Bridging the Anti-Vax Gap — Helping Parents Navigate Anti-Vax Social Media and Online Information

By Lindsey Getz

The anti-vaccination movement has been called one of the greatest health crises of our time. Others have called it a regression in modern medicine. However, it’s a crisis that doesn’t appear to be going away. In fact, there are reasons to believe that it may be growing. The number of pediatricians reporting vaccine refusal has increased significantly; the most common reason cited is the belief that vaccines are unnecessary. With social media providing an easy channel to spread these messages, it can be difficult to get a grasp on the information that is influencing consumers. This underlines the importance of better understanding what’s fueling these beliefs.

A viral Facebook campaign against a Pittsburgh pediatric practice recently created the ideal opportunity for researchers to study the anti-vaccination movement and hopefully come to a better understanding of what’s behind it. In 2017, Kids Plus Pediatrics posted a video on its Facebook page that featured practitioners encouraging human papillomavirus, or HPV, vaccinations to prevent cancer. Nearly a month after the video posted, it caught the attention of multiple anti-vaccination groups. In an eight-day period, it garnered thousands of anti-vaccination comments.

This was discouraging to the practice, says Todd Wolynn, MD, CEO of Kids Plus Pediatrics. But it also created an opportunity to understand what was driving these beliefs. The research, led by Beth Hoffman, BSc, involved partnering a team of scientists at the Center for Research on Media, Technology, and Health with Kids Plus Pediatrics to perform a systematic analysis to better understand the people behind the comments and how they cluster in the digitally connected world of social media.

Hoffman’s team analyzed the profiles of a randomly selected sample of 197 commenters and determined that, although Kids Plus is an independent practice caring for patients in the Pittsburgh region, the commenters in the sample were spread across 36 states and eight countries.

The sentiment behind the comments was also telling. Though it has been a long-held belief that concern about autism has been a primary driver in the fear of vaccinations, the research from the University of Pittsburgh Center for Research on Media, Technology, and Health actually found that the anti-vaccination arguments center on four distinct themes that can appeal to diverse audiences. By delving into the messages that each commenter had publicly posted, the team found the messages clustered into the following subgroups.

Trust: This group was suspicious of the scientific community and had concerns about personal liberty.

Alternatives: This group was focused on chemicals in vaccines and the use of homeopathic medicines instead of vaccinations.

Safety: This group was focused on the perceived risks and had concerns about vaccination being immoral.

Conspiracy: This group suggested that the government and other entities hide information that this group believes to be facts—including that the polio virus does not exist.

Addressing Concerns
“The presence of these distinct subgroups cautions against a blanket approach to public health messages that encourage vaccination,” Hoffman says. “For example, telling someone in the ‘trust’ subgroup that vaccines do not cause autism may alienate them because that isn’t their concern to begin with. Instead, it may be more effective to find common ground and deliver tailored messages related to trust and the perception mandatory vaccination threatens their ability to make decisions for their child.”

Hoffman says that social workers—who are naturally perceptive to peoples’ feelings—can be instrumental in working with parents and families who are fearful of vaccines.

“For instance, if a social worker identifies that a parent falls into the alternatives subgroup, meaning his or her primary concerns about vaccines are related to chemicals or a belief that homeopathic remedies are superior to vaccination, the social worker can then tailor the message and language around vaccines to these concerns,” Hoffman explains. “In this case, it may be effective to reflect back that we all have concerns about chemical exposure, but rather than being unnatural, vaccines are actually a way to boost the body’s natural immune system.”

Wolynn, who was also a coauthor of the research paper, adds that the first rule of communication is to always “know your audience,” and this research confirms the importance of that point.

“It’s important to understand that in the U.S., about 75% of the population is very vaccine accepting,” he says. “When vaccines are offered according to the [Centers for Disease Control and Prevention’s] guidelines by a family’s primary care provider, three-quarters of parents will accept. There is another one to two percent of parents who have been categorized as ‘anti-vaccine,’ because they have come to the misinformed and potentially dangerous conclusion that vaccines are harmful and/or evil. Research shows these parents hold a host of strong, extreme, unfounded reasons for why they refuse vaccines. People in this category often simply refuse to accept decades of science and evidence-based medicine that support the safety and benefits of vaccines.”

