The art of persuasion

Director of Mayo Vaccine Research Group calls for new approaches to vaccine education

A Google search using the terms “vaccines, information, reactions” will return countless stories about the injuries, and in some cases deaths, parents attribute to childhood immunizations.  These moving first-person accounts appear in Internet search results ahead of the Centers for Disease Control and Prevention’s website, which typically takes a quantitative, science-based approach to disseminating information.

This difference in approaches is a major reason many people in the U.S. may still reject vaccines, according to Gregory Poland, M.D., director of the Mayo Vaccine Research Group.

“We [health care providers] give facts; they [patients] want pictorial language,” Poland said in his presentation at the recent International Conference on Emerging Infectious Disease in Atlanta. “We have guidelines that are black and white. They see ambiguity and story.”

Poland called for health care professionals to persuade the vaccine hesitant using the same narrative styles and emotional appeals that vaccine opponents use.

“Patients want to be emotionally engaged, and if I don’t do it, the cognitive void will be filled by the stories on the Internet. These are emotionally engaging, winsome stories, and they lasso and trap otherwise intelligent people because of the way we’re wired. And we [health care professionals] have ignored that,” he said.

Pharmacists can talk to patients about the importance of vaccines in a way that will move them.  Poland and others stress acknowledging patients’ fears and doubts and knowing the science that unseats those fears while being able to communicate the facts in an emotionally engaging way.

“Pharmacists have the ability to reinforce what doctors are telling their patients. However, this implies the responsibility to be informed about the science,” Poland said. Pharmacists, like all health care professionals, should communicate this science to patients in ways that appeal to their emotions.

New ways needed now

 All states allow for medical exemptions from the immunizations required to start school.  All except for Mississippi and West Virginia allow additional religious exemptions, and 20 states allow personal or philosophical exemptions.

National rates for most childhood immunizations are 90 percent or better, but these rates vary greatly by state and county as immunization refusal rates correlate with local exemption laws.

Washington State’s immunization exemption rates, which include those exempting for personal or philosophical reasons, are among the highest in the country. According to data released by Washington State Department of Health, in Ferry County, more than 25% percent of school-aged children had opted out of vaccines in the 2011-2012 school year.  Predictably, the department’s website is currently running an advisory about the unusually high rates of pertussis, or whooping cough, reported in 2011.

In 2010, California, which also allows philosophical exemptions, reported 9,000 cases of whooping cough – the highest number the state had seen since 1947, according to the New England Journal of Medicine.

CDC issued advisories on mumps outbreaks in 2006 and 2010. Outbreaks of measles in 2008 and 2011, and at this year’s Super Bowl.

“Doing what we’ve always done is not producing new results,” Poland said. “In some counties, levels of immunization are about that of Third World countries. Outbreaks of previously controlled diseases are occurring. It’s time for new approaches.”

What pharmacists can do

Poland and others call for approaches that engage the patient emotionally.  A 2012 article in the New England Journal of Medicine by Douglas Diekema, M.D., cites the need to employ the persuasive strategies of Aristotle with patients.

“Aristotle argued that persuasion requires not only a reasonable argument and supporting data, but also a messenger who is trustworthy and attentive to the audience, and a message that engages the audience emotionally,” Diekema wrote. “Data and facts will not be sufficient to compete with the opposition’s emotional appeals.”

Earning trust starts with acknowledging patients’ fears and doubts. CDC recommends that providers familiarize themselves with common fears and be prepared to dispel them, according to the resource “Talking to Parents about Vaccines for Infants.” Those fears include risk of autism; danger posed by the number of vaccines administered at once or their  ingredients, and risk of known and unknown side effects.

Persuasion is not one-size-fits-all. Like Poland, the CDC literature recommends balancing science with story based on the patient’s cognitive style: “Which approach to use will depend on your knowledge of the family. Watch and listen. Be prepared to use the mix of science and personal stories that will be most effective in addressing parents’ questions.”

Stories from providers’ personal experience about patients who were not immunized and then contracted vaccine preventable diseases can be effective in persuading patients or parents. Providers may have memories about a time when diseases now prevented by vaccines were once more common. Physicians in the CDC video “Get the Picture: Child Immunizations” tell both of these types of stories to a group of concerned mothers. More stories can be found on the CDC’s website under “Vaccines: Unprotected Stories.”

Pharmacists, and other providers, are also advised to share with patients when they themselves or their children have received the immunizations under discussion.

Poland urged the health care professionals at his presentation, whom he recognized as predominantly data-driven, analytical thinkers, not to be afraid to use emotionally-charged language with patients.

He offered a striking example of this type of language through a slogan found on a layperson’s blog: “HPV is sexually-transmitted cancer.”  He contrasted this with the language in Vaccine Information Statements filled with data and statistics.

“It doesn’t make sense to the public,” Poland said. “Why are we afraid to say those things?”


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