Journal of Infection (2014) 69, S2eS4
www.elsevierhealth.com/journals/jinf
Communicating vaccine science to the public Beatriz Larru*, Paul Offit Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, ARC Suite 1202, Philadelphia, PA 19104-4318, USA Accepted 18 July 2014 Available online 26 September 2014
KEYWORDS Vaccine; Communication; Social media
Summary Communicating science to the public is not always a straightforward process. In the case of vaccines, fear and lack of knowledge makes it even more challenging. We present some suggestions on how to defend the methods and fruits of scientific investigation to the public: 1) stand up for science, even if it not an easy task, 2) remember that no venue it too small, 3) don’t let bad information go unchallenged, 4) don’t assume other people are doing it, they are not and 5) remember that scientist have a responsibility to the public. ª 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Introduction “Hypothesis testing and presentation of the outcome e either positive or negative e is a fundamental part of the scientific process”. This was the leading statement of the response that Andrew J Wakefield wrote to Brent Taylor and colleagues after their critical review of Wakefield’s original study on mumps-measles-rubella (MMR) vaccination and autism.1,2 Decades later we also have learned that only a rigorous study design is valid for hypothesis testing. Unfortunately, the method chosen by Wakefield was incorrect. The case-series analysis that he claimed proved the causal association between MMR administration and onset
of autism has lead to more that 125,000 children in United States (US) not having the protection of a highly active and safe vaccine, with subsequent measles outbreaks. European parents made a similar decision with similar results.3 Although Wakefield’s hypothesis has been refuted by many well-controlled scientific studies, his work is still cited by the social media and remains a source of controversy when physicians aim to educate parents about vaccines. Communicating science to the public is not always a straightforward process. In the case of vaccines, fear and lack of knowledge makes it even more challenging.4 Those who choose to communicate vaccine science to the public should be aware of several challenges.
* Corresponding author. Tel.: þ1 215 590 2017; fax: þ1 215 590 2025. E-mail addresses: [email protected] (B. Larru), [email protected] (P. Offit). http://dx.doi.org/10.1016/j.jinf.2014.07.009 0163-4453/ª 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Communicating vaccine science
S3
The media’s job is to entertain, not educate
The use of humor
On January 22, 1999, ABC’s ‘20/20’ aired a TV program that deeply scared the American public. Sylvia Chase was the correspondent. The program began with a teaser: “Next, an important medical controversy. Serious new questions about a vaccine most school children are forced to get: one given to millions every year.” The ‘20/20’ program was filled with misleading information about the hepatitis B vaccine telling stories about how hepatitis B vaccine caused sudden infant death syndrome, rheumatoid arthritis and multiple sclerosis.5 Several scientific studies had already been performed prior to this program rejecting these associations.6 Unfortunately medical evidence never found its way in this show. When confronted with an executive producer about correcting this egregious misrepresentation of hepatitis B vaccine safety, the ABC producer’s response was: “Our job is to be interesting. If it also happens to be true, great!” Because of this one television program, the public’s perception about vaccine risk tipped in one direction. The resources spent in vaccine development and safety was apparently less interesting as not a single newspaper, radio or TV program highlighted their results.
Humor can also be used to deflate hokum, as when The Colbert Report’s Stephen Colbert (whose father used to be a prominent NIH scientist) skewered hooey by embracing it so ardently. He presented congressman Michele Bachmann’s opinion that human papilloma virus caused mental retardation based on a woman who had claimed this to have happened to her daughter. Bachmann therefore assumed this to be fact. Colbert showed a mock version of the highly prestigious The New England Journal of Medicine. Except now it was titled “The New England Journal of Some Lady I Just Met”.
The journalist mantra of balance The journalist mantra of e equal time for opposing views e has also blurred the findings of vaccine studies in the news media. Several years ago on the program ‘Meet the Press’, the late Tim Russert featured Institute of Medicine president Dr. Harvey Fineberg on the topic of vaccine safety, countered by David Kirby, an author who not only had no vaccine expertise, but also was an advocate for an anti-vaccine group. In the name of balance, Tim Russert did nothing to educate the audience. At the end of the program the viewers couldn’t recognize who the expert was, having given the same weight to the opinion of a highly-trained epidemiologist as to an author with no expertise in the field.
Pick your spots When dealing with the social media, pick your spots. Many morning TV shows tell the story through three characters: the hero, the victim and the villain. Tearful Jenny McCarthy e former Playboy star and now American’s most recognized anti-vaccine crusader e shared with millions of viewers on Oprah’s TV show the moment that changed her life: “Soon after my son got the MMR shot I noticed a change. The soul was gone from his eyes. Evan, my Evan, my son died in front of me for two minutes.” Her dramatic personal story of being a mother of a child diagnosed with autism related in heart-wrenching terms leaves little doubt on which of the three roles is left for the medical expert, certainly neither the victim nor the hero. This cultural milieu, in which anecdote trumps epidemiology, allowed this celebrity to convince millions of viewers that her son’s autism was caused by a vaccine. Emotions can effectively sell false notions and therefore scientists must be willing to employ emotion to counter falsehood, framing what we are saying in an emotional, impactful way.
