A dose of truth for misguided audiences.
The list of subjects you don’t bring up in polite conversation is growing. The adage about not discussing religion or politics is now insufficient. We can add vaccines to the list of taboo topics. It’s too difficult to predict where someone stands. And it can be terribly divisive to find out.
It shouldn’t be this way.
So many diseases can be avoided or minimized by vaccines, and seeing those who refuse them face avoidable consequences can be demoralizing. One particularly painful example is cervical cancer. A vaccine has been approved since 2006; there are two types of screenings, and it’s highly treatable if detected early. Yet 11,500 cases are diagnosed, and 4,000 women die from the disease each year. It offers a powerful case study in behavioral science and the danger of avoiding truths, one that can be applied to a host of issues begging for changes in social norms.
I recently had the pleasure of interviewing Tamika Felder, founder and executive director of Cervivor, a global community that works to raise awareness, lessen stigma and end cervical cancer. Tamika founded her nonprofit after being diagnosed and thinking: “I can’t be the only one with this disease, so why is no one talking about it?”
When I asked her which was the bigger battle, fighting vaccine hesitancy or increasing screening tests, she immediately chose vaccines. I now see why. Increasing uptake has proven difficult — only 58 percent of adolescents have received the vaccine. And among minority females, the uptake is a mere 38 percent.
Let’s look at why and what we can do to change things.
Why it’s so difficult.
It’s complicated. And complex scenarios are the enemy of prevention. Here’s the simplest explanation I can offer:
Cervical cancer is caused by the Human Papillomavirus (HPV).
HPV is the most common sexually transmitted infection, and most cases go away on their own.
Most men who get HPV never have symptoms, and there is no screening test for men.
If HPV stays in the body for a long time, it can cause cancer.
The CDC suggests vaccination at age 11 or 12, before a person is sexually active.
The vaccine is approved for males and females from ages 9 to 45, and is given in two or three doses, depending on age.
It’s emotional. Parents are the primary decision makers, and the decision involves thinking about their children and sex. Hardly a pairing any parent of a preteen is eager to contemplate. This results in emotional, System 1 thinking. And System 1 rejects any unresolved question or doubt. Is my child sexually active? Is the vaccine safe? How necessary is it? Can it wait until next year? All reasons to procrastinate.
There’s misinformation. We’ve all seen how social media offers a megaphone to idealogues, and the HPV vaccine is no exception. A study of Tweets using #HPV showed 24% contained misinformation (inaccuracies) or disinformation (intentionally misleading content). Examples include inefficacy, adverse health effects and even death. The same study revealed that Tweets containing misinformation or disinformation were five times as likely to be retweeted than posts supporting the vaccine.
What behavioral science is involved?
Optimism bias. “It won’t happen to my child.”
Self-stigma. “I’d rather avoid the issue than consider my child having an STI.”
Confirmation bias. “I’ve done my own research and selected ‘facts’ that reinforce my beliefs or desired outcome.”
Three approaches to counter hesitancy.
Since social small talk is a nonstarter, what can we do?
Social norms are the most powerful tool we have against inaction. We’re wired to be influenced by the behaviors of those around us. Behavioral scientists refer to this heuristic as conformity bias.
The HPV vaccine should be presented as routine, part of the CDC’s child and adolescent immunization schedule and a standard practice. This same approach can apply to other public health initiatives. One is contraceptive access, where we’ve seen an uptick in scheduled appointments following the promotion of a series of interviews that helped normalize contraceptive counseling.Demonstrated prevalence is my weapon of choice against stigma. Showing that a condition is commonplace emphasizes the need for prevention and screening.
Communicating that HPV is the most common STI in both men and women worldwide encourages vaccine uptake among consumers and arms pediatricians with further evidence of necessity. I’ve seen this approach make inroads on many sensitive issues, among them child sexual abuse. One in four girls and one in thirteen boys are sexually abused. While disturbing, we’ve seen greater awareness not only encourage victims and survivors to seek help, but also increase reporting of suspected abuse.Loss aversion is another go-to for public health communications. We value something more when we face the prospect of losing it.
HPV vaccines can leverage this cognitive bias by showing what’s at risk without protection from cervical cancer. Parents envision their children’s milestones. Positioning them as vulnerable without a vaccine can be a powerful motivator. I’ve seen this tactic effectively used in anti-drug messaging. But be careful, it’s a pro move. Unmoderated or overly dramatic depictions of loss can reinforce optimism bias.
As you consider the above approaches, let me acknowledge that we’ve all encountered our own versions of anti-vax zealots, and I realize that zealots of any stripe are not a group that can be swayed by reason or debate. But trust me: for every person that won’t budge an inch, many more just lack the information and awareness required for a wiser decision. These are the people worth engaging – at the right time and in the right way.
Have faith and press on,
Kevin
