Boosting Vaccination Rates, One Conversation At A Time

IRA FLATOW: This is Science Friday. I’m Ira Flatow.

Ever argue with family members about climate change, or a GMOs, or whether they should get a flu shot, someone who you think doesn’t have the science quite right when they form their opinions? Well, we at Science Friday, we want to help you. We’re taking this hour and talking about it, how, if not change someone’s mind, to at least consider the evidence when forming an opinion.

And we’re rolling out a set of social media shareable fact cards. You can whip out these flash cards when you want to remind your friend of the evidence, so to speak, that global warming is not a hoax created by the Chinese.

Let me introduce my first guest, Emily Shepherd, recent graduate of the Missouri School of Journalism’s Donald J. Reynolds Journalism Institute. She was part of a special team that helped us build the new Science Facts resource. And you can check out some of those resources, which we’re rolling out over the next few weeks, on our website. It’s sciencefriday.com/sciencefacts.

Welcome to Science Friday.

EMILY SHEPHERD: Thank you so much, great to be here.

IRA FLATOW: Well, tell us about this. How did this all get started?

EMILY SHEPHERD: Well, Science Facts is about putting the facts first on these controversial topics, like vaccines, GMOs, climate change, just to encourage our audience members to have conversations with their friends and family about those topics. So, we have curated some key facts on these complex issues, and we’ve turned that information into visual, shareable elements for social media to help facilitate those conversations.

IRA FLATOW: And how hard is it to convince people?

EMILY SHEPHERD: See, we are really not, necessarily, taking the approach of trying to convince people. Our goal is really to present the facts first, and kind of let them speak for themselves. The data really does show all of these recent revelations that we’ve had in the scientific community.

And recently, GMOs, vaccines, climate change, they’ve been recently politicized, but we’re talking about facts here. It’s not necessarily something that needs to be debated. But we want to give people the stepping stones to have these conversations and draw their own conclusions.

IRA FLATOW: And what are some of the facts that the team chose to highlight?

EMILY SHEPHERD: Well, we’ve actually had some really great content produced on Science Friday shows. So, we pulled a lot of our content from there. For example, the current campaign that we’re working on vaccines, we had a quote from Dr. Paul Offit talking about the different components of vaccines.

So, we really want to highlight these key facts that really help demonstrate the relevance of these issues, and how to talk about them with people who may not have that information at their fingertips, or don’t understand the topics overall.

IRA FLATOW: How can having better facts change the conversations we have about frustrating subjects, like climate change?

EMILY SHEPHERD: It’s really important that we have really clear and concise information, right? And so, at the Missouri School of Journalism, we really do focus on putting the factual information first. And my specialization is putting those facts in a format that can be applied to social media, and emerging forms of media, because that social media is the place where people are having these conversations. And we want to be able to give people information, so that they can share it, and talk about it, and give people talking points.

IRA FLATOW: Well, why not teach people to argue more persuasively with people who don’t believe that climate change is happening? I want to prove people wrong about this, you know?

EMILY SHEPHERD: Right. And Science Friday has worked with that before. It was actually a really popular– how to talk with climate change was one of our featured articles that we had. And that’s a component that Science Friday has recognized, as well, but we’ve found that, in communicating with people who are nonbelievers, right, you just want to– you have to give them a morsel of information to really grasp onto, because you can’t argue with the facts, really. The studies show data is very, very clear. So, we really are trying to emphasize these fact-based conversations.

IRA FLATOW: I always try to emphasize the evidence more than the facts, because everybody can have their own facts, but they can’t have their own evidence.

EMILY SHEPHERD: Yeah, no, that’s very true. And, for example, in our fact cards, we do highlight all of the important data that helps demonstrate the relevance of these issues.

IRA FLATOW: Well, thank you, Emily, Emily Shepherd, recent graduate of the Missouri School of Journalism. She helped Science Friday make its new shareable fact resources, and you can see the shareable facts at sciencefriday.com/sciencefacts. Thank you, Emily.

EMILY SHEPHERD: Thank you so much.

IRA FLATOW: And in case you just joined us, we’re talking about how to have a civil conversation with people who are skeptical about science. We have talked about discussing climate change, and GMOs on this program, but how about vaccination?

Coincidentally, did you know today marks the 195th anniversary of the death of Edward Jenner, the physician who brought us the smallpox vaccine. And here we are, 200 years later, when many parents are hesitant about the safety of immunizations, or dubious about the necessity of getting their kids immunized. Only about 40% of US population, 40% of the population, had received a flu vaccination and by November this season. Is there a way to convince people they should still get their kids, or themselves, vaccinated, especially in this brutal flu season?

