Public Health Needs Humility to Address Vaccination Fears

by Brian Zikmund-Fisher on January 23, 2011

Last Thursday, the New York Times published an op-ed piece by Michael Willrich titled “Why Parents Fear the Needle.” I won’t go through Professor Willrich’s narrative in detail, though I do think it’s worth a read to provide some historical perspective. He details the extensive anti-vaccination concerns that existed (for good reason) in the late 1800′s and early 1900′s and some of the psychology behind why such concerns persist today.

I do, however, want to focus on Willrich’s final message. He cites the example of C. P. Wertenbaker, an official of the Public Health and Marine-Hospital Service in the early 20th century who chose to advocate for vaccination by getting into communities, honestly describing both benefits and risks, and acknowledging his audience’s fears. Such an approach is consistent with everything we know about effective risk communication.

Yet ultimately, I think Willrich’s piece leaves readers with the wrong conclusion by an unfortunate omission. He ends his article by stating:

“Obstetricians, midwives and pediatricians should present the facts about vaccines and the nasty diseases they prevent early and often to expectant parents. Health agencies should mobilize local parents’ organizations to publicize, in realistic terms, the hazards that unvaccinated children can pose to everyone else in their communities. And health officials must redouble their efforts to harness the power of the Internet and spread the good word about vaccines.

You can bet that Wertenbaker would have done the same thing.”

Yes, Wertenbaker would have done the same thing. But, if we are to believe Willrich’s account, he wouldn’t have stopped there.

I believe that what Wertenbaker would have done is to speak to the uncertainties of vaccination too.

  • He would have acknowledged that vaccination helps us to manage and reduce many well known and serious health risks but also that it introduces an new element of uncertain risk.
  • He would have discussed the data and testing that show consistently that the vast, vast majority of patients get vaccinations without complications, yet also acknowledged and discussed the reality that even the possibility of a risk weighs heavily on us when the benefits of vaccination to the individual have been lowered by low disease prevalence and herd immunity.
  • He would have spoken from the heart, validating the fear that every parent feels when they put their child in harm’s way for the best of reasons.

Simply asking public health officials to redouble their efforts to discuss the hazards of non-vaccination and to spread the “good word” is not likely to be effective. We don’t live in Wertenbaker’s world, in which information transmission was slow and people had few resources to draw on. We live in a world with too much information, a conflicted, overwhelming morass of data that most people simply do not try to understand. In the face of such confusion, it is hardly surprising that people gravitate towards the compelling narratives of those who argue against vaccination. A narrative that is about what might happen more than what is happening.

The public doesn’t need more facts. They need help to make what they know make more sense.

Public health officials must acknowledge the reality that they can neither compel vaccination nor pretend that there are no arguments against vaccination.

  • We must acknowledge that each parent has the right and the authority to make his or her own choices, and that it is our failing (either in the quality of our vaccines or the persuasiveness of our message), not theirs, if we have failed to convince them that vaccination is the better choice.
  • We must acknowledge that we have the best chance of convincing a skeptical public when we put the weaknesses of our arguments and the risks of our interventions front and center and acknowledge the fears that they evoke.

It may seem counterintuitive, but embracing humility may be the best thing we can do. Humility will build trust in those who believe (sometimes accurately) that we are not telling the whole story. Humility might resonate with those parents who genuinely want to do right by their children but have not been convinced by “the facts.”

Doing these things is doing what Wertenbaker did: Going to where the public is and speaking with them instead of to them.

Only then can we stand up as representatives of the public health and truly make the case that the risk tradeoff inherent in vaccination remains one of the most valuable contributions we can offer to improve the public’s lives and livelihoods.

Some will listen and get vaccinated. Some will not. And, even though it is very hard for many public health officials to accept, that’s ok. For it is our job to make parents an offer so good that they cannot refuse.

Wertenbaker didn’t give up on complete honesty in the pursuit of public health. And neither should we.

Brian J. Zikmund-Fisher is an Assistant Professor, Health Behavior & Health Education, in the University of Michigan School of Public Health, and a member of the University of Michigan Risk Science Center. He specializes in risk communication to inform health and medical decision making.

Related posts:

  1. The World Economic Forum Global Risks Report and Public Health
  2. Poster Day at the UM School of Public Health

{ 7 comments… read them below or add one }

Claudia January 23, 2011 at 2:39 pm

And what about the dangers of contaminated vaccines? Parents have no difficultly finding out about haphazard cell lines technology, greedy manufacturers who discount risks, and consequences that may not show up for years.

Until the vaccine industry cleans house and can assure the public of the integrity of their products, suspicion and rejection will continue to grow.

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fatmike182 January 23, 2011 at 4:54 pm

@ Claudia
unless you did not set a link to a particular case of contaminated vaccines, it’s hard to tell what exactly you’re talking about.

In general I can assure, that the risk of catching an infection is much higher that suffering from _any_ severe side effect. So… let’s do the maths.

