{"id":4187,"date":"2021-07-07T12:14:01","date_gmt":"2021-07-07T11:14:01","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4187"},"modified":"2021-11-24T21:18:23","modified_gmt":"2021-11-24T20:18:23","slug":"persuading-anti-vaxxers-stop-talking-about-facts","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/07\/07\/persuading-anti-vaxxers-stop-talking-about-facts\/","title":{"rendered":"Persuading anti-vaxxers: Stop talking about facts"},"content":{"rendered":"<p>By Michelle Bach.<\/p>\n<p>Even before the coronavirus pandemic, the WHO named vaccine hesitancy as one of the <a href=\"https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019\">top ten threats to global health<\/a>. The WHO attributes vaccine hesitancy to <a href=\"https:\/\/www.who.int\/immunization\/research\/forums_and_initiatives\/1_RButler_VH_Threat_Child_Health_gvirf16.pdf?ua=1\">factors<\/a> such as a lack of confidence, complacency, and convenience. In the <a href=\"https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/healthandwellbeing\/bulletins\/coronavirusandvaccinehesitancygreatbritain\/13januaryto7february2021#vaccine-hesitancy-by-personal-characteristics\">UK<\/a>, hesitancy has been associated with certain demographic factors such as race, age, and socioeconomic factors. Race is an important factor in vaccine hesitancy, and is indicative of injustice in access and well-founded mistrust based on historic medical experimentations on people of color. But race, confidence in the vaccine science, complacency and convenience are only part of the story. So often, I\u2019ve seen clinicians and ethicists argue for vaccination based on the facts: The science supports vaccination, we say. We tell patients that rational risk assessment favors vaccination. We believe that if we just adequately inform the public about the safety and benefit, people will do the right thing. But this approach just misses a fundamental truth: For many anti-vaxxers, it\u2019s was never about facts. Instead, among a certain population, vaccine refusal is better understood as a culture of 1) Anti-institutionalism 2) Aspiration and 3) Aesthetics. Heidi Larson, head of the Vaccine Confidence Project, is right when she <a href=\"https:\/\/www.bbc.com\/news\/health-33774181\">says<\/a> \u201c\u2026there\u2019s all this focus on the public understanding the science. I think we\u2019re not focusing enough on scientists understanding the public.\u201d<\/p>\n<p><strong>Anti-institutionalism: <\/strong><\/p>\n<p>It\u2019s intuitive to discuss the science behind vaccines with patients because you and I both know that scientific studies support the safety and efficacy of vaccines. But for a subset of anti-vaxxers, this is an automatically losing strategy because they connect their personal identity with anti-institutionalism. They identify as free thinkers, and part of that identity involves a rejection of \u201cBig Pharma\u201d and the medical institution as a whole. It\u2019s no coincidence that vaccine hesitancy is more prevalent among <a href=\"https:\/\/now.tufts.edu\/news-releases\/survey-despite-similar-levels-vaccine-hesitancy-white-people-more-likely-be-vaccinated\">populists<\/a>. Explore social media for anti-vaxx tags like #HealthFreedom, #truthseekers, #exitthematrix, and #BigPharma and you\u2019ll see anti-vaccination posts that say things like \u201cIndependence and health go hand and hand\u201d and \u201chuman sovereignty\u201d means not listening to scientific and governmental institutions. There\u2019s an emphasis on not being \u201ccompliant\u201d and seeking out one\u2019s own information away from doctors (<a href=\"https:\/\/www.etsy.com\/listing\/1025190919\/but-first-read-the-insert-shirt-crunchy?ga_order=most_relevant&amp;ga_search_type=all&amp;ga_view_type=gallery&amp;ga_search_query=medical+freedom&amp;ref=sr_gallery-1-12&amp;col=1\">t-shirts<\/a> that say \u201cbut first read the insert\u201d are available). Perhaps this is the fallout of decades of magazine articles and television segments titled \u201cWhat Doctors Don\u2019t Want You to Know.\u201d Before we try to convince patients, we need to recognize that for some, their identity is tied up with not being convincible.