Vaccine refusers are health literate and believe they’re pro-science. But this just reinforces their view


Tomas Rozbroj, Monash University

Australians belonging to the vaccine refusal movement consider themselves a science advocacy group, according to a study published today.

My colleagues and I found this group believes it lobbies for unbiased research against increasing industry interference. We also found vaccine refusers construct their identities around developing health literacy, engaging with science and being informed when making decisions about their health.

Other research shows people who refuse vaccines seek to take control of their health decisions. And conversely, they think people who follow public health advice to vaccinate lose out by not educating themselves.

It may be tempting to dismiss these self-perceptions. But that would be to miss the point.

The vaccine refusal movement is a loosely connected community that organises to resist vaccination programs. Not all Australians who refuse vaccines are part of the movement. There is great diversity in the extent to which people refuse vaccines, and in their reasons for doing so.

On average, Australians who refuse vaccines know more about vaccination than do those who fully vaccinate, perhaps because their scepticism prompts them to seek out information. They access both mainstream and alternative vaccine information. People who refuse vaccines are often more likely to have higher health literacy.

Refusing vaccines is risky, and it can be linked to problematic health beliefs and behaviours. But people who refuse vaccines also embody many traits we desire among modern patients, including seeking to be informed, engaged and empowered in their health decision-making.

Is more health information better?

Health literacy means having the knowledge and skills to find, understand and use health information.

The public and policy makers often treat health literacy as an antidote to health conspiracy movements like the vaccine-refusal movement.

Pro-vaccine Australians generally think vaccine misinformation is only accepted by people who are too foolish or too health illiterate to know better.

The president of the Australian Medical Association, in response to growing vaccine refusal, called in May for educational resources to help Australians “differentiate the good from the bad and the downright deadly”.




Read more:
Why people believe in conspiracy theories – and how to change their minds


Some researchers have called for improving health literacy to fight vaccine refusal, and many vaccine promotion strategies rely on improving knowledge and understanding.

After all, it makes a lot of sense. Increased public health literacy often leads to improved health. Evidence suggests it can correct some beliefs in health misinformation. It’s easy to assume that all Australians would be pro-vaccine, if only they had adequate health literacy and critical thinking

Higher health literacy is unlikely to counter refusers’ beliefs

As far as we know, people who refuse vaccines use their health literacy skills to dive deeper into vaccine information, develop more sophisticated views and greater confidence in those views.

But health literacy doesn’t appear to make pro-vaccine evidence look more convincing to refusers. In fact, when people who distrust vaccination also have higher health literacy, they are even more likely to choose information that matches their biases, and to think that information supports their beliefs. Indeed high health literacy seems to help reinforce anti-vaccination beliefs among people who refuse vaccines.




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Vaccine refusers’ “pro-science, health literate” identity is not benign. In their eyes, it makes them highly credible, which helps them resist public health messages. It also makes them look more credible to others, who may in turn be persuaded to question vaccines.

We need to understand the limitations of health literacy

People who refuse vaccines sometimes hold different health beliefs compared with people who accept vaccination, and lean towards conspiracies (though sometimes they don’t).

But their views are built on mainstream trends. These include trends towards consumer-driven health care, exposure to alternative health paradigms, distrust in “big pharma” and in government.

If people who refuse vaccines can go down health misinformation “rabbit holes” despite having high health literacy, it’s feasible any of us could also be misled by health misinformation.




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We undoubtedly need higher public health literacy in Australia. It has clear and well established benefits. But the vaccine-refusal movement shows we may be placing too much faith in health literacy as a solution for health misinformation. It also shows we need to understand its potential to lead some people to internalise harmful health beliefs.

This understanding is sorely needed amid the COVID-19 “infodemic”, where we are confronted with an overwhelming amount of health information. It’s particularly crucial given the public needs to understand and accept credible information to follow public health directives to slow the spread of the virus.The Conversation

Tomas Rozbroj, Post-doctoral fellow, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus anti-vaxxers aren’t a huge threat yet. How do we keep it that way?


