Science tells us that when you tell someone they’re wrong, they’re more likely to dig in than to experience a change of heart. Take the case of childhood immunizations. As long as there have been vaccines, a portion of the population has been opposed to them, with some well-meaning, but misinformed, parents refusing to get the recommended shots for their kids.
But in this age of distrust and fear — of “fake news” and nearly universal access to the internet, which can back up any “alternative facts” — this population appears to be growing and becoming more dangerous to public health.
Just watch the (reputable) news: Measles is making a disturbing resurgence, with Washington state and New York experiencing the worst outbreaks in decades (there are nearly 50 confirmed cases in Washington and more than 200 in New York). Brazil had more than 10,000 cases of measles last year; Europe, nearly 60,000. And that’s just one vaccine-preventable disease.
Have vaccines become victims of their own success? Have we forgotten how many people used to become sick and die from these diseases?
Vaccines are arguably the greatest medical advance of our time. Before the measles vaccine was introduced in 1963, for example, it was the leading killer of children in the world, with an estimated 2.6 million deaths each year. Today, because of a widely available vaccine to prevent it, measles cases are a mere fraction of what they once were; an estimated 110,000 people died from measles in 2017.
I fear those gains will be reversed as more people take on an anti-vaccine stance, rejecting something that has proven to save lives, millions at a time. The danger is such that the World Health Organization felt it necessary to rank vaccine hesitancy — a reluctance or outright refusal to be vaccinated — as one of the 10 biggest threats to global health in 2019.
In 2019, how can this be?
There are many factors at play: distrust in modern medicine and in government; fear of side effects; international travel, which brings diseases from one nation to another through the ease of an airplane flight; poor immunization infrastructure in lower- and middle-income countries; a misguided feeling that vaccines are worse than the diseases themselves.
We must shift the narrative.
We know parents want to help their children. Even as they reject immunizations, parents do so because they believe they are doing the right thing. Doctors need to take those concerns seriously, and carefully counter the misinformation and misperceptions that have led parents to this place without validating claims that have been debunked by science.
The best response may be to lay out the facts about the harms of contracting a vaccine-preventable illness and explain that their child is susceptible, not to simply tell them they must vaccinate their kids.
A limited understanding of probability likely plays a role as well. According to WHO, a vaccine-related adverse effect can be expected in one out of every 1 million doses of measles vaccine. At the same time, WHO says measles vaccination prevented an estimated 21.1 million deaths from 2000 to 2017.
Still, a story on the internet about one of those one in 1 million injured by a vaccine hits hard. It’s rare that there’s a story about the millions of others who remain healthy and don’t contract the many diseases for which there are vaccines.
An old letter from the children’s book author Roald Dahl laying out statistics that counter concerns of substantial harm from the measles vaccine has been making the rounds online, however. It’s from 1986, when some in the in the U.K. weren’t immunizing their children, but it’s just as relevant today. Dahl’s eldest daughter, Olivia, had died from measles 24 years earlier, when there was no vaccine.
“What on earth are you worrying about?” he wrote. “It’s almost a crime to allow your child to go unimmunized.”
At the Johns Hopkins Center for Communication Programs, we have worked with UNICEF overseas to help those workers responsible for childhood immunizations with the interpersonal skills they need to ensure children are protected — including arming them with accurate information about the benefits of vaccination. In the United States, we helped develop content for a new mobile app designed to give moms high-quality information about vaccines tailored to their attitudes and beliefs about vaccination. We are working with the Sabin Institute’s Vaccine Acceptance Research Network to help generate evidence and build collaborative efforts to address vaccine hesitancy.
These are just small steps, I know. But none of us can sit by and let those who oppose vaccines continue to make headway. There has been too much damage done already.
Susan Krenn is executive director of the Johns Hopkins Center for Communication Programs (Twitter: @JohnsHopkinsCCP).