Feature

Q&A: Addressing vaccine hesitancy in the 'post-truth' era

Photo of Barbara Rath
Barbara A. Rath

In the “post-truth era” — a time in which objective facts are less influential in forming public opinion compared with emotion and personal beliefs — the persistent flow misinformation about vaccines represents a considerable challenge for pediatricians.

During the 2018 Society for Risk Analysis annual meeting, co-organized by the Vienna Vaccine Safety Initiative, experts discussed approaches to improve vaccination policy moving forward in the post-truth era. Barbara A. Rath, MD, PhD, co-founder and chair of the Vienna Vaccine Safety Initiative, presented at the meeting about the development of digital tools to improve communication between providers and patients about vaccination.

Infectious Diseases in Children asked Rath about the sources of misinformation surrounding vaccines, how it is spread and the pediatrician’s role in providing education to vaccine-hesitant parents and patients.by Katherine Bortz

Q: Where do parents commonly look for information related to vaccination?

A: It has been confirmed in both our own research as well as in several international studies that the No. 1 most trusted source of information on vaccination are health care providers. This source is increasingly followed by online media.

Parents also frequently mention that they get information on vaccination from their friends, colleagues, other parents and public figures like government officials.

Q: How does correct and incorrect information on vaccination spread online ?

A: We addressed this issue nearly 10 years ago in a design thinking project. There really is a lack of awareness about how misinformation is spread through the internet and social media. People tend to be unaware of how the algorithms of internet search engines are programmed, and how this may affect the information they see online. The initial search terms and subsequent clicks will influence the content they see — making it look as if an initial rumor or suspicion is confirmed by multiple sources.

Child receiving vaccine 
Source: Shutterstock.com

This type of technology doesn’t just affect online search engines but also the algorithms behind commonly used social media platforms such as Facebook, Twitter, Instagram and especially YouTube. It is easy to get yourself down a rabbit hole with recommended videos, and many parents can get increasingly concerned because they might only see misinformation and nothing to correct it.

A good example of this issue is what happens when a concerned parent does a standard search looking for the terms “autism” and “vaccines,” which will automatically lead them to any information that would be promoting a rumor and incorrect information that have long been debunked. The search engine is programmed to show you what you asked for, and you will continue to find information that seemingly supports an initial thought. The sources are not selective in terms of reliability or objectivity, which is how rumors are propagated online within subsections of the internet.

What is missing is the other side of the story, or the counterinformation necessary to balance that information.

This is something that we have been studying since 2011, and we have asked for new models that would insert what we call a “fear terminator.” This is a tool that could help concerned parents search the internet from a more neutral stance without being blinded to important factual information. This would create a better understanding of what the sources of online information actually are.

Q: Who is promoting positive and negative information about immunizations?

A: I think it has become increasingly evident that international efforts in manipulating what is being viewed by users of social media have occurred. A study was published this year that examined the spread of fake news about immunization with the likelihood of a negative intent. That is something that even most doctors are not aware of. This is also placed against the backdrop of consistent underfunding of the communication for public health agencies.

Infant immunization 
Source: CDC

Stakeholder agencies in the U.S. have made some very good health information available for the general public that is very well-written and received. In languages other than English, this is more difficult to find, and a lot of parents have asked me where they can access reliable information. Most people just want to have trustworthy and objective information and are confused as to what to believe when they do see misinformation.

Q: What are some of the more common myths you have encountered ?

A: What I tend to hear from parents is that they think the vaccine schedules we have in most countries could cause something like an “overload” of a child’s immune system. They tell me that they did not have as many vaccines when they were younger, and they did fine during their childhood. This makes them question why their child needs several vaccines early in life, and they perceive it as an additional risk for the child. We do not communicate enough that many vaccines are safer and more effective when given at a younger age.

I think there is some truth in another complaint I hear, which is that parents do not like the way their questions are handled when they try to ask their health care providers about vaccines. Many of these problems have to do with the health care system. We don’t have much in the way of reimbursement for simple consultations. Often, parents are left with this feeling that the doctors are rushing, avoiding the topic or talking in terms that aren’t simple to understand.