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David Bartley January 23, 2011 at 6:57 pm

Brian,

Why did you not mention the anti-vaccination campaign within the cult-like homeopathic community? Also, you’ve forgotten to mention the fraudulent Wakefield claim that MMR vaccination causes autism. Humility is out of the picture in these circles.

David

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Malcolm McIntyre November 18, 2011 at 2:57 am

Trolls are everywhere on the net aren’t they David. Paid shills push penny stocks at pump-and-dump sites, while the Pentagon has recruited agents to obfuscate the fascist coup in the US http://www.washingtonsblog.com/2011/07/pentagon-seeks-to-manipulate-social-media-for-propaganda-purposes.html

And in vaccination discussions there are pimps for the vaccine makers. Although hopefully their efforts to destroy Wakefield’s work have been in vain: http://www.ageofautism.com/2011/11/dramatic-development-further-exonerates-andrew-wakefield-and-puts-pressure-on-british-medical-journa.html

Malcolm

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Brian Zikmund-Fisher January 23, 2011 at 8:50 pm

@David:
Humility is not accepting all criticism as true. Humility is being honest about weaknesses as well as strengths and acknowledging that people have reasons to feel the way they do, even if they have beliefs which are inconsistent with the wealth of scientific evidence. The autism link was inflamed through fraud and intentional deception. Not only should public health not stand by and ignore it, it has a responsibility to address it. But addressing it does not mean ignoring the fact that the autism link was a) legitimately fear evoking, and b) sufficiently imaginable so as to fit a not uninformed mental model of how vaccines work. We’re not talking about what is. We’re talking about acknowledging that risk communication is about what might be.

@Claudia raises the issue of contamination. As Willrich notes, contamination has occurred in the past. Thus, it is not implausible, even if it is highly unlikely. I do not pretend to know the truth one way or the other. But we are more likely to convince people that there is no contamination if we acknowledge that it is not impossible that there could have been.

If we were better at acknowledging that we can’t be 100% sure of much of anything, people would be a lot more likely to believe us when we say we really are 99.9% sure.

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Gaythia January 25, 2011 at 2:32 am

I think that one key missing element is time.
Time to build trust: Instead of a long term family doctor, today most parents spend 9 months building a relationship with an obstetrician, and then at birth, switch over to a pediatrician. It is frequently true that neither the parent nor the pediatrician know each other well at the time vaccinations need to be discussed.
Time to communicate: Most doctor visits these days are time limited. It would be hard to expect a pediatrician to zero in on the personal concerns of individual parents in the allocated time. I believe that part of the efforts of vaccine manufacturers to come up with combined vaccines has to do not only with the increasing number of different vaccines, but also with fitting the vaccine schedule in with insurance company mandated spacings in well baby visits.
Time to get organized: In my childhood, schools had school nurses who tracked vaccinations and public health vaccination campaigns frequently came to the schools. Perhaps some parents gravitate to an anti-vaccination stance partly as rationalization of things that they didn’t do. Today, parents work, health providers may change as insurance changes or jobs change, insurance coverage may lapse, parents may not know about, or feel they qualify for, childhood public health programs. Or maybe they simply can’t remember where they put the vaccine records. When school starts and a vaccination card needs to be filled out, parents can avoid dealing with all sorts of complications by simply signing the form saying that they have objections (I think that the details of this process vary by state). In my opinion, this causes significant overestimation of the numbers of unvaccinated children.

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MW January 25, 2011 at 4:44 pm

Brian, Care to address these facts. They make me livid. You can’t believe how hard I’ve tried to discuss these with arrogant Doctors and public health officials over the last 10 years. Injecting infants with organic mercury is insanity!

0.5 parts per billion (ppb) mercury = Kills human neuroblastoma cells (Parran et al., Toxicol Sci 2005; 86: 132-140).

2 ppb mercury = U.S. EPA maximum limit for drinking water.

20 ppb mercury = Neurite membrane structure destroyed (Leong et al., Neuroreport 2001; 12: 733-37).

200 ppb mercury = level in liquid the EPA classifies as hazardous waste based on toxicity characteristics.

25,000 ppb mercury = Concentration of mercury in multi-dose, Hepatitis B vaccine vials, administered at birth from 1991-2001 in the U.S.

50,000 ppb mercury = Concentration of mercury in multi-dose DTaP and Haemophilus B vaccine vials, administered 8 times in the 1990’s to children at 2, 4, 6, 12 and 18 months of age and currently “preservative” level mercury in multi-dose flu, meningococcal and tetanus vaccines. This can be confirmed by simply analyzing the multi-dose vials.

In addition ethylmercury, the type used in vaccines, is more toxic than methylmercury. Why? Primate studies show that ethylmercury leaves behind twice as much divalent mercury in the brain than methylmercury. Injecting this into the muscle provides rapid access to the bloodstream and just makes this situation much worse. This is why this debate will never go away.

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