Talking and Taking Vaccines in Tennessee

Watch Beth's TED Talk here:

While COVID-19 vaccines are safe and reduce the risk of severe illness, in my state of Tennessee, only 54 percent of the population is fully vaccinated (as of April 1, 2022). How do we boost that percentage? And how can science communication make a practical difference?

Part of the challenge involved in getting people motivated to get vaccinated relates to misinformation around the benefits and risks of the COVID-19 vaccines. Misinformation often stems from gaps in information or uncertainty surrounding the science available.  However, providing additional information to the public may not be enough to encourage widespread vaccination. 

For example, messaging campaigns that focus on correcting misinformation with accurate facts may fail miserably.  In one study, parents of children eligible for the measles-mumps-rubella (MMR) vaccine received messaging strategies refuting the claim that vaccines cause autism, while others featured graphic photos of children with measles. Contrary to what one might expect, these messages did not increase intent to vaccinate. In fact, seeing images of sick children increased the belief in a link between autism and vaccines.

What else can be done? What other forms of engagement can we use to build trust in communities to promote vaccination? One approach that may hold promise is to take a more relational style to science communication focused on understanding your audience and meeting them where they are. 

Here’s an example of this approach. Last year, I was talking with a friend who called to get my advice on whether she should get vaccinated. She asked me what she should do. While my tendency was to put on my physician hat (or white coat), and launch into my well-practiced pitch on why we all need to take the vaccine to protect our communities, I instead asked her about her concerns — and listened deeply. This relational style to science communication — listening to another person with curiosity and empathy — is described in Faith Kearns’ book, “Getting to the Heart of Science Communication: A Guide for Effective Engagement.” 

So what did my friend say? I expected to hear about her worries — an immediate reaction to the vaccine, such as fever and chills or headache and fatigue, or the unknown long-term side effects.  Several of my friends had brought up misinformation about vaccines changing DNA, so I was prepared to hear about that concern as well.  

I was surprised when my friend related that she felt the vaccine was a “political football,” and went on to say “half of my friends tell me I have to take it to protect my community, and half my friends say it is an infringement on my liberty, and that natural immunity from already having had COVID-19 is far more protective and less risky than the COVID vaccine.” She said she thought of herself as independent politically but was so jarred by the crossfire that she had avoided getting vaccinated. 

Having listened to her concerns, I related that I had received that feedback from my friends too. I then said, “you’re an independent — that’s great — does that mean you are an independent thinker?” She nodded. We talked about how it was her decision to get vaccinated, and how she should feel comfortable researching the topic and doing what she felt was best. I asked if I could send her some articles and talk again. In our conversation, I used many of the same techniques I use as a volunteer in Braver Angels: acknowledging common experiences, paraphrasing (“you’re an independent”), asking clarifying questions (“does that mean you are an independent thinker”), and asking for permission to share articles and continue the conversation. Braver Angels is a non-profit bipartisan organization focused on bridging the political divide, not just around COVID-19, but climate change, immigration, and other contentious  topics facing our nation.

I was careful to send my friend credible articles that tackled the uncertainty involved in the decision-making process: yes, there are still things we didn’t know about the long-term effects; and current studies suggest that the risk of serious illness from COVID-19 favors taking the vaccine, and why.  I painstakingly avoided sending any articles that were condescending toward specific political, religious, geographic, or other groups. 

I was elated when she called me a few weeks later to tell me she had taken the vaccine and was recommending it to others. 

Because of our conversation, I got involved in planning and creating a series of videos at my workplace to promote confidence in the COVID-19 vaccine in people with intellectual and developmental disabilities and their families. People with intellectual disabilities have the highest risk of having COVID-19 and, other than age, dying from COVID-19. For the videos, I drafted scripts and portrayed a physician on a video telehealth session talking with a Hispanic teen on the autism spectrum and her mom. 

Our goal was to communicate trust and emphasize that the choice to get vaccinated is a personal decision that every person or parent needs to make on their own, with advice from their health care providers. The content and tone of these videos was shaped by conversations we had with people from the groups we were aiming to reach. Rather than telling people what to do, what we thought was best for them, and figuring out the best messaging, we focused on understanding where they were coming from and drawing them into the dialogue. 

It can be easy to get discouraged by misinformation, but I’m convinced that one can change hearts and minds in communicating science by taking the time to listen with curiosity, understand another’s perspective, and build trust.

Further Reading

COVID-19 Vaccines Work. Retrieved January 15, 2022 from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/work.html

Our World in Data. Coronavirus (COVID-19) Vaccinations. Retrieved April 1, 2022, from https://ourworldindata.org/covid-vaccination

Centers for Disease Control and Prevention. How to Address COVID-19 Vaccine Misinformation. Retrieved April 1, 2022, from https://www.cdc.gov/vaccines/covid-19/health-departments/addressing-vaccine-misinformation.html

Escaping Catch-22- Overcoming Covid Vaccine Hesitancy. Retrieved January 15, 2022, from https://www.nejm.org/doi/pdf/10.1056/NEJMms2101220

Nyhan B, Reifler J, Richey S, Freed GL. Effective Messages in Vaccine Promotion: A Randomized Trial. Pediatrics 2014; 1:133(4), e835-42. Retrieved January 15, 2022, from https://web.missouri.edu/~segerti/3830/Pediatrics-2014-Nyhan-e835-42.pdf

Kearns F. Getting to the Heart of Science Communication: A Guide for Effective Engagement. Retrieved January 15, 2022 from https://islandpress.org/books/getting-heart-science-communication.

VUMC Discover. Facts on Vaccine Decision Examined by People with IDD and their Families. Retrieved January 15, 2022, from https://discover.vumc.org/2022/01/facts-on-vaccine-decision-factored-in-by-people-with-idd-and-their-families/

Gleason J, Ross W, Fossi A, Blonsky H, Tobias J, Stephens M. The Devasting Impact of COVID-19 on Individuals with Intellectual Disabilities in the United States. NEJM Catalyst, March 5, 2021. Retrieved January 15, 2022 from https://bit.ly/39bcYIS

Beth Malow, MD, MS

Beth Malow, MD, MS is a physician and Professor of Neurology at Vanderbilt University Medical Center in Nashville, Tennessee. She holds the Burry Chair in Cognitive Childhood Development, directs the Vanderbilt Sleep Disorders Division and also serves as Core Director for Clinical and Translational Research in Intellectual and Developmental Disabilities at the Vanderbilt Kennedy Center.