Vaccine advocacy 101

I recently finished a 2-year stint as an American Society for Microbiology Distinguished Lecturer. It's an excellent program--ASM pays all travel expenses for lecturers, who speak at ASM Branch meetings throughout the country. I was able to attend Branch meetings from California and Washington in the West, to Massachusetts in the east, and south as far as El Paso, Texas, with many in-between. Each Lecturer selects several topics to speak on, and the Branch chooses from those which they want to hear. Mine included basic research (zoonotic disease, antibiotic resistance) as well as science outreach and advocacy topics (zombies, vaccines).

My talk on vaccines covered vaccine hesitancy and denial, the concerns some parents have regarding vaccination, and the way social media and celebrities contributed to the spread of vaccine misinformation. Inevitably, someone would ask in the Q&A or speak to me afterward inquiring, "But what can I do? I don't feel I know enough about why people reject vaccines, and feel helpless to combat the fears and misinformation that is out there." These were audiences of microbiologists and other types of infectious disease specialists--people who are very likely to be educated about vaccines and vaccine-preventable diseases, but who may not have followed the saga of disgraced former physician Andrew Wakefield, or aren't familiar with the claims of the current anti-vaccine documentary, Vaxxed, or other common anti-vaccine talking points.

To help fill this gap, I recently published a paper in Open Forum Infectious Diseases," Vaccine Rejection and Hesitancy: a Review and Call to Action." As the title suggests, in it I give a brief overview of some of the figures in the anti-vax movement and the arguments they commonly use. I don't go into rebuttals directly within the paper, but the supplemental information includes a subset of both anti-vax literature as well as several published rebuttals to them that interested individuals can look up.

I also briefly review the literature on vaccine hesitancy. Who fears or rejects vaccines, why do they do so, and how might we reach them to change their minds? This is really an area where many individuals, even if they're educated about vaccines and infectious disease, lack a lot of background. As I note in the paper, many science-minded people still think that it's enough to just educate people about vaccines properly, and that will be enough. While accurate information is indeed important, for many individuals on the vaccine-hesitant spectrum, it's not only about misinformation, but also about group identity, previous experience with the health care field, and much more.

Still, vaccine advocates can get involved in a number of way. One of the easiest is simply to discuss your own vaccine history in order to normalize it. I regularly post pictures of my own vaccinations on social media (including my public Facebook and Twitter accounts), and those of my kids*. In over 17 years of parenthood, their vaccinations have all been...boring. These "uneventful vaccination" stories are the ones which rarely get told, as the media focuses on "vaccine injury" stories, in which the injuries may or may not actually be caused by vaccines. Those interested in promoting vaccines can write letters to the editor, get involved with local physicians to speak with hesitant families, break out and be political about vaccine exemptions; there are a number of ways that we can work to encourage vaccination and keep our children and our communities healthy (again, explored in more detail in the manuscript).

Figure 1: Examples of photos posted to the author’s social media accounts. Panel A: The author (middle) and her older children after receipt of seasonal influenza vaccines. Panel B: The author’s youngest child at Walt Disney World, wearing a shirt saying “Fully Vaccinated. You’re Welcome.” Both techniques can serve as conversation-starters around vaccination.


I hope this paper will serve as a starting point for those who want to be a vaccine advocate, but just aren't sure they know enough background, or know where or how to jump in. Whether you're an expert in the area or not, everyone can do small things to encourage vaccines and demonstrate your trust in them. Those of us working in the area thank you in advance for your help.


Smith TCVaccine Rejection and Hesitancy: a Review and Call to Action. Open Forum Infectious Diseases, 2017, in press.


*AKA, how to get your kids' pictures into a scientific paper.

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It is very reasonable for a parent to worry about vaccines. For one thing, most of them involve sticking the baby or child with a sharp object, thus making the little one cry, and it would be abnormal to not have an automatic reaction to that. For another thing, they are drugs, in a sense. When…
It is very reasonable for a parent to worry about vaccines. For one thing, most of them involve sticking the baby or child with a sharp object, thus making the little one cry, and it would be abnormal to not have an automatic reaction to that. For another thing, they are drugs, in a sense. When…
One of the reasons I'm so passionate about pushing back against antivaccine pseudoscience is because I view it as an extreme threat to public health, particularly the health of children. I'm a history buff. I study history. I know what child mortality was like before vaccines. I'm also a scientist…
I've discussed several times over the last several years my impression that the media have become in general less tolerant of antivaccine views. At least, the media seem less willing to indulge in "tell both sides" false equivalence. Back when I started blogging, I routinely used to bemoan how…

People with PhDs in science fell for the MMR scare.

