In my talk at TAM 2011 Las Vegas, one thing I mentioned is that the anti-immunization movement has science advocates stuck in a bad frame. A frame is a particular way of looking at an issue based on how it fits into a pre-existing narrative. People use frames in order to quickly categorize a complex situation they don’t fully understand by fitting it into a simple story that is easy to understand.
For example, one way of framing the current debates over state budget cuts is that it’s about hardworking public servants who are standing up to protect our state from politicians who want to gut education and vital public services to please their corporate donors. Another way of framing it is to say that it’s about hardworking taxpayers standing up to powerful public sector unions who are holding the state hostage to protect their jobs and ‘Cadillac’ benefit plans. When the conflict is framed around public services, people tend to agree that public services are good and support funding public services. When the conflict is framed around taxes, people tend to agree that taxes are bad and support cuts. The same person may even support opposite sides of the same issue when it is presented to them using different frames. Frames are important.
The frame that anti-immunization movement presents to the public is one of scientists as bought-and-paid-for corporate denialists, and anti-immunization activists as a grassroots community of parents banding together to protect their kids. This is a great frame for their side of the issue, because business-sponsored “research” is thing that people know is real: For years, “scientists” supposedly told us there was no solid link between tobacco smoking and lung cancer or other health problems. There are scientists sponsored by oil companies who say there's no proof of global warming. This frame means that when pro-immunization advocates respond with the facts—that vaccines are much safer than children having no immunity—what many people hear is, "trust the scientists, they know better than you what's best for your children." As long as we are stuck in that frame with a particular audience, we can't win with them. We have to get out of that box by giving people a different way to understand the conflict.
Another strike against immunization: Parents’ huge responsibility for our children, and insecurity about ‘doing it right,’ make us especially loss averse. Even more powerful than the fear that something bad will happen to our child is the fear that something bad will happen to our child and it will be our fault. It stands to reason that when presented with a choice between action or inaction when both options are perceived as risky, we tend to favor inaction—the choice that allows us to avoid blame—even when action will likely lead to a better outcome. (See: Trolley problem) When parents aren’t absolutely certain that vaccines are safe, many may find the pre-existing risk of preventable illness more palatable than the thought of possibly causing a serious problem through intervention, however unlikely.
So, how can we overcome these challenges to win over parents to support childhood immunization? This is one of the most common questions people have asked me since I raised the issue in my TAM talk.
First, we need a frame that can compete with the anti-immunization activists’ frame of scientists as pawns of industry. An alternative frame must ‘fit’ the conflict in a way that offers our audience instant understanding of who’s on which side, and it should be a frame that is favorable to us and unfavorable to anti-immunization activists.
To win parent’s trust, I think we need to start by validating parents’ concerns rather than dismissing them. Parents also know that healthcare companies have the same bottom-line goal of any other company—to make a profit—and they don’t necessarily have our children’s best interests at heart. If we are seen as dismissive of (or worse, ridiculing) that concern, parents will not take us seriously as advocates for their children’s health.
Being solely responsible for the health and well-being of a helpless human being, knowing that everyone is watching and ready to blame you if anything goes wrong, is terrifying. Parents want to do what makes us feel more secure and less afraid. Piling on to that fear by telling parents how their kids could die of measles may just lead parents to tune us out with all the other fearmongering directed at them.
Parents know about people trying to scare us and tell us what to do. It starts even before we have a child. People whose knowledge comes from rumors and things they heard third-hand try to snatch the food off our plates and scold us that we’re not supposed to eat fish during pregnancy. A store clerk told my wife, at 40 weeks pregnant, that she shouldn’t raise her arms above her head or the umbilical cord would twist around the baby’s neck. People who say and do things like that to pregnant women and new parents are horrible and annoying. If we use fear to push immunization, we run the risk of joining that chorus. Instead, pro-immunization advocates should be the ones who tell parents they don’t have to be afraid, and let the anti-immunization fearmongers be the people who are uninformed and up in their personal business when it comes to parenting.
A strong pro-immunization message could help parents escape the fear, rather than piling on. We could validate that yes, being a parent is scary, but immunization shouldn’t be. When we have the facts, we can all make healthy decisions for our kids without fear, without being intimidated by uninformed people who want to scare us.
In order for this message to ring true, pro-immunization advocates who use this approach should stick to language about helping parents understand the facts, rather than judging the outcomes. It’s possible to get so caught up with the research and the numbers that one forgets that human choice has a place in medical decisions as well. For example, in a recent post on Skepchick about home birth, some commenters expressed judgment against women who choose to give birth at home, on the basis of a study showing that babies born at home to first-time mothers have a 0.9 percent risk of an adverse event during birth, compared with 0.3 percent for hospital births. Some said the increased risk was unacceptable and should outweigh women’s reasons for wanting to give birth at home. Yet, few people would judge parents who drive their children around in a car instead of using public transportation, or parents who have their babies in the United States instead of Sweden, where the infant mortality rate is roughly a third that of the U.S. In our public messages, even if not in our hearts, we need to accept the value of parents making their own decisions about medical matters for their children. Parents should understand that our goal is to give them the facts they need to make healthy decisions for their children, rather than thinking we’ll say whatever it takes to get a needle in their kid.
We should also insist on the words immunity and immunization as favored alternatives to vaccination. Vaccination conjures up images of strangers stabbing you with sharp things and injecting you with things you don’t understand. The root word refers to cowpox. It’s not a pretty word. Immunity and immunization remind the audience of the benefit rather than the painful process.
Finally, given parents’ understandable loss aversion, we should present scheduled immunization as the status quo, and non-immunization as the risky action. Instead of “get your children vaccinated,” we could say, “Don’t withdraw your children from important immunizations.”
These points outline a different direction for pro-immunization messages that avoid the traps the other side has set up for us. What do you think? Is there another way of framing the issue that gets science advocates out of the “big pharma” box? Leave your ideas in the comments.