by Colin McRoberts

A while back a friend asked me to help with a difficult conversation. Someone she cared about was expecting her first child, and had decided not to vaccinate her baby. My friend desperately wanted to change the mother’s mind to protect that child. But she wasn’t sure how to proceed. She had the facts on vaccines, and knew that refusing immunizations was a dangerous and irresponsible decision. But she wasn’t sure how to convince her friend of that without jeopardizing their relationship. There are some excellent resources for health care providers having this conversation with patients. But there wasn’t much that applied to her particular situation. So she asked me whether my experience as a negotiator gave me any insights that might help her plan for what was sure to be a difficult conversation.

As it happens, I had been thinking about the same thing. I’m particularly interested in how laypeople should approach a conversation like this, since laypeople can be much more persuasive than the family physician. In the real world, our family and trusted friends very often carry more weight than experts. The giant but useless homeopathy industry would collapse otherwise. So when you hear that one of your friends or relatives doesn’t plan to vaccinate, you have the opportunity for a conversation that could potentially change their mind and save that child from terrible harm.

Unfortunately, too many people approach that conversation timidly, without a solid strategy for persuading their friend. That makes it hard to respond when things take an unexpected twist, such as your friend spouting off antivaxer talking points you hadn’t considered. Other people are too aggressive, treating the conversation like the comments section of a blog post. That kind of combative and confrontational dialog can feel good, but it doesn’t accomplish much in the real world.

So what does a strategy for an effective, persuasive conversation look like? There is a world of advice we could give about that conversation. We’ve distilled it into four basic points: be sincere, ask questions, be sympathetic, and provide information.

After the fold, we’ll go into some specific thoughts about each one. We want to stress, though, that this is just a framework. The conversation itself will be different every time. We want to know more about your conversations. If you’ve tried to talk someone into getting a child (or themself) immunized, please share your story in the comments section.



Why you need a strategy

Parents who refuse vaccinations don’t make that decision in a vacuum. Anti- and pro-vaccination voices compete for their attention and trust, and each unvaccinated child is a casualty of that war of influence. Antivaxers have an advantage because they only need to create the impression of a legitimate controversy—the appearance of reasonable doubt—to scare some parents out of vaccinations. Pushing back against that scaremongering requires both good information and good rhetoric. The scientific data on their own, dry and out of context, can’t compete against antivaxers’ scary anecdotes. Pure rhetoric, like you’d find in a hot online debate, only reinforces the impression of a legitimate controversy. To be effective you need a plan for presenting solid facts and doing it in the most persuasive way possible.

This is an attempt to create a framework for your strategy. It’s a long post because there is a lot to go through, but we’ve broken it down into four key elements: sincerity, questions, sympathy and information. Please note that although I refer to mothers throughout this discussion, the same points are applicable to fathers and anyone else with a say in a vaccination decision.

Remember, this is only a framework, not a script. Every conversation will be different. As you read through these thoughts, consider how they apply to the conversation you’re planning to have. If you have questions, don’t hesitate to leave a comment. We’d like to keep updating this guide, and create a more useful pocket version of it, as we get feedback from people using it in the real world.

SINCERITY



Sincerity means going into the conversation openly and honestly. You will kill your credibility if your friend ever feels like you were deceiving or trying to manipulate her. That can be tricky because antivaxers will tell her that whatever information you give her in support of immunizations is a lie. Show her that you can be trusted to protect your relationship with her, your credibility with her, and your ability to persuade her.

Be honest. Be straightforward and direct. Tell your friend that you’re concerned about her decision not to vaccinate, and that you want to talk about it. Assume that she isn’t stupid and won’t be deceived if you try to beat around the bush, so there’s nothing to lose by being upfront about your motives. But make it clear that you want to have a conversation, not to lecture her. Explain that you want to hear more about her reasons for not vaccinating, and show that you’re willing to listen rather than just talk.

Your friend should understand that you want to change her mind, and that you think her decision is wrong. (She should also know that you want to understand her position; we’ll focus on that next.) Assume that she’ll find out all of your motives sooner or later—she shouldn’t be surprised when she does.