If people choose to embrace FUD - as is the current fashion - you will never change their minds about those topics.

What you need to do is go deeper. You need help from psychology - how do you make it uncool to fall for silly scare stories? How do you make it fashionable to openly rise up above tabloid conspiracy theories?

Frankly, my observation so far is that the world is full of people who have no sense of perspective and hence have no ability to make accurate intuitive risk assessments.

By Craig Thomas (not verified) on 27 Jul 2017 #permalink

Thanks. Very nice. You really polished the sentences too.

Finally, while there may be no single leader of an anti-vaccine “movement,” many of those listed in Table 2 are highly media-savvy and unafraid to push their opinions that vaccines
are dangerous, full stop.

Some of those listed in Table 2 hold medical licenses that ought to be yanked by their state medical boards and some of them belong to the American Academy of Pediatrics which ought to show some spine and expel anti-vaccine pediatricians. Such strong actions would send a clear message to the public that quacks like Sears, Mercola, Tenpenny, etc are so far off course that they are not competent to practice medicine.

By Chris Hickie (not verified) on 29 Jul 2017 #permalink

Thanks! You don't have a link to the full paper do you?

Vaccine advocacy is fine and good, and it is essential for free exchange of information. However, everything has a compromise, and as a scientist, I know that it is too easy to turn science into a conviction. The problem I see from both sides of the vaccine argument is the lack of understanding of the compromises. Pro-vaciine folks insist there is absolutely no harm in vaccines, and anti-vaccine folks insist every vaccine is pure poison. The truth is somewhere in the middle.

By Andrew Sarangan (not verified) on 30 Jul 2017 #permalink

Apologies for the delay--the system thought I was a spammer and wouldn't let me log in.

Craig, absolutely--did you read the paper? It gives an introduction to some of those issues and describes a few of the research papers in that area. Unfortunately there's no good answer on how exactly to do that, and likely no universal approach that will work for everyone.

Chris, agree. Sears at one time was under investigation, but I don't know of the outcome to that.

dingo, it's at the link in the reference--go to "pdf" and the accepted proof of the paper is fully available. (Unfortunately the fancy edited version isn't ready yet).

Andrew, I agree, but in all the time I've done this I've very rarely seen anyone say "there is absolutely no harm in vaccines," though I see this frequently as an anti-vaccine talking point. I speak frequently about the risks versus benefits, and note that many "vaccine injury" stories are completely unproven. That doesn't mean that vaccines never can or do harm, but that many of the various conditions that some attribute to vaccines (SIDS, autism, and more) are just not causally related. Even seizure disorders that used to be linked to the prior DTP vaccine have been shown to be instead due to genetic issues such as Dravet syndrome. I think we need to be honest, but part of that honesty is noting that any serious poor outcome from vaccination is truly exceedingly rare.

I have a vaccine injury story that I like to use, to open the discussion.

Once upon a time, I got my flu shot and the next day I was sick as a dog. It was horrible, and my whole body was shrieking "don't ever get that nasty shot again!!!"

Fortunately I know enough about vaccines and possible reactions and food poisoning and a similar illness going around friends and family on that day to recognize that it was all a big silly coincidence.

And yet my body kept yelling about that shot.

So there are many directions a group can go from here: trust and lack of trust in the medical system, personal history including failures and disappointments, and the whole subject of risk analysis - which is often counter-intuitive, and often neglected or poorly taught, but overall is a powerful tool for quantifying dangers and promoting wise decisions.

By Robert L Bell (not verified) on 06 Aug 2017 #permalink

One thing that wasn't mentioned in your post that I think is highly relevant, is the fear that people have based on the fact that the mandatory vaccine manufacturers are exempt from liability. Would you buy a Ford automobile if Ford was exempt from any liability? I certainly wouldn't.

If that wasn't the case then people wouldn't feel like there was no recourse should something go wrong. Since vaccines are so safe and effective, this liability policy does more harm than good at this point. There's no need to shield vaccine manufacturers from liability, and it just serves to call vaccine safety into question, so why not just get rid of it?

By Rochalimæa (not verified) on 08 Aug 2017 #permalink

Completely disagree that we can remove the liability part. Vaccine manufacturers don't make much money off of vaccines relative to other products, and one scare is enough to tank them. Liability is difficult to prove and can be falsely attributed to vaccines (look at GBS and swine flu, or seizures and DPT, both initially attributed to vaccines and only later shown to be falsely associated after much time had passed and many studies conducted).