Katie Attwell, University of Western Australia

The first I heard of the “Plandemic” video was when a friend shared it on her Facebook. “I’m pro-vaccine,” was her accompanying statement. “And I’m not a conspiracy theorist.”

For those who don’t know, Plandemic is a misinformation-driven viral video that’s garnered much attention in recent days.

It’s spreading numerous falsehoods about the COVID-19 pandemic, including that the virus is “activated” by face masks and hand-washing. And the major conspiracy, or the “plan”, as this article explains, is that:

… a secret society of billionaires around the world are plotting global domination, and they plan to control people through a vaccine.

Perhaps even more worrying is the level of traction such conspiracies receive. More than 100 people gathered in Melbourne last weekend, and some in Sydney, to protest lockdowns, tracking apps, vaccines and the public health philanthropy of billionaire Bill Gates. The protests were reportedly promoted on Facebook anti-vaxxing groups.

While Plandemic’s claims have been thoroughly debunked, my friend is exactly the kind of audience that should have policymakers worried.

Planting seeds of doubt

Conspiracy theorists – or “conspiracists” – generally take their place in the rich tapestry of life without causing too much trouble.

But with some governments caught off-guard by COVID-19 (making stuff up as they go), and public health experts wielding considerable power, conspiracists have fertile soil to plough. That soil is us.

The general public is uncertain, afraid, and experiencing cognitive impairment from the strain of it all. Governments overseas, most notably the US government, have failed dismally in responding efficiently to COVID-19. This has the potential to devastate citizens’ trust.

In this volatile cocktail, the distinction between what is “batshit crazy” and what is worryingly plausible starts to break down.

Reaping the harvest

Enter the organised anti-vaxxers, aligning with other conspiracists to spread misinformation and lead lockdown protests.

Underpinning their antics is the idea that COVID-19 is a highly organised operation, and also the accusation that governments will use lockdowns to forcibly medicate populations, perhaps with plans to incorporate a mind-controlling microchip in the vaccine.




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For those who reject these premises, it’s hard to understand how conspiracists sustain this alternative reality. But for those with long histories of rejecting government and expert authority, it’s completely conceivable.

Many of those who reject vaccines, or strenuously object to COVID-19 health measures, are influenced by interconnected social groups with clear identities. Standing atop a hill of self-ascribed expertise, they can gaze down on the “sheeple” eating from the trough.

Groups that set themselves apart from mainstream society, deliberately and with pride, develop strong in-group identification and take cues from people they perceive to be like them.

That may be why Australia is now seeing freedom-focused anti-lockdown protests you wouldn’t generally expect outside America.

Don’t fan the flames

Lockdown protesters remain small in number relative to the wider population. They also lack significant celebrity endorsement in Australia. Even the bizarre communications of disgraced My Kitchen Rules judge Pete Evans have not extended to lockdown resistance.

When it comes to lockdown protesters, it might be best to quietly ignore them, like a parent walking away from their child’s supermarket tantrum.

Ascribing great importance to conspiracists gives them unwarranted publicity, and risks cuing involvement from others who share their goals or opinions.

And lengthening the conversation unnecessarily could sway the minds of undecided onlookers.

Serious implications

That said, damage to public trust because of conspiracies is more complex.

It’s vital for governments to “keep the public’s ear” so they can maintain effective communication about what they are doing and why. This is crucial in retaining broad population support for the necessary health measures.

Western Australian Premier Mark McGowan’s sky-high approval ratings prove governments can bring people with them.

But they can’t bring everybody. And while dissent is not necessarily unhealthy, the burning question is where dissent leads us.

COVID-19 will likely divide people who have been lumped together by general society as “anti-vax”.

Researchers, myself included, have long argued for more nuanced understandings of vaccine refusers, especially because some remain open to changing their minds.

Some vaccine refusers are likely to find the COVID-19 vaccine is one they don’t want to skip. But for the diehard conspiracists, it’s the endgame.

