Measles appeared as the villain in the latest episode of the CBS show Madam Secretary. The story arc captured the risks of vaccine hesitancy — and it showcases the power of a fictional TV show to communicate facts.

The episode is timely given measles’ presence in the news lately. Outbreaks have been spreading across the country, and tech giants Facebook, Google, and Amazon have come under fire for allowing anti-vaccine misinformation to spread on their platforms. But the timing is just a coincidence, according to the show’s executive producer David Grae. Even before measles started making news in 2019, the Madam Secretary team had an episode about vaccine hesitancy in the works. “We all know about this idea of anti-vaxxing and how dangerous it is,” Grae says. “The idea that we could lose our herd immunity — we really need responsible leadership around the world to make sure that doesn’t happen.”

“We all know about this idea of anti-vaxxing and how dangerous it is.”

One of the main storylines in the episode centers on the Secretary of State’s press coordinator Daisy Grant (played by Patina Miller), who comes back from a cruise only to wind up in quarantine with her young daughter Joanna. They discover that Joanna’s friend, another child on the cruise, hadn’t been vaccinated and became infected with measles during the trip. Joanna had received one dose of the measles, mumps, and rubella vaccine, which the show explains is 93 percent effective: Joanna falls into that remaining 7 percent. She pulls through, but Joanna’s unvaccinated friend suffers from a measles complication called encephalitis that gives her brain damage.

Madam Secretary is, of course, fiction. But fiction may be a good vector for fact — at least, when it’s done right, according to Beth Hoffman, a research assistant at the University of Pittsburgh’s Center for Research on Media, Technology, and Health. Hoffman and her colleagues are looking into what viewers learn from medical storylines on television. And in a few different papers, they report that TV shows are especially good at engaging students and the general public, for better or for worse.

“Entertainment narratives have an effect on viewers’ perception, knowledge, and ultimately their health behavior.”

In one paper, they dug through the scientific literature to find a handful of studies investigating what viewers take away from medical dramas like Grey’s Anatomy. There aren’t many studies out there. But their review of the research, published in the journal Health Education Research in 2017, reports that people do absorb medical messaging from TV and might sometimes even change their behaviors based on what they see on screen. “Entertainment narratives have an effect on viewers’ perception, knowledge, and ultimately their health behavior,” Hoffman says. While she doesn’t know of any studies about vaccine messaging in particular, she says, “There’s good reason to think that storylines about vaccine-preventable diseases can have a positive influence on individuals’ perception of vaccination.”

Madam Secretary’s Grae says the whole team felt that responsibility and wanted to get their facts right — particularly when they surround a contentious issue like vaccines. “It wouldn’t be artistically responsible to leave room for, ‘Oh well maybe it’s okay not to vaccinate,’” he says. “And when you want to get it exactly right, Googling isn’t enough. It’s never enough when you have real-world issues.”

“It wouldn’t be artistically responsible to leave room for, ‘Oh well maybe it’s okay not to vaccinate.’”

So the show’s writers turned to Hollywood, Health & Society, a program at the University of Southern California’s Annenberg Norman Lear Center that helps bridge the gap between the entertainment industry and experts in health, science, and security. (There’s also a similar program at the National Academies of Sciences called the Science and Entertainment Exchange.) “We understand it’s fiction and we have to take some liberties,” says Kate Folb, director of Hollywood, Health & Society. But it’s important for public health information to be as accurate as possible, she says. “We don’t want to misinform audiences, because we know that they’ll act upon it.”

There are a few theories about why that is, Folb says. One is that immersion in a plot helps lower viewers’ intellectual defenses. “You’re rooting for your hero, you’re running through the forest with them. You’re right there with them,” Folb says. “So if and when information is presented, it sinks in on a much deeper level.” The other theory is that viewers may identify with and believe characters they connect with on TV shows, she says — which is why it’s so important for public health and science information to be as accurate as possible. “Because it’s soaking in when you’re watching it,” she says.

“We understand it’s fiction and we have to take some liberties.”

Vaccine expert Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine, says he’s consulted with Hollywood, Health & Society before, but wasn’t involved in this episode. And save for some minor quibbles — such as about the low likelihood of Joanna contracting measles even though she’d had a single dose of the vaccine — he applauded the way the episode handled measles and vaccine hesitancy. “It was really helpful that they showed measles as it is: as a serious disease,” he says. “They didn’t try to dismiss it as a benign illness or just a rash, and that’s an important point.”

The episode tackled a lot of important issues surrounding measles and vaccines, including misinformation, Hotez says. In the episode, the mom of the little girl who suffers brain complications from measles explains why she didn’t vaccinate her daughter. She’d thought measles had been completely eradicated from the US, and she was afraid of vaccinations because of articles she’d read. “There were all these articles about possible harm from vaccines, and then a study saying there was no proof, and then you read another article — and you don’t know what to think,” the mom says in the show.

“You don’t reach people by scolding them.”

The show’s writers and the characters they created treat this family with kindness: the parents aren’t blamed for infecting another child, or ridiculed for believing anti-vaccine propaganda. They’re treated as parents who want to do what’s best for their child, and who were misled by the proliferation of scaremongering anti-vaccination propaganda that’s out there. That was partly to stay true to the show’s recurring characters, and partly a conscious choice the Madam Secretary team made after talking with the experts at Hollywood, Health & Society, Grae says. “You don’t reach people by scolding them. You reach people by kindly explaining the truth without scolding or telling people they’re stupid.”

Reaching people is something TV is especially good at, says Hotez, who wrote a book about being a vaccine researcher and the parent of a child with autism called Vaccines Did Not Cause Rachel’s Autism. “Let’s face it. At the end of the day, many more people are going to watch this episode of Madam Secretary than are going to read my book,” he says.

The episode ends with a public service announcement, where Téa Leoni, who plays the Secretary of State, tells viewers to go to https://www.unicefusa.org/vax for more information. Ultimately, the team’s goal is to make a dramatic show, but in this case, they also had the chance to educate people. “That’s a win-win, that’s good for everybody. So we’re happy to do it,” Grae says.