If parents feel like the questions they have are not sufficiently addressed, they may arrive at a different conclusion than the ones health care providers expect. This can create friction that is not easy to overcome over the course of a quick dialogue.

When you put it the other way around, the health care provider’s primary duty is to start any conversation from a common ground. In the beginning of every conversation, it is important to acknowledge that a parent wants the very best for their child and nothing less. You then need to then examine what this means for each child and each parent.

Q: What advice do you have for pediatricians who need to provide vaccine education to patients or parents ?

A: Before you see a patient, it is very important to think for a minute about what they are expecting from you and what they might want you to address, and pediatricians need to be open to that. Even though pediatrics can be very hectic and there are a lot of things to get done, it is important to stay open to questions and concerns. When we do that, we communicate to parents and children that there is room for them to enter the conversation in a way that we might not have expected.

A good example of this is when we see a patient with influenza-like illness. We as pediatricians need to get away from saying things like “it’s just a virus.” For example, an adolescent patient presents to your office 1 or 2 weeks after receiving an influenza vaccine. They are running a fever, coughing and have a runny nose. They will immediately question if the vaccine has anything to do with their illness or whether it has failed to protect them. We need to address that on the spot, and we need to improve our quality of care in terms of diagnostic testing and feedback. Most importantly, we need to communicate in a succinct manner what a patient’s individual results mean in relation to the immunizations they have received.

References :

English Oxford Living Dictionary: Word of the year 2016 is... https://en.oxforddictionaries.com/word-of-the-year/word-of-the-year-2016. Accessed December 13, 2018.

Rath R. Human-centered Infectious Diseases and Vaccine Communication - Bridging the Gap. Presented at: Society for Risk Analysis annual meeting; Dec. 2-6, 2018; New Orleans.

Seeber L, et al. Curr Drug Saf. 2015;10:31-40.

Disclosure: Rath reports no relevant financial disclosures.

Photo of Barbara Rath
Barbara A. Rath

In the “post-truth era” — a time in which objective facts are less influential in forming public opinion compared with emotion and personal beliefs — the persistent flow misinformation about vaccines represents a considerable challenge for pediatricians.

During the 2018 Society for Risk Analysis annual meeting, co-organized by the Vienna Vaccine Safety Initiative, experts discussed approaches to improve vaccination policy moving forward in the post-truth era. Barbara A. Rath, MD, PhD, co-founder and chair of the Vienna Vaccine Safety Initiative, presented at the meeting about the development of digital tools to improve communication between providers and patients about vaccination.

Infectious Diseases in Children asked Rath about the sources of misinformation surrounding vaccines, how it is spread and the pediatrician’s role in providing education to vaccine-hesitant parents and patients.by Katherine Bortz

Q: Where do parents commonly look for information related to vaccination?

A: It has been confirmed in both our own research as well as in several international studies that the No. 1 most trusted source of information on vaccination are health care providers. This source is increasingly followed by online media.

Parents also frequently mention that they get information on vaccination from their friends, colleagues, other parents and public figures like government officials.

Q: How does correct and incorrect information on vaccination spread online ?

A: We addressed this issue nearly 10 years ago in a design thinking project. There really is a lack of awareness about how misinformation is spread through the internet and social media. People tend to be unaware of how the algorithms of internet search engines are programmed, and how this may affect the information they see online. The initial search terms and subsequent clicks will influence the content they see — making it look as if an initial rumor or suspicion is confirmed by multiple sources.

Child receiving vaccine 
Source: Shutterstock.com

This type of technology doesn’t just affect online search engines but also the algorithms behind commonly used social media platforms such as Facebook, Twitter, Instagram and especially YouTube. It is easy to get yourself down a rabbit hole with recommended videos, and many parents can get increasingly concerned because they might only see misinformation and nothing to correct it.

