are not so bad. In fact, they are steady and growing in most countries and the majority of people has confidence in vaccines. Experts continue to highlight the major individual and public health, economic and societal benefits of immunisation. However, vaccine uptake is still not high enough to wipe out measles and rubella everywhere, so there is work to be done.
A small but fast-growing body of research is emerging on why people accept vaccination, and why a small minority does not. The focus is largely on the so-called fence-sitters – people with questions or concerns about vaccination.
The WHO has made recommendations on how to deal with ‘vaccine hesitancy’, and related issues are addressed in the WHO Europe’s Guide to Tailoring Immunization Programmesand the ECDC’s Communication on Immunisation: Building Trust.
(See also this special issue of the journal Vaccine on vaccine hesitancy and the ECDC’s Your Child & Immunisation: Q&A; Voices for Vaccines has published a guide to help people talk to their loved ones about vaccination)
Taking action now
The science of communicating about health issues such as immunisation draws on psychology, communications, sociology, anthropology amongst others.
A new vade mecum– a handy reference manual – seeks to summarise what is known about what works with vaccine hesitancy. Published in Vaccine by Angus Thomson and Michael Watson, the short article is a great introduction to a rapidly evolving topic.
It offers some valuable advice for anyone interested in increasing immunisation rates. The paper suggests reminding the public about why we vaccinate and about the positive health effects of immunisation. Reinforcing vaccination as a social norm is an effective way to maintain strong uptake, according to the authors.
The paper recommends proactively engaging with the news media, mixing positive stories backed up by rigorous science.
Social media too has an important role to play. Building a trusted hub of online information is a vital first step, supported by active engagement through Facebook, Twitter and other social channels.
While it is unlikely that online anti-vaccine activist can be convinced to speak themselves with their doctor about vaccination, it is important to respond to their questions so that others can see there are clear and robust answers to criticisms and conspiracy theories. Remember: your audience is the fence-sitter.
What can health professionals do today?
Central to much of the research on vaccine decision-making is the role of health professionals in communicating with the public.
Healthcare professionals are a trusted source of information and advice. The vade mecum has some tips for medical doctors, nurses and others:
- Present vaccination as the default action. Begin conversations with a recommendation rather than an open question.
To improve medical professionals’ communication skills, experts are designing training programmes to equip doctors to engage with questions about vaccines.
- Be open about local or general reactions such as local redness at the injection site or mild fever. These are relatively common and actually indicate the vaccine is working. It is essential to differentiate these minor effects from serious adverse events which are extremely rare.
- Respectfully address concerns that people raise.
- Beware of too strongly debunking myths as it can be counterproductive. Some research has shown that presenting people with information that ‘corrects’ vaccine-related misinformation can actually decrease their likelihood of vaccinating.
- Don’t overwhelm with facts and statistics. The ‘deficit model’ (which suggests that people just need more information in order to view science correctly) does not seem to change behaviour – otherwise nobody would smoke. Instead, try to use narrative – including your experience and actions – to support your science-based recommendation.
- Be careful with trying to frighten patients into taking action as fear can backfire
The journal article also echoes calls by the WHO and others for strong listening or ‘monitoring’ tools to track public vaccine conversations online. This can cover published media articles and opinions shares on social media channels.
Publicly-available tools – such as Vaccine Sentimeter from Health Map – can provide real-time information on ‘outbreaks’ of vaccine hesitancy.
So, while the field of vaccine hesitancy is very much at the ‘much more research needed’ stage of maturity, there are already some evidence-based principles you can adopt to improve vaccine uptake – and reduce the burden of vaccine-preventable diseases.