What we get wrong about vaccine hesitancy

An immunologist who's been on both sides of vaccine hesitancy talks about what drives it, what gets missed, and how to build trust.

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  Hey, it's Flora and you're listening to Science Friday. Earlier this week, President Trump signed an executive order calling for a change to the childhood vaccination schedule. Specifically, he wants to separate the MMR vaccine, which protects against measles, mumps, and rubella, into three separate shots. There's no scientific research pointing to any benefit to these changes, and the order has sparked backlash from medical associations and drug manufacturers who make the vaccines. Meanwhile, this year, over 2,400 people have come down with measles in the US. That's more cases than we've seen in decades. With vaccine hesitancy and vaccine misinformation on the rise, I wanted to bring on someone

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  with a unique perspective, Dr. Elizabeth Marnik. She wasn't vaccinated as a kid because her parents were concerned that vaccines could do harm. She grew up, she fell in love with science, she got vaccinated, and then went on to earn a PhD in immunology. And now she's the executive director of The Evidence Collective, a science communication organization which works on ways to deploy accurate health and science information to people online and beyond. Liz, thanks for being here.

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  Thank you so much for having me.

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  Liz, we just heard the tiniest thumbnail sketch version of your story, which I'm sure could be its own whole conversation or probably book. But how have your feelings around vaccine hesitancy changed over time, given your experience?

• 1:49Speaker 02

  Yeah, so growing up, it was just something that I never second guessed at all. I was raised to believe that vaccines were dangerous, and it wasn't something I questioned until I started, you know, going to college and I fell in love with science. And in the process, I started learning, one, that scientists were amazing humans, which is not the narrative that I was told, but also I started to realize why we have vaccines in the first place, because of how well they work to prevent these vaccine preventable illnesses. So eventually, I decided to go get myself vaccinated before I went to start my PhD program. And for a long time, I was really angry at my mom for her decision.

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  But over time, when I've become a parent myself, I now have a lot of compassion for how hard it is to make decisions about what you do for your kids, particularly in today's information environment, where it's really hard to know what information is and is not accurate.

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  You said that you realized that scientists were awesome people, but that wasn't the narrative you were told. What was the narrative you heard growing up?

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  I was told that we couldn't trust scientists, that we couldn't trust the information that they were providing because they didn't have the same moral compass that I was raised to have. I was raised a very conservative evangelical Christian, so anyone that kind of contradicted the literal seven-day creationist view that I had were seen kind of as these people who were trying to corrupt us. So that was the narrative I went into college with. But then I actually started to meet real-life scientists. They were my professors, they became my friends, and I started to see that they were just moms and dads and sons and daughters and these amazing humans that didn't fit that narrative that I had been told.

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  How did you find your way to immunology? Was it related to your experience as a kid?

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  So I was in college, and I had the immense privilege of being able to join an undergraduate research lab. And I fell in love with learning about all these intricate aspects of the immune system. So when I decided to go get my PhD, I knew that I likely wanted it to involve immunology in some way. But I ultimately rotated through a bunch of different labs and tried a few different ones out to see which one I liked the best, and then I ultimately did join an immunology lab.

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  So Liz, from your personal experience, what do you think pro-vax people misunderstand about vaccine hesitancy?

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  I think there's a few things. One is I think we tend to paint everyone with the same brush. So we have this one narrative that everyone who doesn't vaccinate their kids or has questions about vaccine is anti-vaccine, when in reality, most people are on a spectrum. One is, if we look at the data, the majority of people in the United States still support vaccination. We do see increasing rates of hesitancy, but the reasons driving those hesitancies are going to be different in every case, and not everyone is going to have the same reasons behind that ultimate decision.

• 4:53Speaker 01

  I mean, do you think of this as like an information war that must be won? Is that the framework that you have for this?

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  I don't think it's just information. I think it also is trust and relationships, and I think that's another big point. Facts aren't enough to change minds, and we form our beliefs and our things that we believe are true based on our identity, the community in which we belong to, the types of information we have access to. And not everyone has the same information access that we do. So in reality, I don't think it's just information. I think information is a part of it, but I also think it's building infrastructures to meet people where they are, build relationships, and then deliver information.

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  Yeah, I mean, you know, I think often we hear this line that, you know, people's trusted source is their family physician. Is that still true? Who are people's trusted sources today?

• 5:49Speaker 02

  That is still true for the people who can access, you know, a trusted family physician or a trusted provider. There definitely is still data that shows people trust their own personal medical providers. But also, we're living in an era where that is harder for people to do. I live in rural Maine, and the waitlist for getting a primary care provider can be over a year long. So it's not like everyone has easy access to that person. So now we see that people go to a lot of sources, and they trust a lot of different places. Sometimes it's news, sometimes it's a local social media influencer or a random social media influencer who maybe isn't even in their community that they trust. So nowadays, it's really fragmented.