How best to communicate the scientific method Scientists are often confounded by how best to communicate the scientific method. A study can reject or not reject the null hypothesis but cannot accept it. It is impossible to prove the null hypothesis (such as MMR vaccine does not cause autism) so technically an epidemiologic study can never provide absolute proof. For example, one can never prove that a five-year old, in an attempt to emulate Superman, can’t jump from a small height and fly. Nevertheless, it’s fair to say that MMR vaccine does not cause autism and humans cannot fly.
The “what do you believe” trap Cause and effect can be hard to communicate in a culture where a non-significant proportion of the population believes in astrology, ghosts or extrasensory perception. Clinicians should not fall into the “what do you believe?” trap. Vaccines are not a belief system. They stand on a mountain of evidence to support their use. No faith is required to support them, just understanding of evidencebased medicine.7 Much is at stake and scientists need to get in the game. The problem is not only a matter of scientific illiteracy. It’s worst than that; it’s scientific denialism. Science has increasingly been seen as just another voice in the room, which is a very dangerous idea. To conclude, we present some suggestions on how to defend the methods and fruits of scientific investigation to the public: 1) stand up for science, even if it not an easy task, 2) remember that no venue it too small, 3) don’t let bad information go unchallenged, 4) don’t assume other people are doing it, they are not and 5) remember that scientist have a responsibility to the public.
Conflict of interest The authors have no conflict of interest to report.
References 1. Wakefield AJ. MMR vaccination and autism. Lancet Sep 11 1999;354(9182):949e50.
S4 2. Taylor B, Miller E, Farrington CP, Petropoulos MC, FavotMayaud I, Li J, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet Jun 12 1999;353(9169):2026e9. 3. Plotkin MD Stanley A, Orenstein WA, Offit MD Paul A. Vaccines. Elsevier Health Sciences; 2008. 4. Offit PA, Moser CA. Vaccines and your child: Separating Fact from Fiction. Columbia University Press; 2011.
B. Larru, P. Offit 5. Offit PA. Deadly choices: how the antivaccine movement threatens us all. Basic Books; 2011. 6. Armstrong GL, Mast EE, Wojczynski M, Margolis HS. Childhood hepatitis B virus infections in the United States before hepatitis B immunization. Pediatrics Nov 2001;108(5):1123e8. 7. Offit MD Paul A. Do you believe in magic?: the sense and nonsense of alternative medicine. HarperCollins; 2013.
www.elsevierhealth.com/journals/jinf
Communicating vaccine science to the public Beatriz Larru*, Paul Offit Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 3615 Civic Center Blvd, ARC Suite 1202, Philadelphia, PA 19104-4318, USA Accepted 18 July 2014 Available online 26 September 2014
KEYWORDS Vaccine; Communication; Social media
Summary Communicating science to the public is not always a straightforward process. In the case of vaccines, fear and lack of knowledge makes it even more challenging. We present some suggestions on how to defend the methods and fruits of scientific investigation to the public: 1) stand up for science, even if it not an easy task, 2) remember that no venue it too small, 3) don’t let bad information go unchallenged, 4) don’t assume other people are doing it, they are not and 5) remember that scientist have a responsibility to the public. ª 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Introduction “Hypothesis testing and presentation of the outcome e either positive or negative e is a fundamental part of the scientific process”. This was the leading statement of the response that Andrew J Wakefield wrote to Brent Taylor and colleagues after their critical review of Wakefield’s original study on mumps-measles-rubella (MMR) vaccination and autism.1,2 Decades later we also have learned that only a rigorous study design is valid for hypothesis testing. Unfortunately, the method chosen by Wakefield was incorrect. The case-series analysis that he claimed proved the causal association between MMR administration and onset
of autism has lead to more that 125,000 children in United States (US) not having the protection of a highly active and safe vaccine, with subsequent measles outbreaks. European parents made a similar decision with similar results.3 Although Wakefield’s hypothesis has been refuted by many well-controlled scientific studies, his work is still cited by the social media and remains a source of controversy when physicians aim to educate parents about vaccines. Communicating science to the public is not always a straightforward process. In the case of vaccines, fear and lack of knowledge makes it even more challenging.4 Those who choose to communicate vaccine science to the public should be aware of several challenges.
* Corresponding author. Tel.: þ1 215 590 2017; fax: þ1 215 590 2025. E-mail addresses: [email protected] (B. Larru), [email protected] (P. Offit). http://dx.doi.org/10.1016/j.jinf.2014.07.009 0163-4453/ª 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Communicating vaccine science
S3
The media’s job is to entertain, not educate
The use of humor
On January 22, 1999, ABC’s ‘20/20’ aired a TV program that deeply scared the American public. Sylvia Chase was the correspondent. The program began with a teaser: “Next, an important medical controversy. Serious new questions about a vaccine most school children are forced to get: one given to millions every year.” The ‘20/20’ program was filled with misleading information about the hepatitis B vaccine telling stories about how hepatitis B vaccine caused sudden infant death syndrome, rheumatoid arthritis and multiple sclerosis.5 Several scientific studies had already been performed prior to this program rejecting these associations.6 Unfortunately medical evidence never found its way in this show. When confronted with an executive producer about correcting this egregious misrepresentation of hepatitis B vaccine safety, the ABC producer’s response was: “Our job is to be interesting. If it also happens to be true, great!” Because of this one television program, the public’s perception about vaccine risk tipped in one direction. The resources spent in vaccine development and safety was apparently less interesting as not a single newspaper, radio or TV program highlighted their results.