I don't know, seems like a no-brainer to me. Lack of liability is used as a canard to fuel conspiracy theories, and not surprisingly, it tends to work in a "follow the money" kind of way. Parents are told that not only are manufacturers not liable for the rare vaccine injury, they aren't liable even for outright negligence. This provides easy fodder for conspiracy theorists. There's no other product that has a similar exemption so it can arouse suspicion in even the most trusting parent.

Given that vaccines nowadays are so safe and effective, manufacturers no longer need exemptions since vaccine injury is so vanishingly rare. No sane personal injury attorney is going to take a vaccine injury case, so manufacturers have little to fear legally, and thus don't need the exemption. Indeed, its doing more harm than good as far as vaccine hysteria is concerned.

Not only would doing that ease fears and derail the conspiracy theorists, it would lower the cost of vaccines since there'd be no need for a separate vaccine injury court. Seems like a win-win to me if reducing anti-vaccine hysteria is the goal.

By Rochalimæa (not verified) on 08 Aug 2017 #permalink

Again, disagree. The cost would increase dramatically. Right now it's just a few cents per vaccine to fund the "vaccine court" and its payments, but if you put that back on the vaccine companies (and eliminate the rules & protections of the court) that means potential settlements of millions right from the companies. Again, making it likely they may stop manufacture altogether. Perhaps instead remind skeptical individuals that it was one of their own, Barbara Loe Fisher of the NVIC, who led the charge for the court's creation.

"This provides easy fodder for conspiracy theorists. "

Conspiracy theorists can twist anything and use it as fodder for their misinformation. Eliminating the court would do nothing to make it harder for them but would, as Tara points out, up the risk for manufacturers by a great amount. It's a complete lose-lose.

" up the risk for manufacturers by a great amount. It’s a complete lose-lose."

What risk? Vaccines do no harm and save lives, its been proven over and over and over again. Are you claiming that manufacturers need protection from lawsuits due to vaccine adverse reactions? That's insane.

No lawyer would ever waste their time/money to try and sue a vaccine manufacturer. In fact, even if one tried it would be thrown out by summary judgement. So I'm really not sure what risk you are referring to.

Conspiracy theory gets traction when there are concrete examples to point to, and the vaccine court is one that is always pointed at to show how vaccines cause damage, requiring a special court. Since vaccines are the one and only product with a special court, it just screams "conspiracy" to the weak-minded.

Since manufacturers don't need protection from liability these days since vaccines are so safe, it seems they are only shooting themselves in the foot by keeping it.

Its like trying to make the claim your house is fireproof, yet you have fire extinguishers placed in every room. It doesn't instill confidence in your claim, and any conspiracy theorist is going to make hay out of that. Get rid of the vaccine court and conspiracy theorists wouldn't have a leg to stand on, and parents would feel less hesitancy about getting their kids vaccinated knowing that if something happened they have recourse. Of course, nothing will happen, but its the reassurance parents need to keep getting their kids vaccinated.

I think it would go a long way in reducing hesitancy. I'm far more concerned about that than manufacturers profits, lawsuits or anything else. Manufacturers can take care of themselves there. What we need help with is with parents hesitancy, and having special courts isn't helping in that regard. When I talk to parents its often something that is brought up, and it makes even the average parent very suspicious. I am sick of trying to answer the question "Why are manufacturers exempt from all liability for their products if they are so safe?"

By Rochalimæa (not verified) on 09 Aug 2017 #permalink

I've already explained how, even though vaccines are quite safe, it can be very difficult to prove a negative (that a vaccine *didn't* cause an injury), and how we've seen false-positives proven wrong but only years or decades later. Not sure why this is so difficult to grasp. And yes, lawyers absolutely would sue. That was the whole issue that jump-started Wakefield's MMR work.

"Are you claiming that manufacturers need protection from lawsuits due to vaccine adverse reactions?"

No, I am not.

"No lawyer would ever waste their time/money to try and sue a vaccine manufacturer."

Well yes, they most certainly would. Despite what your comment implies, not every lawsuit filed now is based on reasonable things.

"Get rid of the vaccine court and conspiracy theorists wouldn’t have a leg to stand on"

There is not a hint of fact to support that assertion. Look at how long conspiracies about JFK's assassination or September 11 have gone on, and the numbers grown, in spite of the fact that in neither of those cases is there any reason to support them.