Public Trust in Vaccines

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Message Framing

The notion that how the vaccine message is framed is an appealing idea. Can vaccine uptake be increased simply by framing the message correctly? A literature review of studies was unable to find entirely convincing evidence for this:

"The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies."[1]

This review's findings are similar to the conclusions of reviews of literature on feedback and learning. Similarly, those studies seek to find factors that can determine how effective feedback is, focusing on whether a feedback message is framed positively or negatively. Both feedback research and research on framing of vaccine information are entangled not just with cognitive but also motivational factors. In both areas of research, the attempt to find a science of framing or of "best practices" has been difficult and perhaps impossible.

HPV Vaccine

Kahan, Dan M. "A risky science communication environment for vaccines." Science 342.6154 (2013): 53-54.

Kahan argues that controversy and polarization relating to the HPV vaccine was an unnecessary result of poor communication. He points out that other vaccines have been introduced without controversy. He locates the issues with a profit-driven introduction of the vaccine for Merck that sought to quickly receive approval for their vaccine (which was only for girls) and ask state legislatures to add it to the list of required vaccinations for school attendance.

Kahan argues that the vaccine would have benefited from a different introduction:

  • Introduction of a vaccine for girls and boys simultaneously would have avoided drawing attention to the sexually-transmitted nature of the disease, and avoided causing a backlash. Kahan points out that the vaccine for Hepatitis B (also a sexually-transmitted disease) avoided this high-profile introduction.
  • The vaccine should have been simply added to required lists through health departments rather than through high-profile state initiatives (which were unnecessary as a legal matter).
  • Parents trust pediatricians and consider them experts on vaccines. Parents could have learned about the vaccine through trusted pediatricians rather than through the news media.
  • While evidence shows that exposure to news that threatens group standing has the effect of polarizing views on the vaccine, evidence also shows that trust in the vaccine is high in the absence of this exposure.[2]
  • Communication should avoid tropes such as "completely safe," as Kahan cites evidence showing this messaging can suggest risk to its recipients.
  • " In addition, people tend to contribute voluntarily to public goods—such as herd immunity—when they believe that others are doing so but refrain when they perceive widespread free-riding. [3]


"One recurring source of risk controversy is a dynamic known as “cultural cognition.” Both to avoid dissonance and to protect their ties to others, individuals face a strong psychic pressure to conform their perceptions of risk to those that distinguish their group from competing ones—a bias in reasoning that can actually intensify as the public becomes more science literate."[4]

"In 2006, the U.S. Centers for Disease Control (CDC) recommended universal immunization of adolescent girls against the human papilloma virus (HPV), which is sexually transmitted and causes cervical cancer, but political dispute blocked legislative mandates in every state but one. Experimental evidence showed that individuals tended to selectively credit information relating to the vaccine’s risks and benefits in patterns reflecting their cultural predispositions (one perceived risk was that vaccination would lead to the engagement of unsafe sex). The resulting polarization was amplified when individuals were exposed to cues—whether explicit, such as news reports ( 3), or tacit, such as fictional advocates of varying appearances ( 4)— suggesting the vaccine was a focus of group conflict. Yet there was nothing inevitable about the HPV vaccine being publicly introduced in a manner so likely to generate cultural conflict."

It was likely inevitable that people of opposing cultural orientations would react divergently to a high-profile campaign to enact legislation

mandating vaccination of 11- to 12-year-old girls for a sexually transmitted disease.