Let me introduce my next guest, Gretchen Chapman, who is a Professor in the Department of Social and Design Sciences at Carnegie Mellon University in Pittsburgh. Welcome to Science Friday.

And also with me is Amanda Dempsey, Associate Professor of Pediatrics at the University of Colorado in Denver. Welcome, Amanda.

AMANDA DEMPSEY: Thanks, Ira.

IRA FLATOW: Well, how big how big is the problem of people saying no to vaccines?

AMANDA DEMPSEY: Well, it’s a growing problem. We know from national studies that, in the past, there have been about maybe 10% to 15% of parents who had concerns about vaccines, such that they might not get one or more of the vaccines that were recommended for their children. And over the last decade or two, that number has grown to be more like 25% to 35% who are refusing at least one vaccine for their child.

That said, though, there’s a pretty stable population of the percent of people who refuse all vaccines, for the last couple of decades, that’s remained steady at about 1% to 2%.

IRA FLATOW: And so, what are the biggest reasons that people tend not to get vaccinated?

AMANDA DEMPSEY: Well, there’s been a lot of research about that. Some of it has come from our own work, here at the UC School of Medicine in Denver. And when you look at the reasons people give for not getting vaccines, they really fall into three main categories.

The first one is that they often have concerns about the safety of the vaccine. Now, whether or not those concerns are valid is a debatable point, but that’s one of the reasons that they give.

The second is that a lot of people aren’t convinced that vaccines are actually necessary. And part of this is because vaccines have been so successful in really reducing the diseases that they prevent, that a lot of people haven’t had firsthand experience with a vaccine-preventable disease that used to be really common.

And then, the third major issue has to do with access. So, people might be interested, or generally accepting, of vaccines, but it doesn’t take priority over other things that they might have to do in their lives that take up time as well. And they, for whatever reason, just can’t get into a clinic or a doctor’s office to get them.

IRA FLATOW: There there are people who sort of are on the cusp of these issues. I have a tweet from themodefanatic, who says “While the actual vaccines are technically safe, I do believe the manner, meaning four in one, bundled and kids at a certain age, does have an effect on kids.” Maybe people want to spread them out a little more. Have you heard that reasoning?

AMANDA DEMPSEY: Yes, definitely. I’m a pediatrician, so this comes up a lot in my own clinical practice. And that is a concern that people have. But I think what a lot of people don’t realize is that actually the vaccines, that people who are now the age of parents might have gotten when they were children, were actually manufactured in such a way that they were getting way more antigens in those vaccines, 20, 30 years ago. So even though there’s an increased number of vaccines, meaning more shots going into arms, in this day and age, they are produced in such a way that the number of antigens that are being introduced is actually less than what we got before.

IRA FLATOW: Gretchen Chapman, when doctors encounter a parent who is worried that a vaccine is unsafe for the child, what’s the best way to handle it? Should they just try to tell them they’re wrong?

GRETCHEN CHAPMAN: Well, we know that physician recommendations are one of the strongest predictors of vaccination behavior. So, just simply a physician recommending the vaccine is very powerful. We also know that the way that physicians recommend vaccinations are important.

So, a recent study shows that presumptive recommendations– so if you say, your child is due for the HPV vaccination this visit, so we’ll be giving it at the end of the visit, that’s a presumptive vaccination that just sort of assumes we’re going to do it, that’s much more effective than if it’s a discussive recommendation, where you say like let’s discuss whether or not you’d like to have the HPV vaccination.

And so it sort of creates the attitude that of course we’re going to do this. And then the parent has to jump in and say, wait, wait, wait, I’m not sure I want to do this, if they don’t want to do it.

IRA FLATOW: So, you’re sort of validating their fears, but telling them how to get around those fears.

GRETCHEN CHAPMAN: Yeah. And you’re communicating that this is the norm, this is what most people do, this is what I strongly recommend.

IRA FLATOW: Yeah. Amanda, your research is looking at a tool for physicians to help them have better conversation with hesitant parents. What would this look like?

AMANDA DEMPSEY: Yeah. So, we actually did a trial here, where we introduced a physician communication toolkit, and the focus was specifically on HPV vaccine, but you could really apply the lessons learned to any vaccine conversation, and we taught providers the presumptive recommendation, like Gretchen just mentioned, and then we also taught them an additional skill called motivational interviewing, which is something that’s been around for a long time, but hasn’t really been applied to the field of vaccinations.

And what motivational interviewing is, is basically a way of framing a conversation, it’s a communication technique, where you try to actively reduce people’s barriers to hearing information that might be slightly different than what they think their beliefs are, and try to use people’s own inherent motivation for making healthy behavior decisions. So, we were able to teach providers how to use some of the skills and motivational interviewing to have more effective conversations about the HPV vaccine, and actually increase their HPV vaccination rates for their patients.