These people know a large proportion of the population will need to receive it for normal life to resume. But if you believe vaccination to be unsafe, corrupt and toxic, the prospect of being pressured to receive one must be terrifying.




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Who is in danger here?

When (or if) a COVID-19 vaccine does come along, will the broader population be able to accept some people’s refusal to vaccinate? There are two answers.

The first is epidemiological. We don’t know how many of us will need to be vaccinated, but the figure for other diseases such as measles is as high as 95%.

Also, as some people can’t be vaccinated for medical reasons and governments may struggle to reach some disadvantaged populations, the remaining 5% leaves little wiggle room for vaccine refusal within the wider population. If there is room for refusal, there isn’t much.

This brings us to the second, political, answer.

If anti-vaccination propagandists achieve widespread community resistance to government power, there will be many more of them than our vaccine coverage goals can tolerate. This will likely result in more coercive policies from governments.

In Australia and California, populations and governments have previously supported crackdowns on vaccine refusers precisely because these activists behaved in reprehensible ways, or because they made it easy for the majority to construct them as a hated group in need of punishment.

Remember, when we walk away from a child having a tantrum in a supermarket, we are also saving them from themselves – even if they can’t appreciate it.The Conversation

Katie Attwell, Senior Lecturer, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

4 ways to talk with vaccine skeptics



If another parent at playgroup says she’s not vaccinating her child, what’s the best way to respond?
from www.shutterstock.com

Julie Leask, University of Sydney and Maryke Steffens, Macquarie University

Your neighbour is telling you about his new baby. He feels nervous about vaccinating, and says he’s considering delaying Lucy’s vaccines.

Your mother’s group is chatting about vaccines. One mother tells the group Jimmy isn’t vaccinated, and she’s using the Immune-Strengthening Diet instead.

In a Facebook parenting group, someone comments we shouldn’t trust pharmaceutical companies because they’re covering up studies showing vaccines cause autism.

These and similar scenarios may sound familiar. So what do you do when you’re faced with someone who questions vaccination? Do you try to convince them to vaccinate? Do you ignore them? Or might something else work?




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Talking about vaccination can be really difficult. Vaccination touches on strong values, like protection of children, social responsibility, and respect for science.

So, if you’re a vaccination supporter, you may feel perplexed, even angry, when people don’t vaccinate their children. If you’re a parent who has overcome minor worries and vaccinated your child, it can be galling when another parent dismisses vaccination, putting others at risk.

But talking about vaccination can also present pitfalls. Attempting to convince someone with strong views they’re wrong can strengthen their commitment to their position.




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Australians’ attitudes to vaccination are more complex than a simple ‘pro’ or ‘anti’ label


Our work, with a team of researchers, clinicians and the National Centre for Immunisation Research and Surveillance, shows the best way to respond depends on the situation. Your approach will be very different with a person who has fixed negative views on vaccination, compared with someone who is cautious. How you respond also depends on what is most important in your relationship.

Here are some options.

1. Don’t go there

This approach is handy if you encounter a person with fixed beliefs. They may say, “I’ve done my research.”

Your automatic response may be to counter their claims, saying “The science is clear. Vaccinate your kids.”

But if the relationship with this person isn’t important to you, or their emphatic pronouncements are unlikely to do harm, then little is gained by engaging. People with fixed beliefs don’t budge much.




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A short history of vaccine objection, vaccine cults and conspiracy theories


You may encounter active opposition to vaccination on social media. A small number of anti-vaccination activists colonise online forums.

So avoid protracted conversations. Facebook’s algorithm privileges posts with high engagement, so your interactions may bring them even more attention. Energised by the response, anti-vaccination activists may coordinate and bombard you or your organisation.

This is what happened to US clinic Kids Plus Pediatrics in Pittsburgh. The clinic eventually produced a guidebook on how to handle anti-vaccination attacks.

