A wrong way and a right way to discuss vaccine safety and effectiveness
Once again I’m blogging about vaccines, and antivaccinationism. Few health interventions that are both demonstrably effective and remarkably cost-effective seem to stir such opposition among a small but vocal few. I have noted before the remarkable statistic that vaccination has prevented more Canadian deaths in the past 50 years than any other health intervention. Yet as long as there have been vaccines, there has been those that oppose them. I’ve spent quite a bit of time outlining the tactics and tropes of the antivaccine movement as well as considering ways in which health professionals and science advocates can improve the way they respond to antivaccinationism.
Rebutting anti-vaccine rhetoric is an unrelenting struggle, but an important one. As I’ve described in prior posts, viewing anti-vaccine material for only five to ten minutes increased the perception of risk of vaccination, and decreased the perception of risk of omitting vaccines, compared to viewing neutral websites. It also lowers vaccination intentions. By changing perceptions of safety, the willingness to vaccination decreases. One of the common themes in anti-vaccination content is raising questions about safety and effectiveness. It’s also the least obvious way to subtly sow concerns about vaccines.
A common way to embed anti-vaccination sentiment in messaging that professes to be science-based is to question the tactics and messaging of pro-vaccination, public health advocates. This is often termed “concern trolling” in online forums, and is common in discussions where there are significant ideological differences between the two groups. From WiseGeek:
Concern trolling is a form of Internet trolling in which someone enters a discussion with claims that he or she supports the view of the discussion, but has concerns. In fact, the concern troll is opposed to the view of the discussion, and he or she uses concern trolling to sow doubt and dissent in the community of commenters or posters. Although this practice originated on the Internet, it has since spread to the real world as well, with concern trolls popping up in a variety of places from network television to op-ed columns.
Artful concern trolling involves developing a believable persona as a supporter of a cause who has legitimate concerns. In an example of concern trolling, a group of people might be having a political discussion on a website about a candidate they support. The concern troll would log on and say “I’m concerned that this candidate might not be strong enough to beat the opposition,” or “I’m worried that the candidate’s history in the legislature might be a problem in the election.”
In the case of vaccines, the concern troll often uses the “Just asking questions” approach, posing questions about vaccine safety or effectiveness, that to the less familiar reader, seem superficially reasonable and legitimate. This is sometime called the “I’m not anti-vaccine, I’m pro-safe vaccine” trope. Once you understand the tactic, it’s easy to spot. Which brings me to the recent post by Alan Cassels on the Pharma Watch Canada blog. Entitled, “Time to outlaw vaccine propaganda: Are we taking the easy way out by labeling vaccine questioners anti-science loonies?” He asks,
Are lifesaving vaccines being ignored by parents because of illegitimate safety concerns?
That’s what many prominent health pundits think, including André Picard at the Globe and Mail. When commenting on an apparent rise of whooping cough, Picard wrote that the increase was the result of parents “shunning vaccination in small but significant numbers because of imaginary fears largely concocted by quacks and charlatans.” Steven Salzberg, a blogger at Forbes Magazine echoed this sentiment pointing to celebrity doctors who “use their medical degrees and their faux concern ‘for the children’ to frighten parents into keeping their kids unvaccinated.” Salzberg also added that the “the media has been complicit in spreading some anti-vaccine misinformation.”
I’d agree that the media might be a problem, adding to the illegitimate vaccine fear floating around, and likely reducing parents’ willingness to immunize their children. And we certainly have our share of charlatans and quacks in cyberspace, aided and abetted by cyberchondriacs of all stripes.
Yet there is real fear among parents, a fear that is palpable. One survey of American parents a few years ago found that the majority of parents agreed that vaccines protect their children from disease but more than 50% expressed concerns regarding serious adverse effects. The same survey found more than 10% of parents had refused at least 1 recommended vaccine. What is at the heart of these concerns? Can it really be due to vaccine fear-mongering?
I don’t think it is. Parents just want to keep potentially harmful things away from their children. And they turn to health experts for guidance, but here’s my take on things: health authorities often fail to acknowledge the risks of some vaccines, refuse to discuss uncertainty over a vaccine’s effectiveness, hype the seriousness of common everyday viruses (c’mon folks, really? The flu? Chicken pox?) and keep piling more and more vaccines onto the list of ‘recommended’ childhood shots threatening to turn our kids into pincushions. Now you’ve got a recipe for even more skepticism and fear-mongering.
