Intended for healthcare professionals

Education And Debate

Concerns about immunisation

BMJ 2000; 320 doi: (Published 22 January 2000) Cite this as: BMJ 2000;320:240

The Facts Are Not Enough

Bedford and Elliman [1] provide a useful summary of the main evidence
supporting the safety and effectiveness of vaccines. The authors suggest
that their evidence-based refutations of erroneous beliefs commonly
expressed by immunisation defaulters may be useful in dispelling
their concerns. This assumes that those who express these beliefs are
simply mistaken and when exposed to counter-arguments they will realize

While we believe it will always be important for scientists and
health professionals to refute misleading information, there is little
empirical support for the hope that decision making about vaccination is
based on 'facts' alone. In their research on cognitive processes in
vaccination decision making, Meszaros et al demonstrated that when parents
opposed to the DPT vaccine were presented with factual information about
risks and benefits they became more committed to their antipathetic
position. This response was moderated by underlying values about death and
chronic disability. [2]

Our own research on anti-vaccination press reportage has shown that
manifest claims about vaccines being dangerous and ineffective tend to be
located under a canopy of more general discourses about cover-up and
conspiracy, manipulation by venal private enterprise interests,
governments with totalitarian agendas and the back-to-nature idyll. [3] We
argue that what generates the appeal of anti-vaccination claims is
underlying reference to these wider issues.

We are now undertaking qualitative research with parents and
immunisation providers in an attempt to explore the nature of the appeal
of both immunisation rhetoric and reassurances by providers. While this
work is incomplete, we have been impressed by how frequently parents in
focus group discussions are adamant that they want to be given the
"facts", but demonstrate minimal retention of "facts" when exposed to TV
items containing pro- and anti-immunisation
claims. What is retained, discussed and prompts strong responses from
participants are images of children who are allegedly vaccine-damaged. In
other words, the facts have little potency when competing with the very
emotive news stories found in the mass media. Any attempt at refuting
or deflating the persuasive power of vaccination arguments must address
the potential 'gut' level appeal at which anti-immunisation rhetoric tends
to operate.

What we have learned about immunisation science will be of no public
value ultimately if we ignore key lessons from health communication


1. Bedford H, Elliman D. Concerns about immunisation. BMJ

2. Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-
Buzaglo J. Cognitive processes and the decisions of some parents to forego
pertussis vaccination for their
children. J Clin Epidemiol 1996;49:697-703.

3. Leask J-A, Chapman S. 'An attempt to swindle nature': Press anti-
immunisation reportage, 1993-1997. Aust N Z J Public Health 1998;22:17-26.

Competing interests: No competing interests

25 January 2000
Julie-Anne Leask
Research Officer, Associate Professor, Senior Lecturer
Simon Chapman, Penelope Hawe
Department of Public Health & Community Medicine, University of Sydney