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Understanding Myths and Immunisation a Slice of NZ Narrative

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Understanding Myths and Immunisation a Slice of NZ Narrative Understanding myths and immunisation A slice of NZ narrative Helen Petousis‐Harris Immunisation Advisory Centre Dept General Practice and Primary Health Care Sept 2015 Thinking about immunisation myths • What is a myth and for what purpose? • What feeds a myth? • Why do we believe? • Why should we care? • What should we do? New Zealand Herald. 3/9/2015 (yesterday) What is a myth and what purpose does it serve? What is a myth? Myth is ideology in narrative form. • Myths may arise as either • truthful depictions or over‐elaborated accounts of events • as allegory for or personification of natural phenomena, or explanation of ritual. • deliberate deception for personal gain* • They are transmitted to • convey religious or idealised experience • to establish behavioral models, and to teach. • generate business/wealth* • attract attention* *these arise by or are transmitted for pragmatic reasons but rely on the ideology of others Lincoln B. Theorizing Myth. Narrative, Ideology and Scholarship. University of Chicago Press. 1999. Myths provide an explanation Myths provide an explanation Endearing myth ‐ sugar turns kids into little monsters Busted by science since 1994 The need for myth • Helps people make sense of the world • Knowledge is power –basis for improving one’s influence 1978 ‐ current DiFonzo N, Bordia P. Rumor psychology: Social and organizational approaches. American Psychological Association; 2007. It’s innate ‐ leaping to conclusions is easy Post hoc ergo propter hoc ‐ after this, therefore because of this –Noni McDonald’s ‘coincidence dragon’ Aren't myth and truth equally subjective? • Myths are either untestable or fallacious • The sun is pulled across the sky by a glorious God in a golden chariot • testable, found to be false • McDonald’s meat patties have worm meat in them • testable, found to be false • The universe was created by a giant flying spaghetti monster • untestable • Testimonials, anecdote, personal experience, lack of openness to evidence • Truth is determined by empirical evidence, testable • Vaccines cause autism • testable, false • HPV vaccine causes paralysis • Testable, false How do you feed a myth? The ideal environment for myth • Rumour/myth thrives where there is • an absence of trust • a vacuum • The longer uncertainty and distrust persist the easier myths spread and the more difficult to counteract • Wrong action or no action at all = rumour fertiliser To the people Ad populum – if everybody else does…it must be right. Also called bandwagon False attribution ad verecundiam ‐ Appealing to an irrelevant, unqualified, unidentified, biased or fabricated source in support of an argument. Evolution of a vaccine myth • Initiated exclusively? from anti‐immunisation protagonists, self motivated. • 21st Century IT propagates magnificently misuse of ‘data’ by individual with something to gain Amplification by mass media including social networks Jo Public –motivated reasoning Why do we believe?Complacency and confidence What drives these beliefs and these actions? Heuristics and cognitive biases Heuristics and cognitive bias • Evolutionary efficiency –intuition, common sense • Usually accurate • But not always –can lead to cognitive biases “I know there’s no evidence that shows the death penalty has a deterrent effect, but I just feel in my gut it must be true.” President Bush while governor of Texas. “I’m a gut player. I rely on my instincts.” President Bush to Bob Woodward on his decision to launch the Iraq war. • Confirmation bias • Search and interpret information that confirms beliefs, discredit information that does not support their views the administration "went to war without requesting ‐‐ and evidently without being influenced by ‐‐ any strategic‐level intelligence assessments on any aspect of Iraq." NI officer Paul R Piller Why do we care? GUiNZ longitudinal cohort study interviewed 6822 mums and 4404 partners • “Negative messages from well‐meaning friends and families, the media and even medical professionals have caused some parents to delay or forgo immunising their child against several potentially fatal diseases.” • “The study showed pregnant women and their partners were twice as likely to delay immunisations after receiving "discouraging" information.” Growing up in NZ. Warnings about immunisation prove more influential that positive messages. New Zealand Herald. 