Smart framing can increase immunization rates

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The measles outbreak that began in West Texas in late January has led to more than 400 cases, at least 70 hospitalizations, and the first U.S. deaths from measles in a decade. Low confidence in vaccination in the affected region means the outbreak could last for at least several more months.

This preventable emergency has been fueled, in part, by misleading messages about vaccines that have contributed to the measles vaccination rate among children dropping below the 95% “community immunity” threshold nationwide, and far lower in areas like West Texas. This puts everyone at risk of outbreaks of vaccine-preventable diseases.

One way to address vaccine hesitancy is by having conversations with friends, family, neighbors, and anyone in our broader networks influenced by myths about immunization. These conversations can provide an antidote to vaccine misinformation that exploits parents’ concern for their children’s health-–but only if they don’t feel judged, ridiculed, or patronized. Otherwise, their concerns about vaccinations are likely to harden. That means what we say and how we say it really matter.

My colleagues at the FrameWorks Institute have conducted interviews, focus groups, and surveys about vaccines with more than 9,000 Americans since 2021. Our findings shed light on why myths about vaccines take root and offer strategies to fight back.

Step One: Understand the pictures in people’s heads

First, understand that thinking about immunization tends to rely on what we call “cultural mindsets” or “mental models.” These models are widespread, which means we can predict that most good-faith resistance to vaccination stems from these ideas:

● Personal choice is paramount. People believe vaccination is a highly personal choice because they control their bodies.

● Natural is better than artificial. People regard “nature” or “natural” as pure, safe, and healthy. By contrast, anything "artificial" that humans design (like vaccines) is viewed as inherently risky.

● The risk isn’t worth the reward. Since the benefits of vaccination are not immediately apparent, concern about side effects or adverse consequences gets prioritized.

Step Two: Bridge

Rather than simply dismissing these ideas, it’s more effective to affirm the person’s values and then “bridge” to the message you want to advance. Bridging is a way to acknowledge someone’s perspective without restating misinformation or engaging in a direct rebuttal, which rarely works.

Here are some ways to do it:

● “I hear that you care about freedom. I do, too. The freedom kids need to explore, learn, and grow starts with staying healthy.”

● “It sounds like you’re really motivated to keep your kids healthy. Can I share something I’ve learned about how the immune system works?”

● “You’re being so thoughtful about personal costs and benefits. For me, that brings to mind the costs and benefits to our community….”

Step Three: Pivot to Framing that Works

Emphasizing the tangible benefits of keeping kids healthy is more effective than explaining how vaccines protect children from disease. Our studies show that talking about risks reminds people of other risks they’ve heard of, such as side effects or unknown long-term consequences. Because the effects of a vaccine working are invisible (a disease that doesn’t happen), it’s important to help people visualize the benefits in concrete ways. To shift to this promotion frame, connect vaccination to the benefits of kids staying healthy: going to school, playing with friends, or participating in their favorite activities. Talk about the good that comes with children being healthy now and ultimately living a long life free from the consequences of a serious illness.

Using metaphors can also open minds to new ways of thinking. Two are particularly effective: software updates and early literacy. Each prompted more attention to the collective benefits of widespread vaccination while reducing concerns about supposed safety risks.

To explain how vaccines strengthen our immune systems, compare them to computer or smartphone updates. Just like software updates protect computers and phones from network viruses, vaccines protect our bodies from viruses in nature. This metaphor increased parents’ sense of the collective benefits of childhood vaccination by 8%, and parents’ sense of collective responsibility for childhood vaccination by 4%. Those gains may sound small, but they’re significant for this type of research. Even a few percentage points can make a big difference.

Comparing vaccines to “beginner books” that the immune system uses to “read” and “understand” a virus is also effective. Just like early “how to read” books help children develop lifelong reading skills, early vaccination allows children’s developing immune systems to recognize and provide protection against illness and disease.

Vaccine hesitancy is a tough nut to crack, and these strategies aren’t a magic wand. But they can open the door to different ways of thinking. All parents want what’s best for their children. If we avoid ridiculing or ostracizing vaccine-hesitant parents and instead use helpful frames that build deeper understanding, we can make an impact.

The West Texas measles outbreak is threatening more children and families by the day. It doesn’t have to be that way. The science behind vaccination is rock-solid. By leveraging the science of communication, we can help ensure that more children grow up healthy and safe.

Dr. Julie Sweetland is a sociolinguist and a senior advisor at the FrameWorks Institute.

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