Debating anti-vaccination messages on social media can backfire.
from www.shutterstock.com

Increasing the visibility of anti-vaccination posts can have other drawbacks. Onlookers may come to see vaccination as riskier, and vaccine refusal as more popular than it really is (in reality, only about 2% of Australian parents decide not to give their children some or all vaccines).

But countering anti-vaccine views can also bring benefits: it can diminish these negative effects, and affirm vaccination for hesitant onlookers or “fence-sitters”.

So which option is best? If this person’s posts are getting exposure anyway or they are influential, then you may decide that responding is worth the risk. Just keep any interactions brief, factual and polite. Otherwise, don’t go there.

2. Agree to disagree

Agreeing to disagree may be an option when you are with friends and family who hold firm views and whose relationship is important to you.

There could be a family get-together with your cousin who steadfastly rejects vaccination and the topic comes up in conversation. Family members start debating it. With strong views on either side, this could be explosive. Here you could say, “This is a topic we all have strong views about. We could just argue, but I propose that we leave this one alone.”

Discussing vaccination would not change your cousin’s mind. Her views are deeply held. Don’t let arguments get in the way of these relationships.

3. Affirm vaccination and move on

This option can be useful when you want to avoid conflict, but also advocate for vaccination.

Parent group situations might warrant this approach. For example, a couple at your antenatal class declare their plan to delay vaccination. While you might feel annoyed, try to focus on a strategic goal: showing other parents it’s not a group norm to delay vaccination.

You could say, “We are planning to vaccinate our baby. We think it’s really important.” While this probably won’t persuade the couple, it may reduce their influence on others.

4. Listen, affirm and recommend

This approach may be suitable when you are with family and friends who are hesitant about vaccinating. For example, your daughter and son-in-law are hesitant about vaccinating their child — your grandchild.




Read more:
Everyone can be an effective advocate for vaccination: here’s how


These relationships may be important to you, and you probably want to encourage them to vaccinate.

We and others recommend several steps:

Understand people’s concerns and motivations

Listen to what people say and ask clarifying questions. This helps you better understand their reasons. Avoid the temptation to jump in, and keep a check on your emotions.

Affirm them as parents

This means acknowledging their concerns, as well as their care as parents. A person who feels respected is more likely to listen to your viewpoint. It’s how we all like to be treated. You could say, “I can see you are trying to do your best.”

Offer to share information

Sharing information means giving factual information relevant to that person, explaining your view, and why you believe it. Use quality information, such as via the World Health Organisation’s Vaccine Safety Net portal. Personalise it: “I believe vaccination is important because …”

Close with a plan

This creates opportunities for future conversations. Some parents review their decisions, such as during a localised outbreak or when the child is older. It’s also good to have an exit strategy because vaccination discussions can go on and on. You might ask, “Can we talk about this again some time?”

Decide how you want to spend your energy

Responding to people who question vaccination can be hard. So be judicious about where you spend your energy.

If you truly want to make a difference, avoid the temptation to reflexively correct what you believe is wrong and getting embroiled in lengthy vaccination debates or games of scientific ping pong.

Jump in without thinking, and you risk wasting your time, affecting relationships with family and friends, or even inadvertently amplifying anti-vaccine views.
Instead, assess that person’s position on vaccination, your goals and what is most important in your relationship.


Information for parents who have questions about immunisation is available here.The Conversation

Julie Leask, Professor, University of Sydney and Maryke Steffens, PhD Candidate, Macquarie University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Anti-vaccination mothers have outsized voice on social media – pro-vaccination parents could make a difference


Vaccinations are important to protect against a host of diseases.
www.shutterstock.com

Brooke W. McKeever, University of South Carolina and Robert McKeever, University of South Carolina

A high school student from Ohio made national headlines recently by getting inoculated despite his family’s anti-vaccination beliefs.

Ethan Lindenberger, 18, who never had been vaccinated, had begun to question his parents’ decision not to immunize him. He went online to research and ask questions, posting to Reddit, a social discussion website, about how to be vaccinated. His online quest went viral.

