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COMMENTARY |
Department of Pediatrics and Adolescent Medicine, Kaiser Permanente, Walnut Creek, California
Abbreviations: CDC, Centers for Disease Control and Prevention
Over the past decade, the reputation of childhood vaccines has been severely damaged. The latest blow came during a recent episode of the Oprah Winfrey Show,1 on which 2 celebrity mothers presented emotional stories about their autistic children and implicated the measles-mumps-rubella vaccine in the cause of their illness. Their stories were told despite ample research that has long since debunked the original article by Wakefield et al2 from 1998 (which linked the vaccine and autism) and the fact that their original article was retracted by the journal (Lancet) that published it.
Nevertheless, attending a lecture at the American Academy of Pediatrics' most recent national conference and exhibition at which the subject of vaccines came up, pediatricians from around the country shared story after story of parents who have refused shots on the basis of what they had seen on Oprah and elsewhere in the media.
I recall at least 2 parents in my practice who expressed concern and suspicion about vaccines, not just because of these mothers' testimonials but also because of the response to it by the Centers for Disease Control and Prevention (CDC). Ms Winfrey read the CDC's statement on air:
"CDC places a high priority on vaccine safety and the integrity and credibility of its vaccine safety research. This commitment not only stems from our scientific and medical dedication, it is also personal—for most of us who work at CDC are also parents and grandparents. And as such, we too, have high levels of personal interest and concern in the health and safety of children, families and communities. We simply don't know what causes most cases of autism, but we're doing everything we can to find out. The vast majority of science to date does not support an association between thimerosal in vaccines and autism. But we are currently conducting additional studies to further determine what role, if any, thimerosal in vaccines may play in the development of autism. It is important to remember, vaccines protect and save lives. Vaccines protect infants, children and adults from the unnecessary harm and premature death caused by vaccine-preventable diseases."
At issue with those parents was the ambiguity of wording such as "what role, if any, thimerosal in vaccines may play" and "we are currently conducting additional studies." To many parents, these assertions seemed to imply that vaccines are not safe after all, despite the fact that virtually all peer-reviewed studies and an Institute of Medicine review3 have stated otherwise.
The CDC's statement gives us a great example as to why we are struggling in the public-relations war over vaccines.
When the controversy arises, vaccine defenders typically do 1 of 2 things, neither of which are effective. The first defense is to issue a statement like the CDC did. Such a statement is usually reasonable, clear, and somewhat sympathetic to parents of autistic children. It is also bureaucratic and filled with cautious language that gives it a measured tone. It therefore arouses suspicion and uncertainty among readers.
The second tactic is to simply ignore or dismiss any assertion that vaccines are unsafe in an attempt to stay above the fray. Such silence, however, can easily be interpreted as concealing a truth.
We need a better approach. To get it, we can look at politics. Cognitive psychologist Drew Westin's book, The Political Brain,4 showed the way.
In his book, Westin showed how Republicans have been able to dominate politics over the Democrats. Although Westin himself is a consultant for Democrats, his observations are valuable for any public-relations campaign. Time and time again, he argued, Republicans won elections not because they showed voters they were smarter or better qualified for office. Rather, it was because they crafted a message by using stories and language that emotionally resonated with the electorate. He cited Ronald Reagan, in particular, as being a master narrator who used anecdotes, quips, and resonant campaign ads like "Morning in America," which ran during the 1984 election campaign. Westin also showed us how Republicans have shrewdly crafted phrases such as "death tax" and "climate change" to gain popular support against the estate tax and environmentalists on the issue of global warming (in fact, Al Gore's movie, An Inconvenient Truth, was lauded for its ability to recapture the emotional high ground by replacing "climate change" with "climate crisis").
On the other hand, only 3 Democrats have been elected to the White House since Kennedy's victory in 1960. As Westin showed, this is because they have relied too much on logic and evidence in their efforts to persuade voters. Although "a dispassionate mind...makes decisions by weighing the evidence and reasoning to the most valid conclusions [this] bears no relation to how the mind and brain actually work." He cited case after case in which both Al Gore and John Kerry made clear, intelligent arguments when they staked out positions on issues. By the election results, however, we know that voters did not take those arguments into voting booths with them. In Kerry's case, Westin showed how his silence in response to a group called the Swift Boat Veterans for Truth, which aired ads attacking Kerry's war record, was irreparably damaging to his reputation as a war hero and strong leader.
We can learn from Westin if we parallel politics to pediatrics. Antivaccine groups are well organized and passionate. They have used popular settings such as Oprah and Larry King Live (on which the same 2 mothers have also appeared) to make strong emotional appeals and get parents to think twice about having their children vaccinated. They have shared the heartbreak when they learned that their children were autistic and tied vaccines right to it. People, logical or not, do not forget this kind of emotional prowess. On the other hand, our medical and scientific experts counter with accurate evidence and citations of studies, which do not resonate with many parents. Thus, we have had a failure to persuade.
We need our academy, along with other groups such as the American Academy of Family Physicians and, yes, the CDC, to be more potent when arguing as to why vaccines are safe, effective, and necessary. They can do this by getting behind a clear and assertive campaign. If opponents to vaccines put a celebrity on Oprah, then we need to take out a full page ad in national newspapers to show parents what a child with tetanus looks like, or air an ad with a parent telling the story of how their child died from Haemophilus influenzae meningitis. Images and stories like that bear much more emotional weight than graphs that show the decline in tetanus or H influenzae meningitis since vaccines for both of these diseases became available. We also need to craft effective language when we address antivaccine groups' accusations against the medical community. In short, we need to defend our beliefs and ourselves more strongly.
Such a stand is not without its risks. Some will criticize us for using fear and anxiety to manipulate public opinion. Such "negative messages" are okay if they are done ethically and tell a truth, that truth being that vaccines save lives. Others may suggest that we urge proxy organizations to spread the word instead of putting our own reputations at stake. However, those people should realize that we physicians still hold the kind of stature that can endorse and affect change. Thus, we should thrust this responsibility on ourselves.
A shift to making a visceral argument like this is not in the DNA of most physicians or scientists. We have been taught, rightfully so, to examine and understand the evidence and use it to decide. But as Westin and our own experience tell us, dispassionate messages are not sticky. Gut-wrenching stories, such as that shared by these 2 mothers on Oprah, are. It is time we change.
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FOOTNOTES |
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Address correspondence to Rahul K. Parikh, MD, Kaiser Permanente, Department of Pediatrics and Adolescent Medicine, 1425 S Main St, Walnut Creek, CA 94596. E-mail: rahul.k.parikh{at}kp.org
Opinions expressed in these commentaries are those of the author and not necessarily those of the American Academy of Pediatrics or its Committees.
The author has indicated he has no financial relationships relevant to this article to disclose.
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 TOP REFERENCES |
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This article has been cited by other articles:
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  A. R. Hinman and L. H. Randall Fighting for the Reputation of Vaccines Pediatrics, July 1, 2008; 122(1): 224 - 225. [Full Text] [PDF]
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