I just returned from an interesting small-group conference on discussions of vaccination risk in the era of Web 2.0 (full program is here).
The conference was sponsored by the Center for Empirical Research in Economics and Behavioral Sciences (CEREB) at the University of Erfurt in Germany and partially funded by the European Center for Disease Control and Prevention (ECDC). It included researchers in psychology, public health, communication, and medicine. These included people who have written about the impact of vaccine-critical websites and the types of statements made by anti-vaccine groups, how parents react to vaccine messages, and how vaccine risk perceptions relate to health behaviors.
One of the themes that emerged from the group’s discussions is the realization that Web 2.0 is subtly but importantly changing the way in which vaccination risks and benefits are communicated online…
Before the Internet, we learned about vaccination risks and benefits primarily through health professionals: public health messages directed specifically to us and conversations with our personal physicians. These communications were generally very directive: We were told to get vaccinated and that the vaccines were safe. Lacking other information, we had no reason to believe otherwise. Furthermore, we knew all about the diseases that these vaccines were supposed to prevent (things like polio, smallpox, and measles). We knew friends and family who had contracted or even died from these diseases. So, for the most part, we got vaccinated.
Two things then happened over time that have changed the world of vaccination communications.
First, vaccination efforts worked. They eliminated some diseases from the American experience (e.g., smallpox, polio) and vastly reduced the prevalence of many others (e.g., measles, pertussis, chicken pox). As the older generations who had lived through epidemics passed away, they were replaced by newer parents and adults who had never actually seen a case of the diseases they were being vaccinated against.
Second, the Internet closed the geographic distance, enabling people to learn information about vaccines, vaccine preventable diseases, and possible risks or complications from anywhere in the world. We can now easily look up statistics from the CDC or the World Health Organization on disease prevalence, side effects, vaccine recommendations, etc. Just look at how the world followed each and every step of the 2009 H1N1 epidemic as it spread from a few cases to a global phenomenon.
But, looking up static information is really first generation Internet, what is often called Web 1.0. Our conference focused on the impact of Web 2.0, the changes in the way the Internet is used that have occurred in the last 5-7 years.
If you look up Web 2.0 in Wikipedia, you get the following definition (or at least did when I went there yesterday):
The term Web 2.0 is associated with web applications that facilitate participatory information sharing, interoperability, user-centered design,[1] and collaboration on the World Wide Web. A Web 2.0 site allows users to interact and collaborate with each other in a social media dialogue as creators (prosumers) of user-generated content in a virtual community, in contrast to websites where users (consumers) are limited to the passive viewing of content that was created for them. Examples of Web 2.0 include social networking sites, blogs, wikis, video sharing sites, hosted services, web applications, mashups and folksonomies.
What does Web 2.0 mean for vaccination risk perceptions and risk communication? I can’t claim to represent everyone who was there, but to me, the discussion led to a few simple and related themes:
- Stories. Web 2.0 is user-generated content, and in the context of vaccination, that means lots and lots of stories. In particular, stories of parents whose child developed problems soon after vaccination. Whether or not these stories represent actual risks of vaccination is not the point here. The point is that the Web 2.0 means that our discussion has shifted from facts and figures to the language of narrative.
- Experience. I noted above that part of what has changed over the past decades is that many people no longer have personal experience with these diseases. This is important in a Web 2.0 world because Web 2.0 is all about experience. We go online to read the comments on articles or posts on social networking sites, and we thereby get a sense of the collective experience (or lack thereof) with diseases, complications, etc. We learn by sampling the set of things we read as much as by listening to what any one source says to us.
Decision and learning psychology has recently had a lot of theoretical work done in what we call dual process learning models. Some examples can be found here and here. The details vary slightly from one author to another, but the main gist remains the same. These theories postulate that we each have two parallel learning mechanisms.
- One is analytical, rational, and rule-based. This part learns facts and makes decisions based on that information.
- The second part is emotional and experiential in nature. This part pays attention to how we feel (does this feel safe?) and learns by repetition over time or space. This is the part that listens to the stories that we see in online vaccine discussions and tries to figure out how many of them represent good versus bad outcomes.
Web 2.0 is in some ways the triumph of experiential and emotional learning over cognitive rational thought. That’s not necessarily a bad thing. The emotional / experiential system is very powerful, and when it learns something, it learns it well. But, it does mean that simply throwing more facts and figures into the debates about vaccination is unlikely to change anything.
This post is not about saying who is right or wrong in the vaccination debates. But, I do think we all need to recognize that Web 2.0 has changed the way in which we all learn about and consider vaccines.
Public health communications about vaccine risks (and forthright critiques of vaccines from others willing to engage in productive discussions) can’t just be about the facts anymore.
In the Web 2.0 era, a mother’s story of how her child developed a debilitating condition that she believes (accurately or inaccurately) to be the result of vaccination is always going to be emotionally powerful and influential now on a global scale.
If public health officials want to persuade those who will read the mother’s story that the should nonetheless support vaccination of their own children, such persuasion will likely require an equally powerful story with a pro-vaccination message. Perhaps one in which a mother learns of an outbreak of measles at her child’s school and then describes the relief she feels knowing her children have been protected. Perhaps one in which the experience of parents who watched their child develop pertussis in one of the present outbreaks is brought to life.
Data, statistics, and trials are always going to be important to the discussion of vaccination risks and benefits. But that type of information only appeals to one of our two learning processes. It can’t help us to imagine what it was like in the midst of epidemics, as our grandparents and ancestors did.
As a result, the discussion of vaccines and their risks in the Web 2.0 context can’t just be about having messages that appeal to our head. We also need messages that appeal to our heart.
Brian J. Zikmund-Fisher is an Assistant Professor of Health Behavior & Health Education at the University of Michigan School of Public Health and a member of the University of Michigan Risk Science Center and the Center for Bioethics and Social Sciences in Medicine. He specializes in risk communication to inform health and medical decision making.