In March 2019, he was invited to testify before a U.S. Senate Committee hearing on vaccines and preventable disease outbreaks. In his testimony, he said that his mother’s refusal to vaccinate him was informed partly by her online research and the misinformation about vaccines she found on the web.

Lindenberger’s mother is hardly alone. Public health experts have blamed online anti-vaccination discussions in part for New York’s worst measles outbreak in 30 years. Anti-vaccine activists also have been cited for the growth of anti-vaccination sentiments in the U.S. and abroad.

We are associate professors who study health communication. We are also parents who read online vaccination-related posts, and we decided to conduct research to better understand people’s communication behaviors related to childhood vaccinations. Our research examined the voices most central to this discussion online, mothers, and our findings show that those who oppose vaccinations communicate most about this issue.

What prompts mothers to speak out

A strong majority of parents in the U.S. support vaccinations, yet at the same time, anti-vaccination rates in the U.S. and globally are rising. The World Health Organization identified the reluctance or refusal to vaccinate despite the availability of vaccines as one of 10 top threats to global health in 2019.

Mothers are critical decision-makers in determining whether their children should be vaccinated. In our study, we surveyed 455 mothers online to determine who communicates most about vaccinations and why.

In general, previous research has shown that people evaluate opinion climates – what the majority opinion seems to say – before expressing their own ideas about issues. This is true particularly on controversial subjects such as affirmative action, abortion or immigration. If an individual perceives their opinion to be unpopular, they may be less likely to say what they think, especially if an issue receives a lot of media attention, a phenomenon known as the spiral of silence.

If individuals, however, have strong beliefs about an issue, they may express their opinions whether they are commonly held or minority perspectives. These views can dominate conversations as others online find support for their views and join in.

Our recent study found that mothers who contributed information online shared several perspectives. Mothers who didn’t strongly support childhood vaccinations were more likely to seek, pay attention to, forward information and speak out about the issue – compared to those who do support childhood vaccinations.

Those who believed that vaccinations were an important issue (whether they were for or against them) were more likely to express an opinion. And those who opposed vaccinations were more likely to post their beliefs online.

Ethan Lindenberger testifies before a congressional committee about his decision to be vaccinated against his family’s wishes.
AP Photo/Carolyn Kaster

How social media skews facts

Online news content can be influenced by social media information that millions of people read, and it can amplify minority opinions and health myths. For example, Twitter and Reddit posts related to the vaccine-autism myth can drive news coverage.

Those who expressed online opinions about vaccinations also drove news coverage. Other research we co-authored shows that posts related to the vaccine-autism myth were followed by online news stories related to tweets in the U.S., Canada and the U.K.

Recent reports about social media sites, such as Facebook, trying to interrupt false health information from spreading can help correct public misinformation. However, it is unclear what types of communication will counter misinformation and myths that are repeated and reinforced online.

Countering skepticism

Our work suggests that those who agree with the scientific facts about vaccination may not feel the need to pay attention to this issue or voice their opinions online. They likely already have made up their minds and vaccinated their children.

But from a health communication perspective, it is important that parents who support vaccination voice their opinions and experiences, particularly in online environments.

Studies show that how much parents trust or distrust doctors, scientists or the government influences where they land in the vaccination debate. Perspectives of other parents also provide a convincing narrative to understand the risks and benefits of vaccination.

Scientific facts and messaging about vaccines, such as information from organizations like the World Health Organization and the Centers for Disease Control and Prevention, are important in the immunization debate.

But research demonstrates that social consensus, informed in part by peers and other parents, is also an effective element in conversations that shape decisions.

If mothers or parents who oppose or question vaccinations continue to communicate, while those who support vaccinations remain silent, a false consensus may grow. This could result in more parents believing that a reluctance to vaccinate children is the norm – not the exception.

[ Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day. ]The Conversation

Brooke W. McKeever, Associate Professor, University of South Carolina and Robert McKeever, Associate Professor, University of South Carolina

This article is republished from The Conversation under a Creative Commons license. Read the original article.