CPHA Canvax

Fake News and Science Denier Attacks on Vaccines. What can healthcare professionals do?

Noni MacDonald - Professor of Paediatrics (Infectious Diseases)


Never before has the public been so bombarded by information, nor has it ever been so difficult to know what and who to believe. Misinformation is contagious; with fake news travelling faster and farther than truth (1) (2). Science deniers, including vaccine science deniers, have a strong and very effective platform now – the web – from which to shill their scientifically bankrupt wares (3). We, who understand the rigor of science and know the evidence supporting immunization for health and well-being, are often aghast at the falsehoods being promulgated – and indeed- too often accepted and acted upon by members of the public. For example, in the US, the variation of HPV vaccine uptake across the country is better explained by exposure to tweets about HPV than by socioeconomic class data (4). 

Why does this happen? 

Sadly, all of us make most decisions based upon our beliefs, not upon a careful weighing of the evidence (5). We see and hear what we believe, rather than believing what we see and hear (6). We are strongly influenced by what we think others around us are doing or expecting us to do (social networks). We see causation in coincidences and we prefer anecdote and stories to data and evidence. 

What can we do in the face of this tsunami of misinformation that is shaping negative beliefs about immunization amongst the general public and even occasionally among our professional colleagues? 

Know the five tactics used widely, often with great vigor, by vocal vaccine deniers on the web, in mainstream media and in public appearances (7). 

  1. Conspiracy – drug companies, the government, the health system – pick your scapegoat – are out to trick the general public - they withhold information, lie,  cover up “the truth” 
  2. Fake experts- quote or use fake expert and vigorously denigrate real experts
  3. Selectivity- refer to obscure and or discredited papers that support their argument but omit the vast science that refute it
  4. Impossible expectations-  vaccine must be 100% safe and effective – no medical intervention is 100% safe and effective 
  5. Misrepresentation and false logic- jump to erroneous conclusion, use false or illogical analogies  
     

Interestingly, once you know these tactics they are easy to recognize, just look at the fake news complaints appearing almost daily albeit not related to immunization. This is important because there are scientific studies that have shown that one way to protect the public against fake news and science deniers is to teach about the tactics used not just correct the scientific misinformation being presented (8). As well, highlighting that there is scientific consensus on the benefit and value of immunization helps (9). These steps will not convince the vocal vaccine denier but are helpful for our target audience- the general public. 

What about addressing vocal vaccine deniers in public?

The Regional Office for Europe of the World Health Organization has developed guidance on how to do this (10). Not an easy task but an important one to undertake if the vocal  vaccine science denier is having or has the potential to have a significant negative impact on trust in immunization in your community.

What about strategies to address vaccine science denier/refuser in one’s practice- office, clinic, hospital ER etc.? 

Determining if the vaccine refusing patient is a science denier or is a simple refuser is key. You may be able to quickly tease this out by asking – what would it take to move you to a yes to accept this vaccine? The simple refuser may pause, think and name the concern. This is even more likely if you have a good rapport and a trusting relationship with the patient. You then need to address this concern. Do not make the session a knowledge dump as overwhelming the refuser with information is rarely helpful and may actually end up raising concerns the refuser was not previously worried about.  Do not spend time refuting myths as this does not change attitudes to immunization (11). Furthermore the myths may stick, not the correct information. Mini motivational interviewing is a more helpful strategy to further understand concerns and move the patient towards acceptance (12). The World Health Organization has a short conversation guide training module on this technique for immunization that you might find helpful (13).  

In contrast, from the serious vaccine science denier you will get a different story. They most often start with a long list of concerns. Beware. Do not get into a debate with the denier; a time wasting trap. There is no debate – the science is clearly behind immunization. State this. Besides, you are highly unlikely to convince the denier with your arguments and are more likely will only end up in the unhelpful “yes but cycle”. You may try mini motivational interviewing as noted above but with strong vaccine science deniers, this is less likely to help than with simple refusers but it is worth a try.

Regardless of whether the patient is a denier or a refuser, if they chose not to immunize their child or themselves that day – leave the door open for future visits and discussion. Do not dismiss from your practice – even if that is tempting- as this is not in the best interests of the patient nor the community (14). As well it is clinically important to go over the risks and responsibilities if choose not to accept the vaccine(s). The Canadian Paediatric Society Caring for Kids website has advice on this that you can then retailor to fit your patient’s situation (15).

Finally, remember – do not remain silent when faced with a vaccine science denier as your silence maybe interpreted by others around you that you are in agreement with the misinformation. Choose carefully and wisely what to say and speak up whether it’s at a dinner party, out with friends or in the office or in clinic. If the target audience is not the denier remember to educate about techniques being used and help inoculate against fake news and science denial. 
 


References

  1. Social Factors in Epidemiology. Bauch CT, Galvani AP. Oct 4, 2013, Science, Vol. 342, pp. 47-49.
  2. The spread of true and false news online. Vosoughi S, Roy D, Aral S. March 9, 2018, Science, Vol. 359, pp. 1146–1151.
  3. Anti-vaccine activists, Web 2.0, and the postmodern paradigm--an overview of tactics and tropes used online by the anti-vaccination movement. Kata A. 25, 2012, Vaccine, Vol. 30, pp. 3778-89.
  4. Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States. Dunn AG, Surian D, Leask J, Dey A, Mandl KD, Coiera E. 23, 2017, Vaccine., Vol. 35, pp. 3033-3040.
  5. DM, Kahan. A Risky Science Communication Environment for Vaccines. Science. 2013, Vol. 342, 6154, pp. 53-54.
  6. Managing the risks of vaccine hesitancy and refusals. Dube E, MacDonald NE. 5, 2016, Lancet Infect Dis, Vol. 16, pp. 518-9.
  7. How to respond to vocal vaccine deniers in public. Schmid P, MacDonald NE, Habersaat K, Butler R. 2, 2018, Vaccine, Vol. 36, pp. 196-198.
  8. Inoculating against misinformation. van der Linden S, Maibach E, Cook J, Leiserowitz A, Lewandowsky S. 6367, Dec 1, 2017, Science, Vol. 358, pp. 1141-1142.
  9. Highlighting consensus among medical scientists increases public support for vaccines: evidence from a randomized experiment. van der Linden SL, Clarke CE, Maibach EW. Dec 2, 2015, BMC Public Health, Vol. 15, p. 1207.
  10. World Health Organization Regional Office for Europe. Best practice guidance: How to respond to vocal vaccine deniers in public . 2016.
  11. Countering antivaccination attitudes. Horne Z, Powell D, Hummel JE, Holyoak KJ. 33, 2015, Proc Natl Acad Sci U S A. , Vol. 112, pp. 10321-4.
  12. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. Gagneur A, Lemaître T, Gosselin V, Farrands A, Carrier N, Petit G, Valiquette L, De Wals P. 1, 2018, BMC Public Health, Vol. 18, p. 811.
  13. World Health Organization. Health worker training module. Conversations with hesitant caregivers. Immunization Vaccines and Biologicals. Addressing vaccine hesitancy. The critical role of health workers. [Online] 2018. http://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/.
  14. Is physician dismissal of vaccine refusers an acceptable practice in Canada? A 2018 Overview. MacDonald NE, Harmon S, Dube E, Taylor B, Steenbeek A, Crowcroft N, Graham J. in press, Paediatrics & Child Health .
  15. Canadian Paediatric Society. When parents choose not to vaccinate: Risks and responsibilities. Caring for Kids. [Online] August 2016. [Cited: August 16, 2018.] https://www.caringforkids.cps.ca/handouts/when-parents-choose-not-to-vaccinate-risks-and-responsibilities.