As the conversation progresses, don’t pretend to have more knowledge or expertise than you really do. It’s ok to be a layperson. After all, almost all antivaxers are. As we’ll discuss later, you can help your friend discriminate between reliable and unreliable expert opinions without being a doctor, nurse, or scientist yourself.

Don’t expect miracles. Your friend knows that vaccination is a Big Deal. If she’s decided to postpone vaccinations, or to reject them altogether, she’s very likely already thinking of it as a fairly momentous decision. Even worse, she may have convinced herself that she’s taking a brave stand defending her child. Confirmation bias will make her reluctant to reconsider that thinking.

The more it seems like you’re applying pressure, the more she will resist it. You may not be able to change her mind on the spot, and you should not expect to. Treat the conversation as a chance to sow seeds. Show her how to discriminate between trustworthy scientific information and hysterical scaremongering, and trust that she’ll be thinking about what you say long after the conversation is over. Be patient and try to stay involved in her decision-making process to the best of your ability.

You might even consider telling your friend your expectations outright. “I really hope this conversation persuades you to get the vaccinations done, but I’ll be happy if we can just talk about it. I think I can give you some interesting resources, and I’d really like to understand where you’re coming from.”

Talk face-to-face. If you can, have the conversation in person. This will take some of the edge off of what could be a difficult conversation. It will also give you a lot more information, since you’ll be able to read some of her body language: does she look engaged when you speak? Skeptical? Upset? How animated is she when she discusses her sources of information, and what does that tell you about how she sees each one?

Be careful about your own body language as well. Hold yourself upright and look her in the eyes. This is important because body language and other forms of non-verbal communication are often more credible than words. Telling someone that you care about their well-being is fine, but it has more impact if you’re leaning in slightly with open body language and good eye contact as you say it. At various points in the conversation, mirror your friend’s body language: if her legs are crossed, cross your legs, and if her chin is in her hand, do the same. Be casual about it. This is a great way to signal that the two of you have a strong connection, which can enhance your credibility.

Don’t fake it. Don’t get involved in a conversation like this because you want to be right, or because you want to prove a point. You’re very unlikely to persuade anyone that you want the best for them and their family if it isn’t true; you’re more likely to make them defensive hostile to your position once they realize you’re being disingenuous. Strategies like mirroring body language aren’t going to help you deceive anyone, they’re simply a way to reinforce the truth of your good intentions. If you don’t actually have a good connection with her, don’t pretend that you do. Try to build that connection instead. One way to do that is to focus on what she believes.

QUESTIONS



Ask lots of questions and take the answers seriously. You’re trying to be persuasive, and people respond better to back-and-forth discussions than to one-sided lectures. You need to make your friend’s thoughts about vaccination a fundamental part of the conversation. To do that, you have to understand her beliefs. Do not assume that you understand those beliefs, ask her about them. There are two reasons for that:

First, if you assume that you understand the bases for her decision you are likely wrong. We tend to think that other people’s beliefs are simpler than they really are, but most people pack a lot of nuance into their strongly-held and controversial beliefs. Unless you’ve already had a conversation about her reasons you probably don’t understand them as well as you think you do. Once you do understand them, you can start to answer those beliefs by refuting them or giving her your own arguments—just don’t jump the gun. Make sure you understand her first.

Second, you want your friend to know that you truly do understand and care about her concerns. You don’t need to agree with them, but you need to send the message that you take them seriously. (And you should. Her fears are real even if they aren’t well founded.) Just telling her that you respect her beliefs isn’t enough, and frankly it sounds stilted and awkward as part of a conversation. Show her that by listening attentively and asking questions about her beliefs. It’s a more natural and more credible way of sending that crucial message.

Reflect her responses.“Listening attentively” is much harder than it sounds. You will be tempted to brush past her answers to get to your counterarguments. That would be a serious mistake. Instead, try reflective listening. Pay careful attention to what she says, and then summarize it back to her. This not only corrects any miscommunications, it sends that very credible message that you are listening to and understanding her position. The reflected answer shouldn’t be argumentative, because at this point you’re simply trying to understand her position and create a rapport.