<\/p>\n<p><strong>Aspiration:<\/strong><\/p>\n<p>The anti-vaxx culture is not about a lack \u2013 a lack of confidence, a lack of information, a lack of motivation to be healthy. In fact, the anti-vaxx culture is full of positive values. It is better to understand anti-vaxx culture as <a href=\"https:\/\/podcasts.apple.com\/lt\/podcast\/the-wellness-to-qanon-pipeline\/id1535408667?i=1000521333353\">aspirational<\/a>. Many anti-vaxxers are seeking a particular vision of health empowerment. They want to see health as within their own control and knowable through their own intuitions and common sense. This brand of vaccine hesitancy\/resistance is linked with the home and \u201cnatural\u201d <a href=\"https:\/\/www.self.com\/story\/from-anti-to-pro-vaccine\">birth<\/a> movement, where the belief is that we all are equipped with what we need for our own health and the health of our children. The anti-vaxx hashtag, #BelieveMothers promotes the idea that a mother\u2019s intuition may be enough to achieve ideal health. We see a plethora of Facebook and Instagram posts that claim achieving health is \u201csimpler and easier than you think,\u201d just a matter of \u201cself-love\u201d, and that we all \u201calready have all we need\u201d to achieve health. We might call this a bootstrap vision of health, where hard work, clean eating, exercise, and individual intuition is the key to well-being.<\/p>\n<p><strong>Aesthetic:<\/strong><\/p>\n<p>The most neglected aspect of vaccine hesitancy and resistance is the aesthetic appeal of the movement. Doctors have an uphill battle in persuading people that a sterile vial in a sparse clinic room is the key to freedom and safety. It\u2019s much more aesthetically pleasing to turn to the beige and pastel themed social media posts that claim viruses are natural, illness is natural, and one\u2019s natural immune system (untouched by vaccines) is intrinsically good and even beautiful. The hyper-emphasis on the \u201cnatural\u201d and \u201corganic\u201d (be it food, d\u00e9cor, essential oils, sustainable fabrics, or letting kids get chickenpox) is an aesthetic choice. There\u2019s simply more appeal to the \u201c<a href=\"https:\/\/www.psychologytoday.com\/us\/blog\/culture-shrink\/201809\/the-psychology-anti-vaxxers\">mother-nature quality<\/a>\u201d of holistic approaches compared to the austere, confusing, and even ugly visage of clinical medicine.<\/p>\n<p><strong>Is it permissible to make irrational arguments for vaccination?<\/strong><\/p>\n<p>Liberalism limits one\u2019s freedom to make irrational decisions (consider for instance <a href=\"https:\/\/plato.stanford.edu\/entries\/paternalism\/#HardVsSoftPate\">John Stewart Mill\u2019s bridge example<\/a>) and we generally require healthcare decision makers to prioritize rationality and reasonableness (including parents making vaccine decisions for their children). But of course, as humans, many of our decisions are not rational. So often, we go by our guts and our traditions. Doctors and public health officials should be allowed to recognize and respond to that aspect of the human condition. Clinicians will have to do a lot of work to be able to speak the language of anti-institutionalism, health aspiration, and naturalist aesthetics. But it\u2019s possible. We might even call it a new form of \u201ccultural competency\u201d.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Author<\/strong>: Michelle Bach<\/p>\n<p><strong>Affiliation<\/strong>: Center for Health Care Ethics Saint Louis University<\/p>\n<p><strong>Competing interests<\/strong>: None<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Michelle Bach. Even before the coronavirus pandemic, the WHO named vaccine hesitancy as one of the top ten threats to global health. The WHO attributes vaccine hesitancy to factors such as a lack of confidence, complacency, and convenience. In the UK, hesitancy has been associated with certain demographic factors such as race, age, and [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/07\/07\/persuading-anti-vaxxers-stop-talking-about-facts\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":354,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8070,475,8084],"tags":[304],"class_list":["post-4187","post","type-post","status-publish","format-standard","hentry","category-pandemic","category-politics","category-vaccines","tag-public-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Persuading anti-vaxxers: Stop talking about facts - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2021\/07\/07\/persuading-anti-vaxxers-stop-talking-about-facts\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Persuading anti-vaxxers: Stop talking about facts - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Michelle Bach. Even before the coronavirus pandemic, the WHO named vaccine hesitancy as one of the top ten threats to global health. The WHO attributes vaccine hesitancy to factors such as a lack of confidence, complacency, and convenience. 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