As an outbreak of measles spreads in New Zealand, experts say there's a better way to counter vaccine refusers.
As it turned out, she did. “She had a specific worry about the MMR [measles, mumps, and rubella] vaccine and whether it was developed with an aborted fetus. I could address that … and she felt comfortable enough to vaccinate her children.
“For years, that woman had been told: ‘Vaccines are safe, get on with it.’” says Turner, who is director of the Immunisation Advisory Centre. “Nobody had said: ‘What are your actual concerns? How can we help with that?’”
That’s how the vaccination conversation should go, she says. “You really listen, and you listen to the concerns the parents have, and not the concerns you think they have.”
All over the world, reluctance to immunise is seen as a public-health threat. The World Health Organisation (WHO) has named “vaccine hesitancy” as one of 10 concerns for 2019, saying it’s at least partly responsible for the 30% rise in measles cases globally. It’s a trend that’s hit this country: more than 700 cases have been confirmed in the Auckland region so far this year and the nationwide total is well over 800. In the past two weeks, passengers on two flights – one from Los Angeles to Auckland and the other from Wellington to Auckland – were asked to check their immunity to measles after a traveller unknowingly flew with the disease.
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Worries about immunisation are only part of the vaccination-promotion puzzle. Factors such as poverty and transport are also being blamed for falling rates. But one cause contributes to another, says Turner. If it’s hard for people to get to the doctor and they see something scary on social media, that might tip the balance away from making the effort to get it done.
Vaccination experts say that the way health professionals talk to parents about vaccination is important. And research shows that some well-intentioned tactics can backfire and entrench anti-vax views.
Vaccination advocates divide parents into three groups: those who are happy to vaccinate, those who are hesitant – they have concerns but could go either way – and those who are staunchly anti-vaccination.
Hard-line anti-vaxxers are just 1-3% of the community at most, says Turner, but it’s hard to change their minds. “They’ve often had bad experiences and they’ve got deeply embedded mistrust – they just will not in any way accept the science.”
Some US paediatricians take a tough stance on vaccine refusers, telling them to find another doctor. It’s not a tactic Turner advocates. Leave the conversation open and keep asking about vaccination, she suggests.
With parents who are on the fence, it’s a matter of teasing out their concerns and addressing them. “Recognise that people’s worries are valid and that it’s okay to have concerns,” she says. “A lot of people are needle-phobic, and we miss that one.” Or they may think their baby is too young to cope with immunisation or be worried about what’s in vaccines.
Though listening is the first step, healthcare providers should confidently recommend vaccination, Turner says. “Sometimes I don’t think we express the importance enough of why we believe in vaccinating.”
Julie Leask, a professor and social scientist in the University of Sydney’s nursing school, who researches attitudes to vaccination and chairs a WHO immunisation group, agrees. “We recorded conversations between hesitant parents and clinicians and sometimes we felt the clinicians were content to follow the parents. We felt sometimes those parents wanted to actually have a recommendation to vaccinate after they’d discussed all the issues. In some ways, it takes the agony of that decision out of their hands.”
However, not everyone will be receptive. “If they’re really resistant and you get too heavy-handed, the discussion can end up degenerating into a conflict or a game of scientific ping-pong,” says Leask.
That can entrench anti-vaccination views. Scientists call it the “world-view backfire effect”. Defending themselves forces people to explain the rationale for their beliefs and that cements their view. Care is also needed when debunking common myths about vaccines, as people have been shown to forget what is myth and what is fact. Lead with positive information, not the myth, Leask recommends.
Tailoring messages to values that are important to people can also help sway them towards vaccination. If they’re big on personal liberty, present the options clearly and work through the pros and cons of each with them. If they’re worried about putting foreign substances in their newborn’s body, talk about how vaccination builds on natural immunity.
As for the social-media minefield, it can be best to stay away from Facebook, as responding means posts get shown to more people. Don’t give anti-vaxxers extra oxygen, Leask says. Australian boxer Anthony Mundine was slammed for an anti-vaccination tweet, but outraged media reports just gave him more exposure.
What about in a face-to-face setting, such as an antenatal group? If someone says they’re not vaccinating, ask why, share your own views and move on. “You don’t want the vaccination debate to drive a wedge into relationships, and it can, because people feel strongly.”
Auckland paediatrician Marguerite Dalton says she’s had some of her most useful vaccination discussions with other parents at the school gate. At a school fundraiser, mothers with girls were discussing the human papillomavirus (HPV) vaccine. Dalton mentioned that her son had it. “They both looked at me and said, ‘But he’s a boy,’ and we got into a discussion about why I thought it was really important that even my son had it.”
She’s chatted with parents on the side of a hockey field, saying her son had a sore arm from his flu shot. “It lets other parents know that’s what you’ve done with your son, who’s the same age as their child – and that you think it’s really important.”
Those conversations are valuable, Dalton says, because it normalises vaccination – “that it’s what we all do, that it’s part of normal life”.
‘Tired & tearful’
About a third of first-time parents at Auckland GP Marcus Bishop’s Te Atatū practice worry about their baby’s first jabs at six weeks, particularly if there is a family history of an adverse reaction or autism. “That’s the key time in terms of education and dispelling myths, and it’s often when people are quite emotional, tired and fearful.”
Building trust and spending as much time as it takes helps parents feel comfortable about immunising, Bishop says. His practice has 20-minute appointment times, instead of the standard 15 minutes. “But I’ve certainly had several vaccine chats that go on for 40 minutes.”
Some parents want to delay the first vaccinations, but letting them know about local cases of whooping cough, which is included in the six-week shots, can change their minds.
If patients know their GP doesn’t just unthinkingly toe the traditional line, they’re more likely to trust what they say about vaccination, says Bishop, particularly if they suspect doctors are being brainwashed by drug companies.
“For a long time I’ve looked critically at the traditional approach of using antibiotics to manage ear pain,” he says. Evidence shows that antibiotics reduce the average length of earache only from eight days to seven. When exactly what is predicted happens, and the child’s ear returns to normal without antibiotics, “they can see we know what we’re talking about”.
This article was first published in the September 7, 2019 issue of the New Zealand Listener.