A good example of this issue is what happens when a concerned parent does a standard search looking for the terms “autism” and “vaccines,” which will automatically lead them to any information that would be promoting a rumor and incorrect information that have long been debunked. The search engine is programmed to show you what you asked for, and you will continue to find information that seemingly supports an initial thought. The sources are not selective in terms of reliability or objectivity, which is how rumors are propagated online within subsections of the internet.

PAGE BREAK

What is missing is the other side of the story, or the counterinformation necessary to balance that information.

This is something that we have been studying since 2011, and we have asked for new models that would insert what we call a “fear terminator.” This is a tool that could help concerned parents search the internet from a more neutral stance without being blinded to important factual information. This would create a better understanding of what the sources of online information actually are.

Q: Who is promoting positive and negative information about immunizations?

A: I think it has become increasingly evident that international efforts in manipulating what is being viewed by users of social media have occurred. A study was published this year that examined the spread of fake news about immunization with the likelihood of a negative intent. That is something that even most doctors are not aware of. This is also placed against the backdrop of consistent underfunding of the communication for public health agencies.

Infant immunization 
Source: CDC

Stakeholder agencies in the U.S. have made some very good health information available for the general public that is very well-written and received. In languages other than English, this is more difficult to find, and a lot of parents have asked me where they can access reliable information. Most people just want to have trustworthy and objective information and are confused as to what to believe when they do see misinformation.

Q: What are some of the more common myths you have encountered ?

A: What I tend to hear from parents is that they think the vaccine schedules we have in most countries could cause something like an “overload” of a child’s immune system. They tell me that they did not have as many vaccines when they were younger, and they did fine during their childhood. This makes them question why their child needs several vaccines early in life, and they perceive it as an additional risk for the child. We do not communicate enough that many vaccines are safer and more effective when given at a younger age.

I think there is some truth in another complaint I hear, which is that parents do not like the way their questions are handled when they try to ask their health care providers about vaccines. Many of these problems have to do with the health care system. We don’t have much in the way of reimbursement for simple consultations. Often, parents are left with this feeling that the doctors are rushing, avoiding the topic or talking in terms that aren’t simple to understand.

PAGE BREAK

If parents feel like the questions they have are not sufficiently addressed, they may arrive at a different conclusion than the ones health care providers expect. This can create friction that is not easy to overcome over the course of a quick dialogue.

When you put it the other way around, the health care provider’s primary duty is to start any conversation from a common ground. In the beginning of every conversation, it is important to acknowledge that a parent wants the very best for their child and nothing less. You then need to then examine what this means for each child and each parent.

Q: What advice do you have for pediatricians who need to provide vaccine education to patients or parents ?

A: Before you see a patient, it is very important to think for a minute about what they are expecting from you and what they might want you to address, and pediatricians need to be open to that. Even though pediatrics can be very hectic and there are a lot of things to get done, it is important to stay open to questions and concerns. When we do that, we communicate to parents and children that there is room for them to enter the conversation in a way that we might not have expected.

A good example of this is when we see a patient with influenza-like illness. We as pediatricians need to get away from saying things like “it’s just a virus.” For example, an adolescent patient presents to your office 1 or 2 weeks after receiving an influenza vaccine. They are running a fever, coughing and have a runny nose. They will immediately question if the vaccine has anything to do with their illness or whether it has failed to protect them. We need to address that on the spot, and we need to improve our quality of care in terms of diagnostic testing and feedback. Most importantly, we need to communicate in a succinct manner what a patient’s individual results mean in relation to the immunizations they have received.

References :

English Oxford Living Dictionary: Word of the year 2016 is... https://en.oxforddictionaries.com/word-of-the-year/word-of-the-year-2016. Accessed December 13, 2018.

Rath R. Human-centered Infectious Diseases and Vaccine Communication - Bridging the Gap. Presented at: Society for Risk Analysis annual meeting; Dec. 2-6, 2018; New Orleans.

Seeber L, et al. Curr Drug Saf. 2015;10:31-40.

Disclosure: Rath reports no relevant financial disclosures.