Communicating Effectively about Immunization

"Effective communication by health care providers has an important influence on people's decisions about whether or not to proceed with immunization."

This chapter, a component of "Part 1: Key Immunization Information 2013" within Canadian Immunization Guide (Public Health Agency of Canada), reviews what is known about vaccine hesitancy, describes basic principles of effective communication, and provides examples of immunisation facts.

Specifically, vaccine hesitancy is a term used to describe refusal or delay in regular immunisation schedules due to concerns about immunisation. "Vaccine hesitancy is a complex issue with multiple determinants, the most important being:

• lack of information about the vaccine being given and about immunizations in general;
• conflicting information from a variety of sources (e.g., alternative medicine practitioners, anti-vaccination websites);
• mistrust of the source of information (e.g., perceptions of business and financial motives of the vaccine industry);
• perceived risk of serious adverse events and concerns regarding injections (e.g., pain and anxiety associated with immunization; coincidental rather than causal adverse events that are perceived as vaccine-related);
• lack of appreciation of the severity and incidence of vaccine-preventable diseases;
• sociocultural beliefs (e.g. religious beliefs)."

"Regular health care providers, such as vaccine providers, are perceived as trusted individuals and have a vital role in ensuring continued success of immunization programs and in maintaining confidence in the effectiveness and safety of vaccines." Thus, it is stressed that vaccine providers need to know how to counsel effectively and how to help vaccine recipients or parents knowledgeably assess the benefits and risks of immunisation, as well as the risks associated with being unvaccinated. To that end, vaccine providers should make the most of each opportunity to encourage questions, address misinformation, and provide valid and appropriate messages and resources, including websites that provide reliable information. Principles that can be used by vaccine providers to communicate immunisation facts effectively (refer to the "Immunization Facts" section) to vaccine recipients or parents:

• Adopt a vaccine recipient-centred approach: "Effective decision making is best done in a partnership between the vaccine provider, and the vaccine recipient or parent. Building these partnerships takes time and should ideally be established prior to the immunization visit. Vaccine providers should be transparent about the decision-making process, as well as honest and open about uncertainty and risks. Engaging and motivating vaccine recipients and parents are best accomplished through dialogue. Motivational interviewing is a semi-directive method aimed at changing behaviour..."
• Respect differences of opinion about immunisation: "...With the public increasingly questioning recommendations of experts and public institutions on the basis of their own, often web-based, research, vaccine providers should anticipate that individuals will question the need for, or the safety of, immunization....Asking vaccine recipients or parents about their perceptions and discussing the benefits of immunization should be done using a non-judgemental and non-confrontational tone. Vaccine providers should clarify why a specific belief about a vaccine is held, especially if it is based on misinformation or misunderstanding. Demonstrating patience and respect builds trust and support for deciding to immunize..."
• Represent the risks and benefits of vaccines fairly and openly: "Candidly communicating information about the safety of vaccines and their benefit–risk ratios is essential....Vaccine providers need to outline the work that is done to assess vaccine safety during development, regulatory review, and on an ongoing basis following use of a vaccine....Through direct dialogue and using language that is appropriate, vaccine providers should contrast the known and theoretical risks of vaccines with the known risks associated with the vaccine preventable diseases. Potential risks of any vaccine should not be considered in isolation but in comparison with risks to the individual and community should an individual remain unimmunized..."
• Clearly communicate current knowledge using an evidence-based approach by:
  • assessing the level and type of information that an individual wants and adapt the information provided accordingly; for example, some people appreciate scientific evidence, while others prefer anecdotal information and stories from personal experience;
  • presenting evidence in an understandable way; scientific jargon and acronyms should be avoided;
  • framing immunisation in terms of positive gains; for example, "A vaccine is 99% safe" is deemed here to be more effective than, "There is a 1% chance of side effects".
  • using and having available varied information formats (visual, audio, printed material, websites) tailored to a range of socio-cultural groups (i.e., educational level, language, and ethnic and cultural background); and
  • informing vaccine recipients and parents about ways that they can make immunisation less stressful (pain and anxiety related to immunisation are important factors in vaccine hesitancy).

To assist vaccine providers in making the giving of information less time-consuming, various URLs are offered, such as one website that features useful vignettes and personal stories concerning immunisation. Also included is a list of immunisation facts to use in communicating, for instance, that the risks of vaccine preventable diseases are many times greater than the risk of a serious adverse reaction to a vaccine. One talking point: "Diseases like polio, diphtheria, measles and pertussis (whooping cough) can lead to paralysis, meningitis, pneumonia, choking, brain damage, heart problems, and even death. Although today these diseases are non-existent or rare in Canada, if immunization programs were reduced or stopped, they would re-appear in epidemics causing sickness and death."