The Best Defense is a Good Offense: Why Public Health Officials Need to Get Tough on Vaccination

But blaming anti-vax zealots for spreading misinformation only points the finger at part of the problem. Americans should also be pointing the finger at state politicians and their public health officials for their generally tepid responses to the anti-vaccination movement and the conditions it has helped create, all the while leaving undervalued and underinvested local public health agencies to play “whack a mole” in responding to the latest disease outbreaks.

Much like co-author Jason Chung wrote about in Canada, our public health leaders have done little to rouse the general public (the vast majority of whom, as surveys show, value vaccinations) in the face of extensive and aggressive misinformation efforts targeting parents who may, understandably, have questions or concerns about safe, effective vaccines for their children.

This lack of response highlights how the public health field has failed to adapt to a changing reality. Doyens of public health appear to believe that remaining calm and appealing to rationality is the way to combat coordinated misinformation. In our media-saturated, “information age,” this is inadequate.

Instead, our elected officials and senior public health leaders should be adopting a more proactive approach to combating anti-vaxxers. Here are just a few ideas:


Can Governor Jay Inslee (D-WA) solve the vaccination crisis in his state?/Official Governor’s Office Photo via Flickr

1. Stop treating a Public Health Problem as a Primarily Clinical Medicine Problem

Public health, with its specific focus on prevention and community health, has a unique, multi-disciplinary toolkit at its disposal to better understand and effectively intervene on this pressing, complex problem. These tools can be leveraged in conducting mass media education or social marketing campaigns, interventions in clinical and community settings, and policy-level actions.

But this array of tools has been underutilized in favor of clinical approaches. While it’s true that improving clinical encounters is an important method for ensuring vaccination uptake, this approach has received far too much focus over other, perhaps more effective, complementary population-oriented approaches.

2. Focus on How Disease Reality is Far Scarier than Vaccine Myths

Public health needs to better emphasize the serious risks posed by vaccine-preventable diseases. Anti-vax propaganda has set the narrative about (miniscule) vaccine risks trumping the substantial disease risks that vaccines prevent (measles especially). That means public health officials are constantly playing defense – debunking dubious vaccine risk claims, at the expense of emphasizing the true, substantial dangers that vaccine-hesitant parents accept by deciding to delay or avoid vaccinations for their children.  It’s time to go on offense and highlight dangers posed by childhood diseases among children and adults in our communities.

Of course, in stressing the risks of a disease, there is the risk of spreading fear. This is an understandable concern. But, when based in truth, fear can resonate with parents susceptible to anti-vaccination messaging. As found by psychologists, fear-based campaigns are effective in helping change both attitudes and behavior. That, combined with the right motivator, may be effective. Likewise, fear-based public health campaigns can also be ethical, provided appropriate considerations are taken.

3. Up the Online Prevention Game

Public health can’t be fighting this problem only in the arenas it chooses. The time that parents spend in a medical office is scant compared to their time spent online. Search engine results and social media sites with anti-vax propaganda have come to dominate website search results and social media spaces that parents turn to for information. Thus, simply referring parents to government websites for accurate vaccine-related information is inadequate. Politicians and public health officials need to be engaging with companies like Facebook and Google (which owns YouTube) to develop solutions to not only better promote the spread of accurate information, but limit the ways that parents are steered online toward anti-vaccination ads, videos, and sites. Due to public pressure, these companies have begun scrutinizing misinformation that can lead to “real-world harm.” Political pressure can help ensure that they effectively follow through in efforts—especially with respect to anti-vax propaganda. 

4. Spotlight the Pro-Vaccination Majority

Currently, the anti-vax movement enjoys media airtime and influence far beyond what their numbers dictate.  The truth is that while there are pockets of “intense anti-vaccine activity”  which are threatening key counties and metropolitan areas, the vast majority of Americans support vaccinations.

It’s time for our politicians and public health officials to recognize this and coordinate effective PR and media campaigns to highlight the good that vaccination campaigns provide.  Increased pressure should be placed on media members to get the story right and counter news stories showcasing anti-vax parents—a small, but highly vocal minority.  Perhaps this can stem declining public support for vaccinations.

These are just four of many ways that public health could be pushing back against anti-vax propaganda. But amidst increased exemptions and outbreaks, politicians and public health leaders appear content to sit back and do the same old routine that isn’t working—or ignore it entirely in the face of lobbying by small groups of misguided activists.

Without more assertive action from politicians and public health leaders, preventable disease outbreaks will be increasing in frequency and severity throughout the US, risking lives and costing tax dollars needed to be directed to other issues. To prevent this future, the best defense is a good offense.

Richard M. Carpiano is Professor of Public Policy and Sociology at the University of California, Riverside. He is also a faculty affiliate of the Center for Healthy Communities in the UCR School of Medicine.

Jason Chung is the Co-Founder of The Deductible and a faculty member at New York University’s Tisch Institute for Global Sport.

12 thoughts on “The Best Defense is a Good Offense: Why Public Health Officials Need to Get Tough on Vaccination

  1. Gentlemen, thank you for this timely post. My aunt died of measles in 1938 and my father almost did as well. Measles is serious and deadly. People seem to have become cavalier about these diseases. This is now a public health issue in need of attention.

    1. Thanks, Niran. I’m also amazed at how complacent the public health field has been on the issue of vaccination. They seem content to just sit back and not contribute to “fear-mongering”.

      I don’t know what they’re waiting for – we’re seriously at risk of things like polio coming back in places like Brazil. I’d saying we’re overdue for a little fear.