Ask open-ended questions. Your questions should invite a conversational answer rather than a yes-or-no response. That’s important because it discourages your counterpart from answering with canned remarks they picked up from antivaxers, and encourages both of you to think about her answer. It also gives you more substantive answers to reflect back to them and to use as a basis for follow-up questions. The result is more, and better, communication.

For example, “Don’t you want to protect your baby?” isn’t a very productive question. The answer is very obviously “yes,” so you’re not learning much from her response. She’ll feel (correctly) like you’re putting pressure on her, and she may fire back with a ready response like, “Yes. And I’m going to do that by not letting people like you talk me into shooting toxins into her.” You’re trying to start a conversation, but that would be the end of it. A better question would be, “How can you tell whether a vaccine is safe?” That would open up a more informative and more productive dialogue.



You aren’t interviewing your counterpart. You should put some thought into the questions you want to ask before the conversation begins, but the discussion should flow naturally from one to the next. Reflective listening can help with that, because it makes it easier to segue from one question to the next.

Don’t be afraid of silence. Your friend may not be very forthcoming with her answers. That’s OK. It’s still important to ask questions, because it signals your interest and respect. You can use silence as a tool to encourage her to answer with more detail. This is an old and very effective negotiation tactic. Once or twice during the conversation (not constantly!) be silent when she finishes answering a question. Don’t stare them down and or be dramatic about it, just don’t react when they finish talking. A couple seconds of silence can encourage them to keep talking to fill the void. Often they’ll do so reflexively, without thinking about what they’re going to say. The result is a more free-form and less scripted answer, which can be a great way to break through the script in someone’s head. Hopefully the result will be a fuller, more honest conversation on both sides.

SYMPATHY



Here we simply mean that you should be giving the other person a friendly ear and positive advice rather than trying to berate her. Playing bad cop will jeopardize your relationship with her, and make it harder to persuade her. That can be hard if you strongly feel that her decision is dangerous and irresponsible; it isn’t easy to be sympathetic towards someone who is endangering a child. You must understand that she isn’t wicked, insane, or stupid. She has reasons for her choice that feel right and logical to her. Most likely she’s simply trying to balance many different competing perspectives on vaccines, and doing a poor job assessing their relative credibility.

Consider a hypothetical counterpart. While she’s intelligent and well-educated, she may not have any kind of scientific background. She’s getting her information about vaccines from the internet, friends, family, and her pediatrician. While you might think that she would consider her pediatrician’s opinion above all the non-expert voices in her life, most people don’t think that way. We tend to give more credibility to the people we know and like rather than the best-educated and most expert opinions. That’s why “playground conversations” between young parents are so incredibly influential.

For example, your hypothetical friend’s pediatrician is probably telling her to vaccinate her child. But she may also be hearing contrary advice from friends and family. It’s harder to disregard that contrary advice, because she cares about and spends a lot of time with those people. The pediatrician is easier to ignore because she’s not as present in your friend’s life. It’s much harder for her to ignore her own community.

Another problem is that it’s relatively easy to disregard someone, like the pediatrician, who is making her feel bad about her choices. If someone makes her feel defensive, she may take refuge mentally by deciding that person isn’t credible. That just pushes her more towards the people telling her that she’s a hero for not immunizing her child.

All the antivaxers have to do is persuade her that that there’s a reasonable chance that they’re right. That’s much easier if they’re the sympathetic voices. Deny them that power.

Don’t be afraid to talk about risk. The concept of risk, the fear of something going wrong, is a tremendously powerful motivator. Use it carefully. You should inform your friend, to the best of your ability, about specific risks that are relevant to her situation and her priorities. You should focus on her priorities rather than the things you think she should care about.