This is only the intro to the post so I encourage you to go and read it in its entirety. Even in this short passage I can spot some common tropes used by antivaccinationists, such as minimizing the severity of the diseases, and stating that health authorities often don’t discuss vaccine risks (both of which are false). Plus there’s the inflammatory language of referring to children as “pincushions”, wording right out of antivaccine messaging. I could continue to point out the tropes, errors, and complaints in his list of what he terms “pro-vaccine hectoring” and “patronizing assurances” from public health advocates. But two bloggers have beaten me to it. Over at Skeptic North, Richelle McCullough has done a thorough line-by-line rebuttal to the entire post. And Orac at Respectful Insolence has also weighed in, with Antivaccine fear mongering? What antivaccine fear mongering? I don’t see any antivaccine fear mongering, which currently has received 283 comments, many of which point out additional problems and factual errors in Cassels’ post.
To be perfectly clear, not every post that looks like concern trolling actually is concern trolling. Someone that sounds like a concern troll, could be genuinely misinformed about the facts. I hope that is the case with Cassels, and that he doesn’t really think that the National Vaccine Information Center (NVIC), is a credible source of information. (It isn’t.) Cassels is a “ pharmaceutical policy researcher” and not a health professional or someone with any particular expertise in public health or immunization. So let’s hope we see some clarifying comments soon. As I have noted before, I had no idea about the tactics of antivaccinationists, and the extent of the anti-vaccine movement, until I began answering questions about the H1N1 influenza vaccine.
Let you think that I always equate criticism of vaccination programs with antivaccinationism, let me point you to another post that raises legitimate issues related to immunization without sounding like concern trolling. This post is from the Healthy Debate blog and is written by Ann Silversides & Terry Sullivan, entitled, Promoting vaccine benefits: public health officials call for a rethink of communication with parents. Silversides and Sullivan identify and analyze several issues that are limiting uptake of vaccines:
Public health officials must find better ways to communicate with parents about the risks and benefits of childhood vaccination, researchers and public health officials agree. That task is particularly challenging in the absence of a national, or a provincial, vaccine surveillance registry because, to target messages effectively, accurate and timely information about vaccination rates and trends is critical. Primary health practitioners can also play a key role by engaging parents in non-judgmental discussions about vaccination at key moments during the course of having children and early development. The call for better information and better communication is prompted by the re-emergence of vaccine-preventable illnesses, such as whooping cough and measles, the outbreaks of which are associated with a drop in vaccination rates.
The issues they raise include:
- There is no vaccine registry in Canada, meaning that there is no systematic tracking of vaccinations administered. This limits the ability to track trends more closely and target communication to parents more effectively.
- There is an increased propensity for parents to seek non-medical exemptions from vaccination laws.
- There is an increasing polarization of viewpoints on vaccination.
- Public health messaging is essential, but inadequate to address parental concerns. Public health agencies are effectively not participating in social media.
- The belief that a “healthy lifestyle” can protect against communicable diseases is prevalent, but wrong.
I like much of what they suggest, though I would have liked to see the authors acknowledge that there is an anti-vaccine movement at work, and that anti-vaccine fears among parents are not developing out of thin air. Further, there are specific tactics and tropes used by the anti-vaccine movement – I’ve documented many of them. Understanding this is essential to spotting anti-vaccine sentiment and countering it effectively. Silversides and Sullivan are correct with their other points: It is absolutely true that public health agencies are largely absent on social media, where enormous amounts of antivaccine misinformation is spread. And they raise the hugely important issue of a Canadian vaccine registry. A few years ago I discussed a case control study on vaccines and autism and commented that the study couldn’t have been done in Canada – because the American managed care organization used an electronic medical record to track all vaccinations. That type of record-keeping just does not exist in an electronic form anywhere in Canada. On balance the post is a good one though, offering constructive criticism without one lapsing into “false balance” around safety and effectiveness, or making errors about the current state of public health messaging.
Vaccines are a remarkably safe and effective health intervention. Yet there are many factors contributing to a waning acceptance of immunization programs. Better strategies to address the contributors to lapsing confidence are required. To succeed, we must understand motivations. Parental concerns are a reality and must be addressed effectively by health professionals. But it must also be kept in mind that many concerns are usually rooted and stoked by deliberate anti-vaccination campaigns that inflate risks, spread misinformation and ultimately aim to undermine confidence in immunization programs.
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