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.