For example, your friend may tell you she really doesn’t care very much about public health outside of her child’s immediate welfare. That’s a powerful hint that explaining the dangers of losing herd immunity probably won’t be very persuasive to her, no matter how important you think it is. You’ll simply make her defensive, since she’ll feel like she’s being accused of not caring about her neighbors, without actually shifting her opinion on vaccines. On the other hand, if you know that she’s planning on a larger family, you might want to discuss the fact that unvaccinated older siblings can pose a serious risk to developing fetuses.

Don’t be a bully. When you talk about risk, give her your arguments and then, unless she invites you to keep going, move on to something else. Dwelling on negative concepts like risk makes people defensive and difficult to reach. For example, the more you reiterate that an unvaccinated child risks missing more school days or even death, the less sympathetic you become. She’s going to feel like you’re pressuring her, or even bullying her, if she gets the impression that you’re rubbing her face in the risks.

It’s natural for someone under pressure to find an escape hatch, something that lets her disregard what you’re saying. For example, she might decide that your information ultimately comes from the scientific establishment. If she takes the position that Big Pharma has corrupted all the data for its own selfish goals, then she doesn’t need to take the risks you’re talking about seriously. That alleviates the pressure you’re putting on her and corrodes your credibility with her.

When you raise risks like these, you should do it in a simple and concise way and then move on to a different part of the conversation. You don’t need to reiterate the risks if it seems like she doesn’t take them seriously—repeating yourself won’t change that. It will only increase her sense of being pressured. Give her the information about the risks and trust that she heard you. The effect might be subtle and long-term rather than immediate, and that’s OK.

Emphasize the positive. Since you’re not dwelling on risks of not vaccinating, focus on the benefits of vaccination instead. You can absolutely dwell on those. Whereas we want to minimize the discussion of risk, you should find as many ways as possible to articulate the benefits. Help her understand that she is protecting her child from harm, protecting herself and her other children from contagion, protecting other peoples’ children, educating herself about the scientific process, supporting public health, helping defeat dangerous diseases, etc.

You don’t need to be as specific here. You can and should raise benefits you think your friend hasn’t thought about, or doesn’t care very much about. Going back to our example of a parent who doesn’t care enough about strangers’ health to vaccinate her child in the name of herd immunity, you might still want to explain to her that the vaccination will help protect other children. Even if those strangers are still not a high priority for her, you’re giving her a reason to feel good about herself if she makes the right decision. You always want to be incentivizing the right decision, so you can be fairly broad when discussing the benefits of vaccination.

You should also use this as an opportunity to refute antivaxer scaremongering by stressing how safe vaccines are. She’s not increasing her child’s odds of autism, vaccines have been proven overwhelmingly safe, vaccine ingredients are safer than the ingredients in most Sunday dinners, and so forth. Sometimes vaccine advocates accomplish both goals at once by analogizing vaccines to car seats: they make children much, much safer while imposing a negligible additional risk. Some children do get hurt when they get twisted up in a car seat’s straps, but the seat is much more likely to save their life than injure them. We’ll talk more about information like that a little later on.

Beware of scary stories. The facts on vaccinations aren’t in doubt. The expert consensus is that their benefits vastly outweigh their potential harms. But that doesn’t matter to your friend if she doesn’t trust the experts. She’s making a credibility determination, and stories about mothers watching their child become autistic the day of a vaccination carry a lot more weight than anonymous experts. Those stories aren’t scientifically plausible, but they are very sympathetic and that makes them emotional heavyweights.

Confront that storytelling strategy. Explain to your friend why she should not be persuaded by another parent’s mere belief that a vaccine gave their child autism. For example, point out that there is conclusive evidence that vaccines simply don’t cause autism, and that noticing symptoms of autism after a vaccination does not mean that the vaccination caused the condition. Discuss the difference between correlation and causation.

You might also respond with stories of your own about the dangers of going without vaccinations. The CDC advises doctors to use anecdotes (as well as scientific data) when they speak to parents about vaccines. Here is an excellent example of what that looks like, in which the physician discusses the story, the science, and the psychology of vaccine refusal. This can be a very effective strategy.