IRA FLATOW: Our number, 844-724-8255, in case you just joined us. We’re talking about talking with your friends about science issues, and we’re focusing on vaccinations. A couple interesting tweets came through here. Darren Sober says, “The medical industry lacks credibility because of profit motives.” Liz says, “We have blood drives. Can we have flu shot drives? I got my flu shot two weeks ago. Would have gotten it sooner, if it had leapt out in front of me.”

[LAUGHS]

AMANDA DEMPSEY: Yeah. Gretchen has some really interesting research on sort of feasibility on making vaccines easier, that support that tweet from the second person.

IRA FLATOW: Do you, Gretchen?

GRETCHEN CHAPMAN: Yeah, absolutely. Making vaccines the easy action to take is a very effective way to foster vaccination rates, especially among people who are generally positive about vaccinations. But maybe it’s just not their top priority. They’re busy.

So, one of my studies manipulated whether or not vaccine appointments were the default, or not. The default is the thing that you get if you don’t take any direct action. So, some patients got a letter saying, you can make a vaccine appointment, if you want one, and other patient got a letter saying, we’ve prescheduled you for an appointment, and you can cancel it if you don’t want it. And more people in that second group got vaccinated.

IRA FLATOW: This is Science Friday from PRI, Public Radio International.

A few years ago, you might have referenced this, we had Paul Offit on to talk about vaccine research. And we had a caller named [? Shantal, ?] who spent eight minutes on the air– I gave her all the time she wanted– explaining how no amount of evidence would ever convince her that vaccines were safe, especially if her– especially because her government was involved in the research. She said– I remember correctly, after all I gave her a long time– I wanted to hear what she had to say– she said, I basically don’t trust anything my government tells me.

GRETCHEN CHAPMAN: Well–

IRA FLATOW: Yeah, she– Is that commonly heard, or is that something you never can overcome?

GRETCHEN CHAPMAN: Trust in the vaccination system, including trust in the government that orchestrates it, is one of the main components of vaccine confidence. And that’s an important part that we have to foster, when we want people to get vaccinated. It’s rare for someone to have that adamant of a view, but certainly it happens. And I think an interesting question is, where should we be putting our priorities in trying to foster increased vaccination? Should we be trying to convince the people who have very strident views, like that? Or should we be focusing our energies on people who are busy, and distracted with other things, and would get vaccinated if it was more convenient for them, but don’t have strident anti-vaccination views?

IRA FLATOW: Does it help, Gretchen, to talk about the worst-case scenarios of not getting vaccinated? For example, more than 30 kids have died this flu season already. Does this sway the hesitant at all?

GRETCHEN CHAPMAN: Well, I do think that that’s an important technique that vaccine advocates should use. That’s sort of taking a page from the book from the anti-vaccination advocates, who often use very salient personal stories that are easily remembered and have a high emotional content. And I think that the people supporting vaccination can do the same thing. And unfortunately, we do have people dying from vaccine-preventable diseases, and those make very tear-jerker stories, which we could be preventing if more people got vaccinated. So, let’s tell those stories, and hopefully convince some more people.

IRA FLATOW: Let me go to Rita, before we go to the break, go to Rita in Kansas City, Missouri. Hi, Rita.

RITA: Hello.

IRA FLATOW: Hi, go ahead.

RITA: OK. My question, or my comment, has to do with the training of physicians to just consider some vaccinations just to be a matter of course, and not allow the parent to consider that it might be something they don’t want. And I feel like by doing that, it disrespects the parents. I feel like physicians should be educators too, and that parents should be fully informed.

AMANDA DEMPSEY: Yeah. So, I agree. I agree with that. I agree with that viewpoint. I mean, parents are the ultimate decision makers for what their children get. But the reality is that there are very strong and clear recommendations that all children should get vaccinated. And it is considered the norm. So if you, as a parent, decide not to do that, then that’s going against what every medical organization says is the right thing to do.

So, what we try to train providers to do is to just reiterate that message, that this is considered the standard of care, and, of course, as a parent, you have the ultimate decision-making power of what goes into your children’s body. And I think all providers are prepared to answer parents’ questions about vaccines. So, we certainly would never advocate that people withhold information.

But for a lot of parents, they don’t actually have that degree of concern, and so just hearing a strong, clear recommendation from their provider is enough to make them feel confident about getting the vaccines, and to allay any minor concerns that they have.

And so, what we try to do in our trial is to start the conversation that way, but then to have providers quickly recognize if a parent does have more questions, or has concerns that they want to talk about, that they have the skills and the tools to be able to address those concerns, as much as the parent needs them to be addressed.