However, Wolynn says that in knowing one’s audience, it’s important to recognize that the remaining (roughly) 23% of parents out there fall into the “vaccine hesitant” category. They describe themselves as having questions and concerns. Wolynn says that trepidation about what’s best for one’s child is perfectly natural and understandable. He adds that these are most easily addressed when the following two key factors exist:

1. The questions stem from a parent’s sincere desire for evidence-based, scientific answers.

2. The parent trusts that the health care provider is competent, knowledgeable, intends to follow “best practices” to protect patient health, and—like the parents or caregivers—wants to always act in the best interests of the child.

“While the line between extremely hesitant and lightly anti-vaccine is worth deeper exploration, there is general consensus that with resources—namely face-to-face time—being limited, the most effective strategy is to focus efforts on engaging families falling in the ‘hesitant’ category,” Wolynn says. “This doesn’t mean that everyone can benefit from being engaged, but resources are not limitless, and those parents and caregivers offer the best chance of success.”

Reaching Common Ground
While it can be difficult for those in the “vaccine accepting” category to look across the gap and be understanding of those with opposing viewpoints, the researchers of this study express that there is a missed opportunity if those who are pro-vaccination don’t try to find common ground. Simply dismissing opposing beliefs—even if unfounded—is not going to help bridge the gap.

But social workers are incredibly skilled when it comes to working with those who have unpopular or opposing viewpoints—and they often serve as excellent mediators. This puts them in a unique position to possibly help move things in a positive direction.

Given that the client’s right to self-determination is a social work value, some social workers may be feel they are in a precarious position. They want to support their clients’ decisions, but anti-vaccination choices are also a public health concern. Approaching it from a place of understanding can help.

“I think it is helpful to first recognize that most people are simply trying their best to make good decisions for the health of their family, which is hard when we are inundated with information 24/7,” Hoffman says. “Discussing this common goal of keeping one's family safe is a great way to start building common ground. Once the social worker has identified more specific concerns, it may be helpful to reflect on these in a way that helps the person feel heard and understood. For example, emphasizing that we all have concerns about our family’s safety or chemical exposure. This common ground then builds a foundation upon which to deliver a tailored message about vaccination in the context of working together to raise a healthy child.”

Hoffman adds that both medical professionals and social workers can ask patients/parents in a nonjudgmental way what they’ve seen online and on social media related to medical topics. That often opens up an opportunity to discuss vaccination viewpoints.

“Related to that, teaching people how to navigate online information and how to identify credible sources of information can also be vital tools,” Hoffman continues. “These are skills that are important for kids and teens to learn, too, and could be done with the whole family.”

Wolynn agrees that navigating information in this day and age can be challenging.

“In 2019 and beyond, we’ve become firmly immersed in not just the ‘Information Age,’ but also the ‘Disinformation Age,’” he says. “There is almost no escape from fake news, frightening opinions, urban myths, viral hoaxes, and sensational conspiracy theories—all of which masquerade as gospel truth.”

Wolynn suggests that social workers should prepare themselves for questions and concerns that vaccine-hesitant parents might have. As trusted advocates, well-educated social workers may be in a position to sway clients in the vaccination debate.

“As a science-based health care advocate, you will likely already be in the ‘Vaccine Accepting’ category,” Wolynn says to social workers. “But since you will be engaging people in discussions regarding their health and the health of children, it makes sense to increase your understanding of vaccines and, more importantly, the myths. The resources available on the summary sheet from the Immunization Action Coalition (www.immunize.org/catg.d/p2070.pdf) has great information. Much of the information listed is set to answer vaccine questions from parents.”

— Lindsey Getz is a Royersford, PA–based freelance writer.