Vaccine-hesitancy — the reluctance or refusal of people to allow themselves or their children to be vaccinated despite the availability of vaccines — is a driving factor behind the outbreaks of measles, pertussis (whooping cough) and other childhood diseases around the world, according to health officials.
Here in the United States, it is the driving factor behind such outbreaks, including this year’s highly troubling surge of measles cases.
Those cases keep climbing. On Wednesday, the Centers for Disease Control and Prevention (CDC) announced that the number of measles cases reported in the U.S. since January had reached 1,001.
That’s the highest number since 1992, and means that the U.S. is at risk of losing its measles “elimination” status. Measles is considered eliminated in a country or geographical region when it is no longer endemic (constantly present). Thanks to a highly effective vaccination program, measles was declared eliminated in the U.S. in 2000.
Pointing out that measles is “an incredibly contagious and dangerous disease,” Health and Human Services Secretary Alex Azar urged parents on Wednesday to make sure their children are vaccinated.
“We cannot say this enough: Vaccines are a safe and highly effective public health tool that can prevent this disease and end the current outbreak,” Azar said in a released statement. “The measles vaccine is among the most-studied medical products we have and is given safely to millions of children and adults each year.”
“I encourage all Americans to talk to your doctor about what vaccines are recommended to protect you, your family, and your community from measles and other vaccine-preventable diseases,” he added.
Convincing vaccine-hesitant people that vaccines are safe as well as necessary has been a challenge, however, particularly given the massive misinformation about vaccines that has been spread on social media. Indeed, studies have shown that correcting myths about vaccines often triggers a “backfire effect” that can cause vaccine-hesitant individuals to hold on even tighter to their false beliefs.
In other words, presenting only the facts can be counterproductive.
So, what can be done? Well, researchers at Brigham Young University have identified an approach that may prove effective. In a study published recently in the journal Vaccines, they report that exposing people to the pain and suffering caused by vaccine-preventable diseases helps a significant proportion of vaccine-hesitant people become pro-vaccine.
“Vaccines are victims of their own success,” says Brian Poole, the study’s senior author and an associate professor of microbiology and molecular biology at Brigham Young University, in a released statement. “They’re so effective that most people have no experience with vaccine preventable diseases. We need to reacquaint people with the dangers of those diseases.”
The study involved 425 Brigham Young University students who were enrolled in one of three biology courses taught during the 2018 winter semester. Two of the courses were specifically for biology majors, but the third was a general education non-science-major course (“Principles of Biology”), which non-science majors could take.
Students were recruited for the study because, as Poole and his co-authors explain, “[i]nfluencing students before they become parents will likely encourage pro-vaccination behaviors for their future and current families, as children and adolescents who participate in health education activities in school can positively influence family health management.”
The researchers also point out that Provo, the city where Brigham Young University is located, ranks sixth nationally for under-vaccinated kindergartners.
At the start of the study, the students were asked to rank 13 health-related statements on a 1 to 5 scale, from “strongly disagree” to “strongly agree.” Five of the statements (such as “Vaccines are more helpful than harmful,” “Vaccines cause autism” and “Vaccines are effective at preventing disease”) were used to determine the students’ attitudes toward vaccines.
Based on their answers, 491 of the students were categorized as “pro-vaccine” and 83 were categorized as “vaccine-hesitant.”
Half the students in each category were asked to interview someone they knew who had experienced a vaccine-preventable disease, such as polio, shingles or measles, while the other half (the “control” group) interviewed someone with an autoimmune disease that’s not preventable by a vaccine, such as lupus or rheumatoid arthritis. Some of the students from both groups also received vaccine-related curriculum in the biology courses.
At the end of the study, all the students filled out another survey to see if their attitudes toward vaccines had shifted.
Poole and his colleagues found that 68 percent of the vaccine-hesitant students who interviewed someone who had experienced a vaccine-preventable disease were pro-vaccine by the end of the study — even if they were not taught about vaccines in the biology course they were taking that semester.
The greater the suffering caused by the disease, the bigger the impact on the students. Poole and his co-authors explain:
One student interviewed a member of their church congregation who had singles. “The pain was so bad that she ended up at a pain management clinic where they did steroid shots into her spine. The pain meds didn’t even touch [reduce] her pain, even the heavy ones. For months she couldn’t leave the house.” This interview led the student to explain that “The project showed how the lack of vaccination is essentially accepting the pain and suffering that comes with disease.” Another student interviewed his or her grandmother about tuberculosis: “Before getting diagnosed and during the time that she was treated, she could work her eight-hour temple shift and then she would go for a short time to get small tasks done before retiring to bed for the night.” This students summarized the interview experience as “I dislike the idea of physical suffering so hearing about someone getting a disease made the idea of getting a disease if I don’t get vaccinated seem more real.”
Yet, although the interviews had the biggest impact on changing students’ attitudes toward vaccines, being exposed to vaccine-intensive educational curriculum was also important. Overall, about 75 of the vaccine-hesitant students expressed more positive attitudes about vaccines at the end of the study, and 50 percent of them had attitudes that had changed to the point where they were now “pro-vaccine.”
The study comes with important caveats. It included a relatively small group of vaccine-hesitant people, and all were students at one university. The findings may not be expandable to other populations.
In addition, the study did not follow the students to see if the changes in attitudes toward vaccines led to them being more likely to vaccinate their own children.
Still, despite these limitations, the study suggests that “interview-based interventions and intensive [vaccine-preventable-disease]-dependent vaccine education does significantly increase vaccine attitudes, in a population susceptible to anti-vaccine attitudes,” the researchers write.
“If your goal is to affect people’s decisions about vaccines, this process works much better than trying to combat anti-vaccine information,” says Poole. “It shows people that these diseases really are serious diseases, with painful and financial costs, and people need to take them seriously.”
FMI: You’ll find the study on the website for the journal Vaccines.