  2. Appreciate the dire situation, but I don’t agree that cheap propaganda should be counteracted with equally cheap propaganda, plus censorship.
    Public health entities can and should launch a campaign to INFORM people on the FACTS. People fall pray to anti-vaxxer histrionics because they lack the facts, such as research results. So, by all means go big and go creative (on TV during the Super Bowl would have been nice), but don’t stoop to psyops, because a) it’s disgusting, and b) it may have the opposite effect on people who can see through the BS.

    1. Appreciate your view, Margalit, but I hardly think that demonstrating the real effects of measles and childhood diseases equates histrionics. The problem is that facts can’t always fight feelings and visuals of the real, actual effects is not BS – it’s reality.

      1. Sure, if you want to put pictures of kids with measles, fine, but I think there’s a different thing playing out, and remember that at least in America the anti-vaxxers are otherwise pretty well educated.
        I don’t know about other people, but when confronted with autism and mercury and what have you, I don’t have a response at my fingertips. I don’t have studies and statistics off the top of my head to hurl back. All I can do is point to all my well-vaccinated kids and that’s not enough.
        I’m sure the CDC has the stuff somewhere, but the public doesn’t. I would make TV ads with factual stuff like that, dynamic graphs, crashing myths, talking squirrels, whatever, good music. Something memorable.
        Maybe some rich creative types can be convinced to organize a multi-channel campaign, seeing how they all love to throw money and talent around for useless virtue signaling projects….. 🙂

  3. we need to accept that the information model has changed irrevocably

    the old top down “The Surgeon General has determined ..” is broken

    – u will be challenged
    – people will accept laughable arguments
    – bad ideas will travel

    how u respond is everything, or more harm than good

  4. Say it again! Louder, for the people who are partially deaf thanks to measles.
    As someone who combats the misinformation on social media regarding vaccination (daily), this article highlights one of the major obstacles to promoting vaccine safety and efficacy: where are CDC, WHO, HHS? Where are the policy makers?
    If you take a look at the CDC and WHO Facebook pages, you will find that these organizations are great about posting articles, information, and links on immunization facts and statistics, but the comments, on every single post regarding vaccines, are a cesspool of anti-vaccine propaganda.
    Links to YouTube videos, sloppily done studies published in low/no impact predatory journals, retracted studies, articles from whale(dot)to, Learn the Risks, and NVIC- misrepresenting the findings of legitimate studies, and comments using cherry picked data from VAERS, the VICP, vaccine package inserts, and Supreme Court rulings. But you won’t find a single offical response from these pages. The comments giving incorrect information or linking to invalid sources are never deleted, and the handful of regular commenters posting this pseudoscientific nonsense are never muted.
    Very rarely will you see policy makers advocate for vaccination on social media or even in real life. Which, in my opinion, is understandable considering what anti-vaxxers do to any authority who speaks publicly in favor of vaccination. While their numbers are small, anti-vax “activists” are loud, and often the only ones heard when individual doctors, scientists, and policy makers speak to the importance of vaccination or attempt to introduce legislation that would mandate vaccines in certain circumstances.
    Something must be done, and I think it starts with public health agencies informing the general public that health and government officials need their support.
    Thank you for such a spot on call to action!

    1. I couldn’t agree more, Amber. As an MSN and Nurse Educator I’ve been fighting this battle along with my fellow RNs for nearly 5 years now, and I’ve been more than disappointed at the lack of response from the Surgeon General, CDC, and WHO. Whenever the CDC posts a piece regarding vaccines the AV crowd considers it a free for all. It’s high time the medical community comes together in a coordinated effort to put a stop to this dangerous nonsense.

    2. Thanks, Amber. I’m regularly amazed at the misinformation out there and how hard and passionately that it’s pitched. I think public health needs to take a good long look at its approach and stop pooh poohing effective communication strategies from other fields.

  5. Margalit, mercury has not been in the major vaccines for more than a decade and a half. I am actually a little disappointed by your response. There is NO link to autism. It is frankly ridiculous to even discuss. Autism is genetic and the studies show pregnant mothers taking antidepressants or even Tylenol during pregnancy are FAR MORE likely to have children with autism than anyone else.
    If people want to refuse immunizations for other reasons well, then let’s discuss it, but please do not propagate fear based on propaganda and false statements.
    I am probably overly sensitive on this subject — there is a child out there who may very soon be dying of measles in my state and in my county. It is too close to home right now.

    1. I know all that Niran, but my point is that I don’t know what to say to people that argue these things. I don’t know what to show them. I don’t know where the authoritative information resides. Sure, I can and I do say that the research shows all these things, but there is no easy to access and understand place to point people to.
      Anti-vaxxers are loud and can quote you all sorts of weird stuff, plus anecdotes, they heard about. Our side is not nearly as well equipped to have this debate.
      Now, you may dismiss the need to debate, because obviously they are crazy, but this approach has not been very effective, has it?
      There needs to be a well-funded and well-designed campaign to disseminate information. There isn’t one now, and that’s the point I am trying to make.

      1. thank you Margalit for clarifying. I thought for a moment I had entered an alternate universe because we tend to agree on most things. I feel so much better. Your point is well stated (now that I understand it). The approach I have taken for years is that I say my peace, and they say theirs. Then we follow the law, which currently allows personal exemptions. I don’t think arguing with anti-vaxxers advances our cause in any way. I do however find that once some anti-vax parents trust a physician, they are more willing to hear what I share with them and vice versa. it does increase the vaccination rates over time. Thanks again for making sense of your comments for me. 🙂

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