Anecdotes are most useful for physicians and other experts, who have more exposure to real-life cases and are more likely to be armed with a useful story. They also have the experience and expertise to explain the hows and whys of their stories. If you are a layperson, you should be careful about using anecdotes.

First, your own personal experiences are drawn from a limited source—the things you’ve seen and done. But the internet is full of “it happened to me” horror stories about vaccines. And while those stories are unsubstantiated, unreliable, and untrustworthy, they are also scary as hell. You’ll have a hard time coming up with a credible anecdote to match them.

Another risk is that scare tactics are a high-pressure strategy. You should be very careful about applying pressure in a conversation like this. It’s more likely to make your friend defensive and confirm her in her beliefs than to persuade her to change her mind.

In other words, anecdotes about the risks of not vaccinating can be a wonderful tactic for physicians, nurses, and other people with serious and relevant credentials. The rest of us need another foundation for our arguments: objective facts.

INFORMATION



There are so many sources of facts and “facts” competing for your friend’s attention that you might not make much (immediate) progress throwing additional information at them. But you should nevertheless give her good, solid, factual information that supports your argument. There are some things to be wary of, though.

Be accurate. Your counterpart may be looking for a reason to ignore your position, either due to confirmation bias or simply because she doesn’t want you to be right (since that would imply that she’s endangering her child). She may also be talking to antivaxers who will hunt for ways to discredit you. In either case, your position is in jeopardy if you have misrepresented any facts.

Protect your credibility by being accurate and honest. Make sure that the information you share is the best information out there. If you don’t know an answer or haven’t read a study, admit that rather than bluffing. (And for those of us who aren’t scientists or doctors, learn how to read those studies.) Even if you think that an answer could be used against you, such as admitting that there are known side effects to most vaccines, be straightforward and honest. You’re trying to persuade her, not manipulate her.

Make it relatable. This RN’s article about the flu vaccine leads off with an excellent example of making information relatable: “Last year 169 children died from influenza. To put that number into perspective, that’s more than six Kindergarten classes.” The raw figure is alarming, but the way she personalizes it makes those children more than just a number. She gives that fact emotional weight and makes it memorable and affecting. Whenever possible, do the same thing with the facts and figures you use to support your position. The simplest way to do that is to explain what every fact means, so that nothing stands alone as an abstraction or confusing number.

Be specific. It’s best to provide information that addresses your friend’s concerns as specifically as possible. Someone who is worried about autism doesn’t need or want to see the same facts as someone who’s worried about fetal tissues in vaccines. If possible, be armed with facts that specifically answer your friend’s worries.

If you don’t know exactly what her concerns are in advance, don’t throw the encyclopedia at her. Ask questions, find out what she is worried about, and continue this part of the conversation when you can respond with specificity. In other words:

Be patient. The facts you give her aren’t going to win her over right away. These aren’t “gotcha” moments. Think of them as seeds. Give her information she can mull over and that will affect the way she interprets the data she gets elsewhere. For instance, if you know that your friend is concerned about autism, you might explain that Andrew Wakefield, who popularized many myths about vaccines and autism, is not a credible source. Be sure to explain why. With that information in the background, she’s less likely to be persuaded if someone else tries to use Wakefield’s name to scare her later. You won’t see the results immediately, in your conversation, but you’re helping provide a critical tool to help her to discriminate between reliable facts and crackpottery.

Rely on experts. The most important information you can give your friend is guidance on how to distinguish informed opinions from nonsense. This won’t be easy, especially if the informed opinions are contrary to her established position—confirmation bias will encourage her to disregard inconvenient experts. But it’s necessary to push back against the antivaxer use of phony experts and bad information.

First, make it clear who the real experts about vaccines are. Antivaxers have lots of spokespeople and cheerleaders for their misguided cause, but very few qualified experts. Jenny McCarthy famously said “My science is Evan, and he’s at home. That’s my science.” Ten out of ten for sympathy, but it’s also an admission of abject, irresponsible ignorance. Real experts use science as their science. They are the researchers who study vaccines, the physicians who administer them, and the epidemiologists who track outbreaks of preventable diseases.

