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Understanding Vaccine Refusal

Why We Need Social Media Now
Published:December 02, 2015DOI:https://doi.org/10.1016/j.amepre.2015.10.002
      The recent Disneyland measles outbreak brought national attention to a growing problem: vaccine refusal—herd immunity is no longer a reality in many communities. Only 70% of children aged 19–35 months are up-to-date on immunizations,
      • Bass P.F.
      Vaccine refusal.
      and in some communities, more than a quarter of school-age children have exemptions on file (www.doh.wa.gov/Portals/1/Documents/Pubs/348-247-SY2014-15-ImmunizationMaps.pdf). Although they vary across the ideological spectrum, vaccine refusers tend to be well educated, white, and more affluent than people who typically experience health disparities.
      • Bass P.F.
      Vaccine refusal.
      Prior studies
      • Zhao Z.
      • Luman E.
      Progress toward eliminating disparities in vaccination coverage among U.S. children, 2000–2008.
      • Luthy K.E.
      • Beckstrand R.L.
      • Callister L.C.
      • Cahoon S.
      Reasons parents exempt children from receiving immunizations.
      have found that a diversity of motivations drive vaccine refusal, including fear that vaccines cause autism, concerns over toxins, beliefs about the benefits of measles to the immune system, distrust of government, distrust of pharmaceutical companies, and preference for a “natural” lifestyle. Arguments recommended by physicians’ groups and public health agencies to counter these beliefs do not always change minds
      • Nyhan B.
      • Reifler J.
      • Richey S.
      • Freed G.L.
      Effective messages in vaccine promotion: a randomized trial.
      ; even parents who indicate high trust in their pediatricians may not follow doctors’ recommendations.
      • Bass P.F.
      Vaccine refusal.
      Ultimately, people “persuade themselves to change attitudes and behavior,”
      • Perloff R.M.
      The Dynamics of Persuasion: Communication and Attitudes in the Twenty-First Century.
      and communicators must tailor messages to the beliefs, attitudes, and motivations of particular audience segments.
      • Kotler P.
      • Roberto E.L.
      Social Marketing. Strategies for Changing Public Behavior.
      Effective health communication about vaccines requires answering three questions:
      • 1
        How do individuals’ vaccination adherence
        • Downs J.S.
        • de Bruin W.B.
        • Fischhoff B.
        Parents’ vaccination comprehension and decisions.
        and vaccine refusal patterns vary with their beliefs? We cannot assume that rationales for religious exemptions to vaccination are rooted in the same beliefs as those driving advocates of “natural cures.”
      • 2
        How do beliefs vary by community or social group? We cannot assume that a liberal Democrat in Los Angeles refuses vaccinations for the same reasons that a staunch Texas conservative might.
      • 3
        Which persuasive strategies used by vaccination advocates and vaccine refusers are most effective? We cannot assume that the same types of arguments will be compelling to members of different groups.
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