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  People are getting information from all sorts of places and kind of forming their own beliefs about that information based on their own, you know, perspective and lived experience.

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  What kind of work are you doing at The Evidence Collective on this issue?

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  So we at The Evidence Collective are a group of scientists and clinicians and public health leaders who also communicate science on social media, because for better or for worse, social media is one of the places in which people go to access information. I wish it wasn't that, because we know that social media algorithms are skewed. So we work to help get evidence-based information out on social media, but not just from scientists. We're also trying to build collaborations with mom influencers and faith leaders so that they can feel empowered to talk about science and public health topics in ways that will resonate and reach their communities, where somebody may not want to listen to me as a scientist.

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  Are you working or training other scientists and clinicians?

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  Yeah, one of the things I've been doing a lot of is trying to help scientists and clinicians and members of the public who care start using more storytelling in their conversations and communications with the public, because it's a much more effective way of ultimately helping people receive the information you're trying to deliver. We tend to default to just giving people a bunch of facts and assuming that that will be enough, because we really love facts and we love those information. So I've been doing a lot of work to try to remind the people who care about science that weaving stories and narratives while you're giving those facts is going to make them much more impactful long-term than just giving them a bunch of data about why the MMR vaccine is important.

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  What about the science community? How has your scientific community responded to, you know, some of the writing that you've done on your own story and your thoughts on vaccine hesitancy?

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  I will say that it tends to be pretty mixed. I wrote a guest essay for The New York Times about my experience, and I got a lot of great messages, but I also got a lot of angry messages. And I got more angry messages from people on my side, so pro-science people. And a big pushback I got is I talk a lot about the importance of empathy and storytelling in communication with parents who have questions around vaccines. And a lot of people were saying that empathy is permission for bad behavior, that by saying I should be empathetic to people who have these beliefs, that I was essentially excusing their behavior and saying it was okay. And that's not true. I think people forget that you can hold multiple things at once, and you can, you

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  know, firmly say that the benefits of vaccines outweigh their risks, and that if you choose not to vaccinate your kid, they can't go to public school because there's a school immunization requirement. But you can also be empathetic for how hard it might be for that parent to navigate the information ecosystem and try to make the best decision they can for their kid. And both of these things can happen at the same time.

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  So how do you center empathy in your conversations with people or in the work that you're doing online?

• 9:46Speaker 02

  Yeah, so when I'm talking to parents, whether it be in person or, you know, on an online conversation, I always remember that at the end of the day, every single parent that I've talked to, without exception, has been trying to make the best decision for their kids that they could, because they want their kid to be healthy and happy and live a long life. And I really have a lot of empathy for how hard it is in today's information ecosystem to tease out what information is true from what information is not true. It's very obvious to people with a science background, but it isn't obvious to a mom who's scrolling Instagram in the middle of the night while feeding her newborn and sees all these scary stories about potential, you know, things that vaccines could do

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  that we know are not true, but are really compelling to that mom. I really lean heavily on that, is like remembering that at the end of the day, parents are trying to make the best decision they can and being compassionate for how hard that is.

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  You know, I get this question a lot, like if you wanted to have a conversation with someone who sees it differently from you around vaccines, you know, should you have it and how do you do it? And what should you keep in mind?

• 10:58Speaker 02

  Yeah, so I think, yes, it's always worth trying to have a conversation with somebody, but I think you need to remember that it may not always be successful in the way that you hope. So I never go into a conversation with the intention of changing somebody's mind in that moment. I go into a conversation hoping that I plant some seeds and make them feel safe enough to come back to me with questions in the future. And I like to remind people that this is work that takes time, which is, you know, very frustrating, particularly when we have measles outbreaks like we're having right now. But we have to remember that beliefs and values and all of those things are tied a lot to these prior experiences that we have, and you're not going to change somebody's

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  mind necessarily in a five-minute conversation. I like to remind people that it, like even me, it took me three and a half years to finally feel comfortable to go get vaccinated after starting college, and that it takes a long time to ultimately get.

• 11:58Speaker 01

  Liz, thank you so much for being here.

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  Thank you so much for having me.

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  Dr. Elizabeth Marnik is an immunologist and the executive director of The Evidence Collective. Produced by Shoshada Buxbaum, if you have questions or comments or feedback, we always love hearing from you. 8774 sci-fi is our number, 8774 sci-fi. I'm Flora Lixman. We'll catch you next time.