3/9/2015 (yesterday) Why should we engage in myths? Will it get another child immunised? Elaine Boyd ~1997 • NZ has improved immunisation coverage dramatically • One of the likely contributing factors is the focus on the health professional –primary care • Knowledge and confidence • This has been via • Training and education • Active communications • Providing support and information to health professionals to counter myths can make a difference • HOW to have the conversation is another issue! Turner N. Factors associated with immunisation coverage for the childhood immunisation programme in New Zealand: 1999 – 2012. MD Thesis. University of Auckland Library. 2015. In 2003 HPs wanted support to deal with myths “Family physicians re‐emphasised patients’ fear of vaccinations due to this misinformation. They also identified a lack of resources, both to inform themselves and also in formats to help educate patients and counter the misinformation.” “…parents’ lack of information, or misinformation regarding immunisation, especially that received from their attending midwives.” Petousis‐Harris H, Goodyear‐Smith F, Turner N, Soe B. Family physician perspectives on barriers to childhood immunisation. Vaccine;22(17‐18):2340‐44, 2004 Don’t ignore it!!! • Misinformation thrives in a vacuum, don’t leave one. • This approach has been used in the past • “ignore it and it will go away” • “you will just draw attention to it” • “people will see it is nonsense” • And how did that work out? • Smallpox in 18th and 19th century • MMR in UK 1990s • MeNZB in NZ 2000s • HPV in Japan today • Evidence shows strong leadership and professional advice has greatest influence* *Turner N. The challenge of improving immunization coverage: The New Zealand example. Expert Review of Vaccines. 2012;11(1):9‐11. What should we do? Correcting myths can backfire and positive messages not always helpful “The study, of 6822 women and 4404 of their partners, also found "encouraging" information had no effect on when they chose to immunise, and more than half, 56 per cent, did not receive any information at all before birth.” Growing up in NZ. Warnings about immunisation prove more influential that positive messages. New Zealand Herald. 3/9/2015 (yesterday) Betsch, C. "Innovations in communication: the Internet and the psychology of vaccination decisions." Euro Surveill 16.17 (2011): pii‐19849. Opel D et al. The influence of provider communication behaviors on parental vaccine acceptance and visit experience Five worst communications mistakes Show respect, express empathy Be the first to provide Paternalistic Front up immediately, use social media attitudes Not Be accurate as reliable Information countering info comes to hand – released late myths in real share messages time Mixed PR Public power messages disaster! struggles Margaret Reynolds. Crisis and Emergency Communications: Best practices. CDC Healthcare workers a source of bad info “While most discouraging information came from friends, books, magazines, newspapers, family and the internet, Dr Grant said it was worrying that healthcare workers were identified as sources of 16 per cent of discouraging information.” Growing up in NZ. Warnings about immunisation prove more influential that positive messages. New Zealand Herald. 3/9/2015 (yesterday) This week on FB About 8 scientists/experts replied. Strongly and respectfully. Post removed next day. Do equip health professionals • Ensure position of government health ministry and health professionals are aligned on key messages • Ensure front line professionals have the information they need • Get the messages out • Ministry website position statements • Professional colleges etc. position statements • Key spokespeople accessible and friendly to media – relationships • Blogs • Professional newsletters • Facebook, twitter…. Margaret Reynolds. Crisis and Emergency Communications: Best practices. CDC HP’s need support • When presented with list of various educational needs…those identified by the nurses as most important were information on current issues reported in the media, for example anthrax and bio‐ terrorism, or the relationship between MMR and autism …. • From the qualitative analysis of their responses to other immunisation related information they would like, the major (most frequently raised) theme to emerge was the need for resources to counter misinformation on immunisation …. Petousis‐Harris H, Goodyear‐Smith F, Soe B, Turner N. Family practice nurses perspectives on barriers to childhood immunisation. Vaccine;23:2725‐2730, 2005 Case study Complex Regional Pain Syndrome following HPV vaccination CRPS • Initial nerve trauma, usually limb, usually major • Symptoms, change over time • Continuous burning/throbbing • Sensitive to touch or cold • Swelling • Changes in skin temp, colour, texture • Changes in hair, nail growth • Joint stiffness, damage • Muscle spasms, atrophy • Decreased movement • Can be challenging to treat • Early treatment important, range of therapies Wiki • Relapses with cold or emotional stressor CRPS and HPV • Reports of CRPS following HPV vaccine appeared in Japanese media • Repeated press reports, print and TV from 2010 • WHO
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