New research just published suggests that debunking myths regarding the MMR vaccine is not enough to encourage skeptical parents – it may even harden their resolve not to let their children be vaccinated. This should give pause if our aim is to encourage parents to vaccinate children, rather than scold them into accepting the medical evidence.
Peter Hitchens made this point on MMR vaccine:
As a parent myself, I sympathised then, and sympathise now with those parents who were worried. It is a very heavy responsibility to authorise an injection, in the fear that it may unpredictably do permanent and irreversible damage. The chance may be very small. The authorities may be saying that it does not exist. But if it is your child, you won’t necessarily be convinced by such words. Any parent will know this. Many non-parents will simply not understand. [Hitchensblog]
In a randomized trial parents were assigned one of four communications regarding MMR or measles:
1. Information explaining the lack of evidence that MMR causes autism from the Centers for Disease Control and Prevention
2. Textual information about the dangers of the diseases prevented by MMR from the Vaccine Information Statement
3. Images of children who have diseases prevented by the MMR vaccine
4. A dramatic narrative about an infant who almost died of measles from a Centers for Disease Control and Prevention fact sheet;
Or they were assigned to a control group using reading material unrelated to health. The research results and conclusion were:.
None of the interventions increased parental intent to vaccinate a future child. Refuting claims of an MMR/autism link successfully reduced misperceptions that vaccines cause autism but nonetheless decreased intent to vaccinate among parents who had the least favorable vaccine attitudes. In addition, images of sick children increased expressed belief in a vaccine/autism link and a dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects.
Current public health communications about vaccines may not be effective. For some parents, they may actually increase misperceptions or reduce vaccination intention. Attempts to increase concerns about communicable diseases or correct false claims about vaccines may be especially likely to be counterproductive. More study of pro-vaccine messaging is needed. [Pediatrics]
How do we view such parents? As delusional, self perpetuating an idea that may be harmful to their children. Or as fearful parents, who have heard past bogus reports, who need a different response. Is a single jab better than none at all for these few, do we really think parents that would have the combined MMR vaccine would not if given the choice of single jabs?
Peter Hitchens had a point in his observation in April 2013 that fears of a parent are not easily put aside. The published research could not have come soon enough if we are serious about preventing future outbreaks in our communities. Effective communication is not just about being convincing about the health benefits of immunization, but increasing immunization.
In July 2013 following the Swansea measles outbreak, Dr Millington commented:
“There was a refusal to have immunisation in the cohort that had not been immunised despite very considerable effort. Having said that we’ve offered it whenever we can wherever we can,”
“Some of the responses we get are really quite difficult. ‘Mind your own business.’
“People say ‘Every time I come here you ask me about my child’s immunisation status. Why don’t you mind your own business?’
“That’s a very difficult conversation to have. I do think we’ve tried everything else. Once the outbreak started I think things were different and I think different methods were used and I think they were effective.
“But it is surprising how many people did not listen to the message and it’s surprising how many people have still not listened to the message – they don’t want to hear it.”
For too long it has come across as we know best, you are just a parent, do not worry. We cannot afford to take that attitude when immunization matters to reach the optimum level in the population.
Article written by John Sargeant on Homo economicus’ Weblog