Make sure your friend is aware that among the real experts, there is no genuine dispute about the safety or efficacy of vaccines. You can reinforce that point by providing the sorts of informational resources we’ll discuss later on, but it’s important that you remind your friend that the evidence simply doesn’t support antivaxers’ scary rhetoric. If it did there would be more scientists in the Canary Party and fewer Jenny McCarthys.

Defend expertise. Antivaxers know there is a tremendous imbalance of expertise in this fight, and push back in a few different ways. One is to try to convince laypeople that experts don’t really know very much, or don’t know as much as a mother’s intuition. You can respond by emphasizing the real-world value of expertise. Remind your friend how much we rely on experts in our daily lives, from plumbers to heart surgeons. Contrast antivaxers’ lack of credentials, studies, and tested information with the sound science that supports vaccines. Remind her that doctors and scientists study the safety and efficacy of vaccines using the same methods they use to test antibiotics and anesthetics, and that no one has ever shown that vaccines are more dangerous than those medicines. Would she trust a layperson who told her to ignore the experts and refuse penicillin for her child?

As you’re defending expertise, there are a few of things to bear in mind. First, be careful of your tone. Make sure your defense of expertise doesn’t come across as belittling laypeople. There’s nothing wrong with laypeople working to understand complex issues (that’s likely your personal situation, after all). When laypeople dispute technical issues with experts, though, the experts are usually right.

Second, acknowledge that experts can be wrong. But that doesn’t mean that they are wrong. Antivaxers have had many years to make a case that the expert position on vaccines is wrong, and have consistently failed. Meanwhile, almost every real expert who has investigated vaccines has concluded that they are effective and safe. There are always outliers, and always will be, because experts are people too and tend to fall along a spectrum of opinions. But that just means that the consensus position is constantly being tested. The fact that it’s constantly being proved right is a powerful testament to vaccines.

Finally be forewarned that antivaxers have a few MDs and PhDs they can trot out to demonize evidence-based medicine. (And far more naturopaths and homeopaths, which your counterpart may lamentably find equally persuasive.) But if your friend is tempted by a rogue doctor’s credentials, remind her that it simply reinforces the weight of the vast majority other doctors with the same credentials who support vaccination.

Provide factual resources. Finally, give your friend the resources she needs to find her own facts. Research she does herself will be more memorable and more credible than information you hand her on a silver platter. If she has the patience and willpower to review vaccine studies for herself, give her the tools to do so effectively. Most people would rather get scientific information filtered and synthesized through others, though, so help steer her towards reliable and unbiased sources. Some good starting points:

http://www.cdc.gov/vaccines/vac-gen/common-faqs.htm

http://www.immunize.org/handouts/vaccine-questions.asp

http://www.mayoclinic.com/health/vaccines/CC00014

http://www.fda.gov/BiologicsBloodVaccines/Vaccines/

Stress that these are unbiased sources, to the extent that any source can be unbiased. Antivaxers often claim that pro-vaccine sources are corrupt, but the CDC and FDA exist to promote public health, not sell products for “Big Pharma.” Antivaxers themselves have their own biases, of course. Jenny McCarthy garnered quite a bit of free publicity from her stint as the cover model for preventable diseases. Perhaps more importantly, she got to feel like a hero without having to do any of the hard work. Professional and government agencies are hardly infallible, but they are subject to the kind of public scrutiny that makes them much more trustworthy than fringe anti-science groups.

AFTER THE CONVERSATION



Once you’ve had your conversation, you aren’t done. Try to stay involved in her decision-making process as much as you can, without being overly intrusive. You’ll have more opportunities to help her make the right decision as time goes on. You also have an opportunity to influence other discussions by sharing your experiences here and elsewhere. Please leave a comment and tell us how you’ve persuaded someone to vaccinate, or how a conversation like this went wrong. We’d like to continue refining this guide over time, and your feedback is an invaluable part of that process.

Colin McRoberts (@Kolyin) is a Texas attorney and consultant

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