Nearly nine in 10 Americans strongly believe in the overall value of childhood vaccines. Reflecting the value communities place on them, every state and the District of Columbia require children to get vaccinated against certain diseases before they start school, including measles, mumps, polio, tetanus, whooping cough, and chickenpox.
Troubling stories about outbreaks of previously eradicated diseases like measles notwithstanding, most schools are free of vaccine-preventable diseases. This is precisely because vaccination requirements ensure that virtually every child’s immune system has been prepared to recognize and resist these diseases.
For these things to remain true, people who advocate for public health — government public health messengers, immunization coalitions, policy advocates and others — have important, urgent communications work to do. With several legislative seasons of unprecedented attempts to roll back school vaccine protections, and a national election season looming, public health promoters can’t afford to lay low in the hopes of avoiding a politicized issue.
Nor can they afford to turn to framing strategies developed in a different time, like stock language asserting that vaccines are safe and effective. Without updated, innovative approaches to reclaiming and reframing the public conversation about childhood and adolescent vaccinations, there’s a real risk that more children in the U.S. will lack access to highly immunized learning spaces than at any time since the first Bush administration.
Stories now circulating in the public square are dress rehearsals for the vaccine policies society will endorse. Right now, the stage is set with fear and disinformation. The leading independent candidate for president is well-known precisely because of the following he built by spreading misinformation about vaccine safety and fostering doubt about it. The presumptive Republican nominee has issued vague but repeated threats to defund public schools that require vaccination for school entry. It remains to be seen if vaccines become a major campaign issue in the 2024 cycle, but it’s certainly possible.
It’s next to impossible, however, that the well-organized groups pushing for “medical freedom” by weakening vaccination requirements will give up and go away, especially in a moment when their movement has momentum: In 2022-2023, vaccine exemptions increased in 41 states.
It’s risky for people who believe in public health to resign themselves to these realities as a “new normal.” Instead, immunization advocates must take them into account when setting communications priorities. With suggestions to weaken vaccine protections in the news, on the campaign trail, and in our communities, it’s essential to counterbalance them with health-oriented, scientifically grounded ideas as soon as possible and as much as possible. By ceding the spotlight to vaccine deniers, the public hears only their lines, which are lies.
The way ideas are presented on the public stage matters tremendously. In a series of communications studies conducted in partnership with the American Academy of Pediatrics, researchers at the FrameWorks Institute, where I work, found that many of the ways that immunization coalitions, public health departments, and individual pro-vaccine commentators talk about vaccination have little effect — or the opposite effect — of what they intend. For example, starting an op-ed by lamenting declines in vaccine uptake or confidence may actually reinforce the faulty assumptions that vaccine risks are driving most people’s decisions, when in fact, it’s a minority concern.
Making the story about declining uptake or increasing hesitancy normalizes the idea that people are worrying about — or even avoiding — vaccines. The stories that vaccine advocates are encouraged to tell — such as framing the issue in terms of the “newsworthy” problem of vaccine avoidance or aversion — may not be the stories we need.
One way to tell a new story is to use new metaphors. Metaphors are powerful. In fact, FrameWorks researchers found that metaphors could increase or decrease people’s support for strong immunization programs.
Well-worn military language that compares vaccines to weapons in a fight against viruses leads people to think about personal risks, but not about public benefits. In contrast, a different comparison — that vaccines help improve the immune system like regular software updates help digital devices work better — moved people to think about how viruses move through computer networks and, by extension, their communities. In a nationwide survey experiment, we found that the software update metaphor increased parents’ sense of collective benefits of childhood vaccination by 8%, and parents’ sense of collective responsibility for childhood vaccination by 4%, both significant results for this type of research.
Another way to tell a new story is to refresh the basic framing of vaccination and why it matters. For years, public health advocates have relied on the messaging that “childhood vaccines are safe and effective,” a tacit response to thoroughly disproven claims that vaccines are a hidden cause of poorly understood conditions like autism or sudden infant death. The impulse to reassure parents makes sense, and it has a place in the overall repertoire of messages. But our research suggests it’s not the most powerful opening argument for childhood vaccination, and neither is a parent-oriented reminder that vaccines protect their children from preventable diseases.
While both of those messages aim to reduce parents’ sense of risk, raising the topic of risk reminds people to think about it, and that thinking quickly turns to concerns about side effects or adverse reactions. Our research found that a different angle — increasing parents’ recognition of rewards — was more effective. It’s important that vaccine advocates shift to talking about routine immunizations as a platform for healthy child development and well-being. This reframe simply reminds people that when children’s immune systems are equipped to recognize and resist contagious diseases, they can stay focused on growing, playing, and learning.
Effective communication will be a vital part of rebuilding widespread trust in public health, which was eroded by social and political commentary surrounding Covid-19 measures and mandates. Just as a physical structure needs a carefully constructed frame to stand sturdy, efforts to rebuild trust must involve tested, effective ways to frame issues like vaccination.
Because culture-wide mindsets can shift rapidly in periods of social upheaval, the U.S. is now at a moment when there is not only an opportunity, but an obligation, to reclaim the public conversation about vaccines. Public health agencies, health care systems, and advocacy organizations must work together, using the best available evidence, on rebuilding public understanding of how vaccines improve the human immune system and creating healthier, more engaged schools and communities.
Julie Sweetland, Ph.D., is a senior advisor at the FrameWorks Institute.