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  • Brendan Shaw

How do we turn the tide?: Winning the measles vaccination debate

“Of the modes of persuasion furnished by the spoken word there are three kinds. The first kind depends on the personal character of the speaker [ethos]; the second on putting the audience into a certain frame of mind [pathos]; the third on the proof, or apparent proof, provided by the words of the speech itself [logos]. Persuasion is achieved by the speaker’s personal character when the speech is so spoken as to make us think him credible.”

- Aristotle, Rhetoric, 350 BC

“The great enemy of communication, we find, is the illusion of it.”

- William H. Whyte, Fortune, 1950

“I’m very lucky that my anger ended in dialogue with experts.”

- Sceptical 36 year-old Italian mother converted to vaccination, Economist, 2019

We are losing the public relations war about measles vaccinations.

It should be an argument we are winning.

But we’re not.

The World Health Organization has listed vaccine hesitancy – defined as “the reluctance or refusal to vaccinate despite the availability of vaccines” – as one of the top 10 international threats to global health in 2019.

The fact that the WHO has listed vaccine hesitancy alongside things like climate change, Ebola and drug-resistant superbugs speaks volumes for how serious vaccine hesitancy has become for human health.

And UNICEF recently released a major statement sounding the alarm on the worldwide surge in measles cases and the dangers of not vaccinating.

Measles is not the only area where vaccine hesitancy occurs, but it is perhaps currently ground zero in the anti-vaccination misinformation campaign.

Source: OECD. Health statistics., accessed 11/3/2019.

Measles vaccination saves millions of lives

The WHO noted that in the case of measles, some countries that were on the verge of eliminating the disease have seen a resurgence.

Before the introduction of the measles vaccine in 1963 an average of 2.6 million people died from it every year.

Many of them children.

Even at the beginning of this century, over half a million people – mostly children – died each year from measles.

Today, that figure has fallen by 80% to just over 100,000 people.

That’s still 100,000 people a year unnecessarily dying from measles.

There’s no doubt that the ramping up of measles vaccination has saved the lives of almost half a million people a year – most of them children.

The WHO estimates that just since the beginning of this century, measles vaccination has prevented just over 21 million people dying.

That’s equivalent to the entire population of Sri Lanka alive today thanks to measles vaccines since 2000.

Measles can, and does, maim and kill.

“The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.”World Health Organization.

Vaccine deniers

But winning the debate about measles vaccination and convincing people of the benefits of vaccination more generally is not just going to be about science and facts.

The truth about the value of measles vaccination has been out there for years.

But, sadly, scepticism and suspicion of some people in the community, stemming – as the WHO diplomatically put it – from complacency, a lack of convenience and a lack of understanding and belief, is threatening to undermine years of progress in preventing measles and savings lives.

What also hasn’t helped is active campaigning by anti-vaccination groups that rehash falsehoods, fake news and discredited fraudulent claims such as that the measles vaccine causes autism.

Yet another major study has just been released, this time studying over half a million children, which categorically shows there is no link between the measles vaccine and autism.

The claim that the measles vaccine causes autism is rubbish and people who repeat this claim today are just wrong, some of them perhaps bordering on lying.

Ironically, while we are pouring resources into eliminating measles among poorer countries in the world, we are seeing the re-emergence of measles outbreaks in richer countries.

Authorities are increasingly laying the responsibility for this re-emergence squarely on anti-vaccination campaigners in these countries.

Within the last 12 months we’ve seen recent outbreaks of measles with record cases in many cases in the US in Washington, Oregon and New York states, Europe, Australia, Japan, New Zealand, Madagascar, Ukraine, the Philippines and Thailand.

In many cases, these outbreaks are, at least in part, directly due to the anti-vaccination movement in countries where the disease had previously been eliminated.

But why?

How has the anti-vax movement succeeded in scaring enough people about measles vaccination in the face of overwhelming evidence that what they are saying is factually wrong and dangerous to the community?

It’s due to many factors, including a combination of a lack of accessible information from experts, persuasive emotional messages and misleading stories from anti-vax campaigners that spread false information and fake news on social media.

The anti-vax movement also taps into the growing ‘anti-establishment, don’t trust the institutions and elites’ social trend on both the right and left of politics.

The elites and institutions that are distrusted can include scientists, politicians, government regulators and businesses - including pharmaceutical companies.

Like a lot of issues these days, in the face of all this misinformation many caring and worried parents just don’t know who to believe any more.

Show some emotion

So, is the answer just developing more evidence?

As one commentator recently said, there’s not much point doing more research and evidence gathering because it’s already all been done.

Doing more research actually risks diverting resources from other areas where medical research is still required.

The public health experts at universities must feel like they are living through Groundhog Day having to redo studies time and time again that show the same thing.

Measles vaccines are safe and they stop kids dying.

The global data proves it.

Rather, our success in overturning scepticism in communities around the world about measles vaccination is going to be won through credible and effective communication.

The WHO has rightly highlighted that it requires health workers explaining the facts to parents combined with community engagement.

And luminaries like Bill Gates have made great efforts to publicise the benefits for everyone of vaccination.

But we can’t just assume that facts alone are going to change behaviour.

As one commentator said, today we live in a “fact resistant world”.

To convince uncertain parents, we’re going to have to utilise the three elements of successful persuasion that Aristotle wrote about over 2,000 years ago – pathos, ethos and logos.

Aristotle's point, recognised through the millennia by politicians, poets and PR experts alike, is that data and evidence is not enough to persuade people to your point of view.

Just as for vaccines more generally, we need to have a more persuasive campaign that combines credibility, passion and facts to convince parents concerned about the measles vaccine that they need to get their kids vaccinated.

We need to convince wavering parents that it’s unfair to their kids and their kids’ friends to put them at risk of entirely preventable deadly diseases all because of fake news and personality cults in the anti-vax movement.

The recipe for a successful PR campaign that wins over the hearts and minds of the wavering minority is a combination of credibility, a dash of emotion, backed up with a compelling explanation of the facts.

We need to get our act together on this.

Otherwise fake news will keep killing our kids for years to come.

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