This is the third part of a series on how anti-vaxxers have fed off of science communications missteps to become an energised movement. It is based on observations from watching a day of speeches from the anti-vaxx gurus during the Truth About Cancer Live conference. The first part looked at how the anti-vaxx guru emerged from the 1970s-80s style Praise-the-Lord TV preachers and the tools they use in their naturopathic faith healing. Part Two considered how certain failures in science communications on vaccines has created the monster of the enraged anti-vaxxer. This final part shares some lessons learnt for vaccine communicators.

Watching the Truth about Cancer Live was enlightening. True to expectation, the missionary zeal of the naturopaths was amusing and I found myself screaming at my screen several times. But at the same time, some of these opportunists played on the weaknesses of the science communications techniques on vaccines, and we urgently need to tighten these practices up.

There are many good efforts and the field of vaxx-comm has developed very useful tools in the 20 years I have been involved in science and risk communications. But the activist world is changing, the issues keep evolving and the social media tools have created new challenges. Scientists and regulatory comms officials have to work harder just to keep from slipping. I am hoping my points will be taken openly rather than prompting defensive reactions. The anti-vaxxers are playing a wicked game that needs continual analysis.

From my observations on anti-vaxx framing, here are six points where I feel vaccine communications should reconsider or improve on their strategies:

1. Stop the “Vaccines are 100% safe” line.

It’s not that your evidence is bad but that they think you aren’t being totally honest. And if they think you aren’t being totally honest, then your evidence must be bad. Welcome to “conspiracy science” in the 21st century. If vaccines aren’t 100% safe (and nothing is), then don’t voluntarily jump down that rabbit hole.

Safety is an emotional concept that is interpreted differently depending how we land on the “risk perception spectrum”. “Read my lips”, nothing is categorical (especially in the field of scientific research). It just takes one suspected negative vaccine reaction to make the “100% safe” claim seem constructed and untrustworthy (and everybody knows somebody who knows somebody …).

Religion claims to be infallible, science is not … but both are in dire need of some humility. The errors in the Philippines with the first dengue vaccine trials and the widespread belief in developing countries that they are getting lower quality vaccines has created an emotional bias that no appeal to reason or declaration is going to fix soon. By needing to declare that something is 100% safe, you are letting what Hans Rosling called “The Negativity Instinct” ignite our fears for our children.

Rather than “Read my lips“, it would be better to frame getting vaccinated into a positive context like: “Hundreds of millions are vaccinated every year with very few negative reactions“; or stress the achievements: “Because of vaccines, many deadly diseases have been eradicated and our quality of life has greatly improved“; or focus on innovations: “The new nasal vaccines reduce risk …“; or appeal to the scientific discovery pathways: “New research has found that a large number of cancers can be prevented with vaccines“. I know this has been done, often quite well, but then “vaccines are safe” seems to always creep back into the messaging at the end.

The key to communications: benefits, benefits, benefits!

Furthermore, insisting that vaccines are safe when a trusting public had already assumed that was a given does much more harm than good. When the American CDC went out of their way to state there was no evidence linking the HPV vaccine to infertility, parents may have suddenly become alarmed about something they might not have ever considered.

2. Stop Falling into the Denial Trap

But how do you deal with a loud crowd of anti-vaxx zealots making ridiculous claims that appeal to emotion and conspiracy theories?

By not being part of their story.

Every risk perception crisis we have had to manage since the 1990s has been due to denial becoming a central frame of the discussion. This is the “denial trap”: when communicators spend more time denying the feared negative effects of a technology than promoting the benefits.

Cranks like Wakefield or Séralini did not become famous for their rather weak and biased papers but rather for the attacks they endured from an outraged academic community making the effort to deny or refute their bad science. A generation of useless debate on GMOs and the MMR triple-jab vaccine has been built around the media-crafted perception that the “science is divided”. The science isn’t divided – there were two bad papers that should have been ignored or laughed at.

Other risk areas fall into this same denial trap: nuclear safety, pesticides, food additives, PVC, phthalates, flame retardants… I tried to defend brominated flame retardants during the chemophobic noughties and one day, scanning all of the reports and studies disproving the health risks of bromine exposure on my desk, I prayed out loud for just one bit of positive news on the benefits of flame retardants. I fear vaping advocates are falling into this same denial trap which might push up sales of tobacco again; if the zealots have their way here, it will spell a great loss for public health advances in harm reduction.

On the other side, technologies and products that have not fallen into the denial trap have prospered without the negative stink of public risk perceptions.

• The early mobile phone technologies raised some serious health concerns regarding electro-magnetic fields (remember the first generation phones that could pop popcorn kernels). Rather than denying the risks and claiming the phones are safe, the industry continued to innovate and add more benefits to their products. I wanted the newest iPhone more than I wanted to know about the risk of a brain tumour.
• Benefits matter. I have spoken about the benefits of coffee translating into an easy pass for the battle-ready coffee lobby. No one will consider banning coffee even if the toxins and cancer risks are far higher than from our exposure to pesticides. (Read your Bruce Ames.)
• Salmon aquaculture techniques raise issues that no environmentally-concerned individual should ignore, but since most of us enjoy cheap salmon and the industry (in Europe) has stayed positive, we all look away.
• And then there is Coca-Cola. These marketing geniuses made it a policy to never fall into the denial trap. While sales in soda are falling because of changing lifestyles, it was never because of the fears that Coke caused leukemia, cancer, leaky gut, allergies, heart disease or, of course, Alzheimer’s. None of those campaigns stuck because Coke didn’t get into the mudpit with their trolls, preferring instead to focus on their message of taste and being “Happy”.

I keep trying to get NGO activists to fall into the denial trap (like getting them to deny that pesticides approved for organic farming kill bees) but they are too clever by far. They wrote the denial playbook.

