You Catch More Flies with Honey than Vinegar: A Health Educator’s Guide to the Anti-Vax Movement

On March 17, 2000, the National Immunizations Program of the Centers for Disease Control and Prevention invited experts to discuss the status of measles in the United States. They unanimously declared that measles was “eliminated” in the United States (1).

On March 27, 2019, the Michigan Department of Health and Human Services (MDHHS) announced that there were 22 confirmed cases of measles in Michigan, the worst outbreak since 1994 (2).

What changed in the 19 years between these two events? This article will outline what happened, and what health educators can do to help fix the problem.

What happened?

The short answer: the anti-vax movement. Fueled by social media, celebrities, and pseudoscience, the anti-vaccine movement has gained traction in the U.S. in recent years. The movement encourages citizens to not vaccinate their children and questions the safety and effectiveness of vaccines. This has caused a sustained decrease in vaccination rates in the United States and a resultant increase in the incidence of previously uncommon diseases (3). Despite vaccination requirements in most public schools, vaccination rates in schoolchildren have continued to drop due to an increase in vaccination waivers. Michigan is one of nineteen states that grant philosophical-based waivers (4); the state ranks in the top five in kindergarten vaccination waivers (5). This has led to only 94% of children in Michigan’s K-12 schools being fully vaccinated as of 2017 (6). The threshold for herd immunity to prevent the spread of measles is 95%, indicating the urgent need for action (4).

Map of top 10 waiver states

In addition to measles, other diseases thought to be eliminated are making a comeback. The number of cases of pertussis, or whooping cough, in Michigan rose ten-fold between 1995 and 2014 (5). A 2008 study found that the geographic clusters of pertussis cases overlapped substantially with clusters of vaccine waivers, indicating a likely association between the two (7). Another disease with increasing incidence in Michigan is chicken pox. The highly contagious disease had decreased in incidence by 97% since the introduction of a vaccine in 1995, but from 2015-2016 there was a 57% increase in incidence. Almost all of those afflicted in 2016 were unvaccinated (8).

Graph of pertussis rates in Michigan

What should health educators do?

So what can be done? What is the role that health educators can play in protecting the public’s health from anti-vaccine rhetoric? Before answering these questions, it is important to recognize why parents are hesitant to vaccinate their children: fear. Parents who are considering not vaccinating their children are not unintelligent or anti-science, they are merely worried about the consequences of sticking a needle in their seemingly healthy baby. The spread of misinformation by celebrities and other popular figures reinforces this fear. This protective instinct has the opposite effect and puts their children as well as the community at risk. Addressing the root of the problem through respectful dialogue, rather than judgmentally berating parents who refuse to vaccinate their children, is the best way to address this problem (9).

Infographic of why some people are vaccine hesitant

How should you discuss vaccination?

Research has shown the following to be the most effective technique to change a parent’s mind about vaccination (10):

  1. Ask about and listen to their concerns

  • Each person has a unique set of reasons that they are worried about vaccination.

  1. Acknowledge their concerns

  • Acknowledgment can be the first step in establishing trust.

  1. Provide evidence in response to these concerns

  1. Share stories

  • The anti-vax movement uses the power of storytelling to promote their own agenda; this power can be harnessed to promote public health as well (11).

  • Tales of adverse reactions to vaccines most likely led to the fears surrounding vaccines.

  • Use your own stories of the benefits of vaccines to help alleviate these concerns.

  1. Don’t pass judgment

  • The goal of this dialogue is not to convince a parent to vaccinate their child immediately, it is to establish yourself as a trusted partner with whom they can ask questions and share concerns.

  • Forming this relationship has a much higher likelihood of success than aggressively scolding them and passing judgment.

Respectful communication is the common theme at each step of this approach. It is critical that health educators do not put vaccine-hesitant parents on the defensive, but rather acknowledge the source of their fears and slowly address them. Like in most areas of life, the old saying holds true, “you catch more flies with honey than vinegar.”

References

  1. Walter A. Orenstein, Katz L. Samuel, Alan R. Hinman; Summary and Conclusions: Measles Elimination Meeting, 16–17 March 2000, The Journal of Infectious Diseases, Volume 189, Issue Supplement_1, 1 May 2004, Pages S43–S47, https://doi.org/10.1086/377696

  2. Mack, J. (2019, March 27). What you need to know about Michigan's measles outbreak. Retrieved from https://www.mlive.com/news/2019/03/what-you-need-to-know-about-michigans-measles-outbreak.html

  3. Hussain A, Ali S, Ahmed M, Hussain S. The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus. 2018;10(7):e2919. Published 2018 Jul 3. doi:10.7759/cureus.2919

  4. Dionne M. Michigan's low immunization rates threaten measles outbreak. Detroit Metro Times. https://www.metrotimes.com/news-hits/archives/2019/02/14/michigans-low-immunization-rates-threaten-measles-outbreak. Published February 14, 2019. Accessed February 21, 2019.

  5. Parker R, Parker R. Vaccination waivers put hundreds of Michigan communities at risk of disease outbreaks. MLive.com. https://www.mlive.com/news/index.ssf/2014/12/michigan_vaccinations_risk_imm.html. Published December 16, 2014. Accessed February 21, 2019.

  6. Mack J. Look up vaccination rates at any Michigan school or day care. MLive.com. https://www.mlive.com/news/2019/02/look-up-vaccination-rates-at-any-michigan-school-or-day-care.html. Published February 8, 2019. Accessed February 21, 2019.

  7. Saad B. Omer, Kyle S. Enger, Lawrence H. Moulton, Neal A. Halsey, Shannon Stokley, Daniel A. Salmon; Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis, American Journal of Epidemiology, Volume 168, Issue 12, 15 December 2008, Pages 1389–1396, https://doi.org/10.1093/aje/kwn263

  8. Ellison G. Michigan chickenpox cases jump 57 percent. MLive.com. https://www.mlive.com/news/index.ssf/2016/05/michigan_chickenpox_cases_jump.html. Published May 12, 2016. Accessed February 21, 2019.

  9. Gartner N. How do you get anti-vaxxers to vaccinate their kids? Talk to them - for hours. The Washington Post. https://www.washingtonpost.com/outlook/2019/02/19/how-do-you-get-anti-vaxxers-vaccinate-their-kids-talk-them-hours/?utm_term=.d13057317c37. Published February 19, 2019. Accessed February 21, 2019.

  10. Kaufman J, Danchin M. You should stop berating anti-vaxxers on Facebook. Here's why. ABC News. https://www.abc.net.au/news/2019-02-20/anti-vaxxer-wont-convince-them-by-berating-them-on-facebook/10826298. Published February 19, 2019. Accessed February 21, 2019.

  11. Ashley Shelby & Karen Ernst (2013) Story and science, Human Vaccines & Immunotherapeutics, 9:8,1795-1801, DOI: 10.4161/hv.24828

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