Humor can also be used to deflate hokum, as when The Colbert Report’s Stephen Colbert (whose father used to be a prominent NIH scientist) skewered hooey by embracing it so ardently. He presented congressman Michele Bachmann’s opinion that human papilloma virus caused mental retardation based on a woman who had claimed this to have happened to her daughter. Bachmann therefore assumed this to be fact. Colbert showed a mock version of the highly prestigious The New England Journal of Medicine. Except now it was titled “The New England Journal of Some Lady I Just Met”.
The journalist mantra of balance The journalist mantra of e equal time for opposing views e has also blurred the findings of vaccine studies in the news media. Several years ago on the program ‘Meet the Press’, the late Tim Russert featured Institute of Medicine president Dr. Harvey Fineberg on the topic of vaccine safety, countered by David Kirby, an author who not only had no vaccine expertise, but also was an advocate for an anti-vaccine group. In the name of balance, Tim Russert did nothing to educate the audience. At the end of the program the viewers couldn’t recognize who the expert was, having given the same weight to the opinion of a highly-trained epidemiologist as to an author with no expertise in the field.
Pick your spots When dealing with the social media, pick your spots. Many morning TV shows tell the story through three characters: the hero, the victim and the villain. Tearful Jenny McCarthy e former Playboy star and now American’s most recognized anti-vaccine crusader e shared with millions of viewers on Oprah’s TV show the moment that changed her life: “Soon after my son got the MMR shot I noticed a change. The soul was gone from his eyes. Evan, my Evan, my son died in front of me for two minutes.” Her dramatic personal story of being a mother of a child diagnosed with autism related in heart-wrenching terms leaves little doubt on which of the three roles is left for the medical expert, certainly neither the victim nor the hero. This cultural milieu, in which anecdote trumps epidemiology, allowed this celebrity to convince millions of viewers that her son’s autism was caused by a vaccine. Emotions can effectively sell false notions and therefore scientists must be willing to employ emotion to counter falsehood, framing what we are saying in an emotional, impactful way.
How best to communicate the scientific method Scientists are often confounded by how best to communicate the scientific method. A study can reject or not reject the null hypothesis but cannot accept it. It is impossible to prove the null hypothesis (such as MMR vaccine does not cause autism) so technically an epidemiologic study can never provide absolute proof. For example, one can never prove that a five-year old, in an attempt to emulate Superman, can’t jump from a small height and fly. Nevertheless, it’s fair to say that MMR vaccine does not cause autism and humans cannot fly.
The “what do you believe” trap Cause and effect can be hard to communicate in a culture where a non-significant proportion of the population believes in astrology, ghosts or extrasensory perception. Clinicians should not fall into the “what do you believe?” trap. Vaccines are not a belief system. They stand on a mountain of evidence to support their use. No faith is required to support them, just understanding of evidencebased medicine.7 Much is at stake and scientists need to get in the game. The problem is not only a matter of scientific illiteracy. It’s worst than that; it’s scientific denialism. Science has increasingly been seen as just another voice in the room, which is a very dangerous idea. To conclude, we present some suggestions on how to defend the methods and fruits of scientific investigation to the public: 1) stand up for science, even if it not an easy task, 2) remember that no venue it too small, 3) don’t let bad information go unchallenged, 4) don’t assume other people are doing it, they are not and 5) remember that scientist have a responsibility to the public.
Conflict of interest The authors have no conflict of interest to report.
References 1. Wakefield AJ. MMR vaccination and autism. Lancet Sep 11 1999;354(9182):949e50.
S4 2. Taylor B, Miller E, Farrington CP, Petropoulos MC, FavotMayaud I, Li J, et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet Jun 12 1999;353(9169):2026e9. 3. Plotkin MD Stanley A, Orenstein WA, Offit MD Paul A. Vaccines. Elsevier Health Sciences; 2008. 4. Offit PA, Moser CA. Vaccines and your child: Separating Fact from Fiction. Columbia University Press; 2011.
B. Larru, P. Offit 5. Offit PA. Deadly choices: how the antivaccine movement threatens us all. Basic Books; 2011. 6. Armstrong GL, Mast EE, Wojczynski M, Margolis HS. Childhood hepatitis B virus infections in the United States before hepatitis B immunization. Pediatrics Nov 2001;108(5):1123e8. 7. Offit MD Paul A. Do you believe in magic?: the sense and nonsense of alternative medicine. HarperCollins; 2013.
