How does fear influence vaccination decisions?

by Tara Haelle  

Part one on the impact of social networks on parents’ vaccination decisions explored how the way people moralize vaccination might play a part in how receptive they are to data about vaccines. But moral undertones only partly explain the phenomenon seen with Twitter and in Emily Brunson’s study, however. There is also the fear factor. “We are hard-wired for fear,” says Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia . “We are compelled more by emotion and fear than by reason. It’s the fight-or-flight response: we’re still running away from bigger mammals.” Offit notes that the part of our brain in control of emotions and fear has been around longer than the cerebrum, or our “reason center,” which is a relative latecomer in evolutionary terms.

Much of Melanie Tannenbaum‘s social psychology research, at the University of Illinois at Urbana-Champaign, has also focused on the influence of fear, which works, she says, plain and simple: “There is generally a positive, linear effect of fear appeals on attitudes, intentions, and behavior.” Returning to Brunson’s suggestion that public health officials think more broadly about interventions, then, it would appear fear might be worth considering in such appeals. And in fact, many have tried scare tactics in discussing reasons to vaccinate, asking questions like, “Do you want to risk your child’s dying of pertussis?”

Not so fast, though. “Research suggests that although fear generally works, when a message hits too close to home, it can backfire,” Tannenbaum says. “If you are trying to scare someone about a behavior that is particularly self-esteem relevant, highly valued, or a core part of someone’s identity, they will likely tune out the message or – even worse – act out against and do the exact opposite of what is being advocated,” she says. “Rather than changing someone’s mind, you may just be encouraging defensiveness.”

So if attempting to frighten someone into making the right decision to vaccinate (even if the fear-inducing information is factual) may backfire, and promoting positive messages about vaccination on social networks like Twitter can backfire, and people are pretty much seeking out information that generally already conforms to what they are thinking… Where does that leave us?

There is no simple answer to that question. Tannenbaum suggests research on what to use instead of fear, such as positive appeals, perhaps “stressing the positive impacts of doing something rather than the negative (or scary) impacts of not doing something.” That’s tough to do with vaccination, especially when the biggest positive impact is your child’s avoiding a disease. There are, however, the altruistic reasons of contributing to herd immunity, protecting immuno-compromised individuals and simply keeping the likelihood of an epidemic low overall.

In a commentary in last week’s Pediatrics (paywall), Douglas Opel, MD, and Edgar Marcuse, MD, suggest more research into what works based on social psychology research has already revealed. “We must develop and test public health interventions that are based on the cognitive processes actually used by parents in their immunization decision-making while working to increase the role of science in parent’s decision-making,” they wrote.

Meanwhile, one place where real change can happen is in doctor’s offices. “I still think that’s where the rubber meets the road,” Offit says. “If I point to the one place we fail the most, it’s right there, where we can be far more passionate than we are.” Offit says doctors and nurses have tremendous influence in helping patients understand the safety and value of vaccination because most people trust their doctors.

Of course, people will continue to seek info from their social networks and online, which acts as both a window (in friends’ and families’ beliefs) and a mirror. So one thing science-based parents who vaccinate can do is to share science-based information or personal stories, but perhaps without going overboard on the intensity of the messages or fear-mongering. “If we are to sustain adherence to the recommended immunization schedule as a social norm, we need to learn how to empower immunizing parents to become vocal and talk with other parents, including prospective parents, about why they chose to immunize their children,” wrote Opel and Marcuse in their commentary.

Social networks will continue to exert their strong influence, and the growth of online social interactions will only continue to inflate that influence. Trying to manipulate that opportunity too much can, as the study on Twitter showed, be fraught with backfires or missteps. Hopefully further research will point the way toward successful interventions. Until then, “Hello, my name is Tara Haelle, and I fully vaccinate my children on time …”

Photos courtesy of Microsoft/Corbis royalty-free stock.