However, as public health officials ponder how to combat misplaced concerns over vaccines, opinion is divided on whether it is appropriate to frighten people into protecting themselves against infectious diseases.
Those in favour argue that appealing to such fundamental emotions is the most effective way to grab public attention and change behaviour in an increasingly noisy media environment. Plus, they say, it was scare tactics that dragged vaccine-uptake rates down in the first place – fighting fire with fire is fair game.
But psychologists suggest pushing fear-based public health messages may backfire, warning that scientists and public health authorities could sacrifice long-term credibility in exchange for a short-term gain.
Paul Arnold, a UK-based advertising consultant, believes it is reasonable to show the public the true consequences of infectious diseases – some of which have faded from the public mind because vaccines have made them less common.
“Advertising is a very expensive way of talking to people and you don’t get much opportunity with a short television ad, for example. So if you look at advertising what you often find is that messages are wrapped in emotion, with storytelling, humour and metaphor,” he said.
Arnold pointed to how children’s charities and NGOs routinely appeal to fundamental emotions when fundraising because it is more likely to success than presenting cold facts alone.
“If you look at human psychology, the reality is that we are driven more to avoid fear than we are to go and seek pleasure. So I’m sorry but I think we sometimes do need to use fear. When you go to your doctor he doesn’t waste time with nice words, he says “Listen, if you don’t lose weight the consequences will be dire,” he told Vaccines Today after addressing a conference hosted by Fondation Merieux.
Arnold said real stories about the consequences of a particular action or inaction can have a lasting impact, but he accepted that an overdose of fear can cause people to “switch off”.
He highlighted the use of shock tactics employed by road safety authorities, notably in Australia, which had helped curb road deaths and turn the tide against speeding and drink driving.
Human emotions: handle with care
However, Dr Cornelia Betsch, a psychologist at the University of Erfurt in Germany, said exploiting negative emotions can be counterproductive.
She acknowledged that perceived risk is a major driver of decision-making and that concerns over vaccine safety can lead parents to opt out of immunisation schedules. Understanding risk perception can help to design effective communication campaigns, according to Dr Betsch.
She and her colleagues have studied online discussions about vaccines and found that anti-vaccination websites typically use stories of children being harmed by vaccines. The research also noted that people often prefer to know how bad negative outcomes could be rather than how likely they are.
“Online information searches ask about consequences rather than probability,” Dr Betsch said. “It is also clear that parents who see vaccination as a risk have a preference for parental narrative. They see other parents as trusted sources; as people with no agenda who will not make things up.”
Dr Betsch said German health authorities had experimented with range of poster campaigns including one of a boy who had suffered brain damage due to the measles. This was essentially a fear-based campaign designed to hammer home the frightening prospect of what could happen if children are not vaccinated.
“However, fear appeals in a context of vaccination campaigns may backfire. There have been successful campaigns with more positive messages – such as a poster aimed at young women which says ‘Protect against cervical cancer. I did.’ and another which read “Healthy thanks to MMR.’
Fear of regret
Whatever about weighing fear of disease against fear of vaccine-related adverse events, it seems one of the subtle drivers of decisions-making is fear of regret.
Also speaking at the Fondation Merieux conference, Dr Nick Sevdalis, lecturer in patient safety at Imperial College London, said human beings are fundamentally “regret averse”.
“We all hate regretting a decision and will try to avoid this where possible. We hate to feel like we’ve made a mistake,” he said.
This can be particularly powerful when making a decision for somebody else, such as children or older relatives.
In practice, that means we sometimes opt not to vaccinate a family member because we cannot bear the thought that we might regret it later – our psychological hardwiring makes us inclined to passively accept the higher risks associated with inaction rather than assume the relatively lower risks linked to taking action.
“We feel worse about negative outcomes that result from our actions than for equivalent outcomes that result from the status quo. The decision to vaccinate is a departure from status quo,” Dr Sevdalis said.
“You feel worse about outcomes of your own decision than those that you see as having happened due to bad luck or an ‘act of God’.”
So it seems fear is a major factor in all decision-making but, like all emotions, it is complex and not terribly well understood. If health authorities (who are universally in favour of vaccination) and those who oppose vaccination both resort to fear-based communication the public will be bombarded with scare stories – to which they may well become immune.
The long-term impact of running fear-based advertising is far from clear given that such tactics are still relatively new. The short-term effectiveness, however, is considerably better understood.
Proof, if proof were needed, comes from Hollywood…
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