Vaccine debate: Is fear fair?

Gary Finnegan

Gary Finnegan

December 19th, 2011

Gary Finnegan

‘Immunisation programmes have been frequently undermined by outbreaks of a highly-contagious phenomenon: fear.’

Is-fear-fairHowever, 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.

Advertising tactics

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…

Contagion: nothing spreads like fear


  1. cia parker

    cia parker

    December 20th, 2011

    I thought the part about fear of regretting a decision very poignant. I actually did not decide: I had told the pediatrician a month before my baby was born that I didn’t want her to get the hep-B vaccine at the hospital because I had read even back then, in 2000, that it had caused a lot of autism. But they gave it to her without asking my permission, and she reacted with four days and nights of endless screaming, vaccine-induced encephalitis, and was later diagnosed with autism. I am consumed with regret that I didn’t insist on keeping my new-born baby at my side from the moment she was born, to protect her from being damaged by the vaccine. But it’s too late for us.
    It goes without saying that I refused the MMR for her. I understand that if the current outbreak in Europe comes here, she may get measles, the way I did when I was six, when many of the children at Halle Hewetson Elementary got it that spring, and we all recovered just fine. Yes, complications, death, and permanent disability are possible outcomes of measles, but are close to nonexistent if vitamin A is given and fever reducers are not. Why does no one mention that death from measles is five times more likely if Tylenol or other fever reducers are given?
    Dr. Richard Moskowitz has this to say about the advantages of just getting measles and forgoing the vaccine: “The death rate from wild-type measles is very low, the incidence of serious sequelae is insignificant, and the general benefit to the child who recovers from the disease, and to his contacts and descendants, is very great. Consequently, even if the measles vaccine could be shown to reduce the risk of death or serious complications from the disease, it still could not justify the high probability of autoimmune diseases, cancer, and whatever else may result from the propagation of latent measles virus in human tissue culture for life.”
    The bottom line is that nearly all Americans now have either seen their own children react to vaccines, or have someone in their acquaintance who has. We have realized that autism, asthma, allergies, bowel disease, seizure disorders, ADHD, dyslexia, other learning disabilities, one or more of which afflict nearly half of American children, result from the immune system reacting to the antigens in vaccines with a more extreme or prolonged inflammatory response than the measured, limited inflammation they were supposed to produce. Another word for the extreme inflammation is encephalitis, and another word for the prolonged inflammation is auto-immune disease. And increasing numbers of us are deathly afraid of this, and are just saying no to vaccines. I don’t know what kind of spin you may be able to put on this bottom-line, ineluctable fact.

    • Editorial Board

      Editorial Board

      January 27th, 2012

      The passing of a child is a tragic event and merits everyone’s support to deal with such an irrevocable loss. Understandably, parents, friends and loved ones feel the need to understand why something so terrible could have happened. It’s reasonable to look critically at anything that might have taken place at the time, including any vaccination, to try to establish the cause of death.

      It is for this reason that health authorities require such events to be reported to them, so that they can perform an independent objective investigation into the potential cause of death and determine whether the vaccination is the culprit or whether there is another possible explanation. Time relationship between vaccination (or drug intake) and a subsequent serious event is only one of many considerations in the formal safety evaluation that is aiming at identifying a true causal effect.

      Arriving at the correct conclusions through this evaluation is not only important for the child’s parents so that they might come to terms with their loss, but also to help health authorities make decisions in the best interests of the wider community that they serve.

      If indeed a clear causal link is found between a particular vaccination and a subsequent serious event, it is important that the public health agencies monitoring safety through Europe, independently determine if the further use of the vaccine should be seriously reconsidered as, in that case, it might do more harm than good.

  2. Tumelo


    March 2nd, 2012

    for that moeltrhy instinct! Nobody should act based solely on what their doctors tell them is best nor on what some celebrity has said. I would like to point out that I don’t know anyone who has made the decision to not vaccinate (and I know several) that has not agonized over it I still do and my kids are 9 and 6.Like you, I went about things the accepted way with my first until various things made me start questioning. So with my second I researched (and am still researching) and decided to wait a year to do any vaccinating and then only got one at a time so it took a long time to complete that first schedule. Plus I just completely opted out of a few (and now wish I had opted out of more) and will probably forgo boosters. And, no lie, it is one confusing web of information (and lack-thereof) out there I’m left with that damned-if-I-do, damned if I don’t, feeling. But I’ve gotten to the place where I evaluate things based on the risk of the vaccine (and it’s not just concerns about the thimerisol but all the other toxins that are included and have never been tested most of the safety studies on vaccines were only performed on the biological components of the vaccines and not the adjuvant/preservative cocktail that’s included) versus the risk of the disease I’d also like to point out that it is still possible to carry these diseases even though you have been vaccinated such is the case with pertussis. The problem with this is that you may be carrying (which means you can pass it on) the disease but you are unaware of it because you are not sick if you are not sick you are not taking the same kind of precautions that a sick person would, like staying home, staying away from vulnerable people, washing hands more often, etc. etc. So the idea that it’s the unvaccinated population that is the sole cause of these epidemics’ is kind of ridiculous.Again, thanks for taking the time to write these posts and for your level-headed views and sorry for my long-winded response