IRA FLATOW: Wish we had more time, we’d talk with Rita. We have to go to the break. We’re going to take a break and come back, and talk lots more about vaccinations, global warming, things like that, how to talk to your friends and relatives about these sticky subjects. We’ll be right back after the break. Stay with us.

This is Science Friday. I’m Ira Flatow. We’re talking this hour about how physicians can help convince more patients to vaccinate their kids, or vaccinate themselves, saying this as the flu is really bad this year, but also because the US continues to experience the occasional measles epidemic, whooping cough outbreak, and more. Our number, 844-724-8255.

Lots of tweets coming in. Let me just read a few of them.

Diane Ports says, “I’m 65. I have two doctors who will not administer the shingles shot. They claim they have seen patients have heart attacks. How would you address this?” Other listeners want you to address how vaccines are linked to autism. Is there any evidence for that?

We– Someone else says, “We need to stop advertising any drugs and shots on TV. Big farmer rules on all fronts.”

We also have some phone calls coming in. Let me go right to the phones. Let’s go to Ken in St. Louis. Hi, Ken.

KEN: Hi. I really want to thank you for doing this topic. I’m a pediatrician at St. Louis University and Cardinal Glennon Children’s Hospital, and I do all the things that we talk about here. One thing I would like to add, though, is that it is key for me to address the fears of patients and take them seriously. It can be really frustrating to hear a patient say things that I know are wrong. And I have to remember this is about the patient. And so, I’ll start with the fact that you have fear about your child’s safety is normal, and natural, and healthy, and it shows me how much you love your child. When I do that, they see that I see them, I take them seriously, and then we can have a conversation.

IRA FLATOW: OK. Thanks for calling. Good rules that this doctor is following, my guess, Gretchen Chapman, Amanda Dempsey?

GRETCHEN CHAPMAN: Yeah, absolutely. I mean, belief that vaccines are safe is part of vaccine confidence. And by and large, vaccines are very safe. For example, the belief that the MMR vaccine causes autism does not have any scientific evidence behind it. In fact, there’s lots of scientific evidence refuting that association. Unfortunately, autism is just a quite prevalent diagnosis. More than 1% of children in the US are diagnosed with autism, and often the first signs come around the same time that kids are getting the MMR vaccine. So, there’s just a coincidental confluence of getting that vaccine, and then noticing signs of autism, which causes people to think that there’s an association.

AMANDA DEMPSEY: Yeah. And I think what that doctor did is really a key example of how we use motivational interviewing to help with this problem. He really keyed in on a motivating factor for that parent, which is being concerned about their child’s health, and doing what they think is in their best interests. And so, there are ways to use leverage points like that, to get parents to see vaccines, maybe, from a slightly different angle, in a way that they hadn’t thought about before.

IRA FLATOW: Yeah. We’ve been talking about how the healthcare system can better encourage people to get vaccinations, but is there a role for the rest of us, for the media, or for– We all are in this together.

AMANDA DEMPSEY: I think it’s really important to realize that the number of people that are really completely against vaccines is very small, and the number of people that are for vaccines is actually the majority of the population, and then there is a pretty good sized group that are basically in support of vaccines, that maybe have some pretty serious questions or concerns about them.

And I think what ends up happening in the media, a lot, is that the newsworthy stories are the stories about the people who are strongly against vaccines, and maybe talking about these emotional stories, and so it appears to the general public that maybe this is way more common than it actually is.

We don’t hear a lot of stories about people who are supportive of vaccines, got their children vaccinated, and were happy to do so. And I think it really tends to undermine the message about how normative that behavior actually is.

IRA FLATOW: I want–

GRETCHEN CHAPMAN: Yeah, vaccine success stories, by definition, just aren’t much of a story. If vaccination goes as planned, the person gets vaccinated, there’s no side effects, and they don’t get sick. So, absolutely nothing happens. It’s a really boring story. But that’s what we want.

IRA FLATOW: Yeah. Yeah. We also don’t see people in with polio, lying flat for the rest of their lives inside a machine, either, when–

GRETCHEN CHAPMAN: That’s right. We don’t see these infectious diseases that used to be quite prevalent because, guess what, vaccination works.

IRA FLATOW: Yeah. Yeah. I think that’s where we’re going to leave it. I want to thank my guests, Amanda Dempsey, Associate Professor of Pediatrics, University of Colorado in Denver, Gretchen Chapman, Professor of Social and Decision Sciences at Carnegie Mellon in Pittsburgh. Thank you. Thank you both, doctors, for taking time to be with us today.

GRETCHEN CHAPMAN: Thank you so much.

AMANDA DEMPSEY: Thank you, Ira.

IRA FLATOW: You’re welcome.

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