Vaccine communicators should learn from these activists and let others dispel the risk claims while they concentrate on the positive benefits messaging. Taking the lead from Coke, the American CDC should have an external site that addresses vaccine fears and myths while keeping their site positive and on message.

3. Stop Treating all Vaccines as Imperative and Equally Important

I understand that scientists see all preventative vaccines as gifts to humanity and feel they have the obligation to promote the widest improvement of public health possible. It is amazing what has been achieved in the last 50 years. But not everyone sees public health in the same way and in some cases time may need to be taken for some in the public to adapt. In risk perception management, patience is a valuable tool.

People should consider some vaccines as necessary for saving a child’s life and then there are those that can improve the quality of life. Overwhelming people with a myriad of “jabs” on a schedule that looks like one’s baby has just joined the army is not a good way to encourage compliance to the priority vaccines. Vaccines should be a matter-of-fact part of the doctor’s visit, in consultation as a calm decision. It is always the parents’ choice and as public health officials panic as the numbers of unvaccinated increase, I worry they are forgetting that.

Choice allows people to think. We have to stop assuming the worst in their decision-making process. Engaging with individuals and explaining the benefits versus the risks of certain vaccines, why some are essential (don’t say mandatory), letting them know the high level of research and quality while listening to their concerns works better than saying: “Shut up and vaccinate your child!“. We should not be treating parents with concerns like pariahs and threatening to deny them access to public services. Empathy is a much better communications tool than imposition or shaming.

The argument should be “At least ten, but all is better” rather than “All vaccines or your child can’t go out in public“. If you lose the argument with one person, it is not the end of the world. If you insist on winning that argument, you will likely lose a lot more arguments. Like any polarising debate, it is the middle ground you need to play for, not the cranks on the fringes.

The concerned parents need to feel that you’re engaged, not enraged.

4. Stop Thinking People don’t have the Right to Choose

Respecting a parent’s right to make decisions for their children is a rather important part of a democratic society. In his speech at the Truth About Cancer Live, Del Bigtree depicted US public health officials as representatives of the US military imposing some martial law on a population with no rights left. Putting our public health officials together with conspirators from industry (greed, lies and poison) trying to take your freedom away further cemented the anti-vaxx outrage in the room. Watching Bigtree’s fire and brimstone speech, I was impressed how he tried to make it feel “un-American” to vaccinate your child. How much of Del was our creation?

Agency is perhaps the most important step in risk management. Those taking the risk need to feel informed and involved in the decision or have control in the process. Smokers will light up knowing full well the risks but they are the ones choosing to take those risks. They would be rightly outraged if they were not informed of dioxins in their food (regardless how small the relative exposure is compared to smoking). The best a regulator can do is nudge the public to make the right decisions in a reasonable manner. Benefits, incentives and role models work better than insults, obstruction and threats – actions that have rallied the anti-vaxxers, drawing moderates into their fold.

Regulators can’t regulate Stupid. They cannot win if they impose vaccines or threaten denial of services like schools or healthcare on people who belong to a naturopathic cult that has taught them the authorities are part of a conspiracy. The only thing such acts will do is give their gurus more air-time and oxygen. It would make more sense to make a parent liable for damages for any at-risk person their unvaccinated child may harm – let them exercise their right to choose (… to risk losing their home in a lawsuit).

When Italy imposed ten mandatory vaccines for children to access schools, the anti-vaxx Five Star Movement rocketed up in the polls. A year later when in power, the Five Star health minister reversed that decision. Taking rights away from parents will merely harden them. Regulators need to understand they are no longer dealing with misinformed individuals but rather angry, organised communities.

5. Understand that the Sense of “Community” has Changed

We are now embedded in isolated tribes – social media communities – for our information … determined, edited and delivered via algorithms. I spend a good part of my day speaking with people I’ve never met while I rarely speak to my neighbour. So concern about “herd immunity within a community” is framing the conversation at a level above how most individuals are getting their information or where their interest lies. (Discussions on this blog-site have already accepted that the term “herd” was an unfortunate word choice.)

The algorithm is very efficient at sorting people into communities of like-minded people. If parents feel concerned about vaccinating their children, their Google searches and click history will likely land them on sites where others feel the same (and where opportunists are feeding them misinformation). If you tell them they need to vaccinate for the benefit of all society, their community will reassure them that is not true. They will quickly not feel part of your “herd of sheeple”.

You need to remove the fuel of conspiracy that breathes life into these communities and that comes from listening rather than lecturing, proposing rather than imposing, attracting rather than attacking. With the polarisation going on in our online communities, I fear individuals today are no longer taking the good of society into serious consideration when they make decisions.

6. Stop Thinking anyone is Blaming You

I have spoken with and to many vaccine communications specialists. I worked in communications for a company that was a major flu vaccine producer. I am equally to blame and am not condemning anyone. I get how painful it is for individuals who have committed their entire lives to improving public health and I sympathise with their outrage at these wing-nuts who piss in the well of public trust with a simple tweet.

But after seeing how the anti-vaxx opportunists are using these strong reactions to their benefit to grow their tribe and seriously challenge herd immunity in many areas (while making themselves rich selling fear to vulnerable people), I felt I needed to share some observations. I am expecting some blow-back from friends working in this field and I respect their right to disagree and feel offended. And then what?

We have created some great tools and solved incredibly difficult challenges, but this serpent has many heads and keeps evolving. Two decades after Wakefield, our science communications efforts have not sufficiently raised the rationality in this debate, the anti-vaxxers have not moved back to the fringe and the public has become more confused than reassured.

Like so many risk issues, our vaccine communications strategy needs more attention, creativity and innovation. It also needs more patience than panic.

Good luck!

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