For Christine Vigeant, being an anti-vaxxer was bigger than just the vaccine decision. And changing her mind was bigger than just one conversation.

When Vigeant was pregnant with her daughter, she had an idea of the kind of mother she wanted to be. Drawn to an alternative, attachment parenting style, she breastfed her daughter until she was 5, wore her in a carrier often, fed her organic food and swaddled her in cloth diapers. Vigeant saw forgoing vaccinations – and the toxins she believed lie within them – as a natural extension of alternative parenting.

The son of Bill Sears, one of the most well-known proponents of attachment parenting, wrote The Vaccine Book: Making the Right Decision for your Child, which health experts say reinforces vaccine myths.

"You just start thinking all of these things go hand in hand. The anti-vaccine belief became part of my mindset – part of a larger idea," she said. "And you can find anything on the internet to confirm your beliefs."

Vaccine hesitancy, defined as the reluctance or refusal to be vaccinated or to vaccinate your children, has been identified by the World Health Organization as one of the top 10 global health threats of 2019. Measles was declared eliminated from the United States in 2000, but now, just from Jan. 1 to Feb. 28, 2019, 206 cases of measles have been confirmed in 11 U.S. states, according to the Centers for Disease Control and Prevention.

Experts say people who are militantly anti-vaccine are rare. Those who are skeptical of vaccines are far more common, and they are the people, like Vigeant, who may be swayed.

"There are vaccine opponents who hate vaccines – you're not going to change their minds. They're in the minority of vaccine critics. They've heard all the facts and they don't care," said Arthur Caplan, a professor of bioethics at New York University. "Then there are the vaccine-hesitant – they're fearful ... but they're not closed off."

The anti-vax issue dominated headlines: a new decade-long study of more than half a million people found the measles vaccine does not increase the risk of autism – a chief fear among those concerned about preventative shots. A teenager who defied his anti-vax mother testified in front of Congress, saying she was misinformed by social media. Facebook announced it would reduce distribution of anti-vax posts, following the lead of Pinterest, which has blocked all searches using terms related to vaccines or vaccinations as part of a plan to stop the spread of misinformation. And on Friday the CDC released a case report that showed a 6-year-old boy who didn't receive childhood vaccinations nearly died after contracting tetanus.

Caplan said vaccine skeptics bring forward several arguments:

Vaccines are not safe (such as concerns they are linked to autism, which study after study has debunked).

It's a plot by big pharma (people are concerned pharmaceutical companies make big money off vaccines, but Caplan says companies don't make much profit off of immunizations).

It's about parental rights (parents don't feel people should be able to tell them what to do with their own children, but experts say this ignores community responsibility and other existing laws around child safety, including car seat and bicycle helmet laws).

Natural is good (the idea that vaccines are "toxic" and it would be better to contract the disease and/or build resistance naturally, but Caplan says science does not support this).

Jennifer Reich, a professor of sociology at the University of Colorado Denver and author of Calling the Shots: Why Parents Reject Vaccines, says distrust underlies a lot of parental fears.

"I think one of the things parents are grappling with is how much they trust government regulation, how much they trust information that they're given," Reich said. "Parents cited to me a similar distrust of food regulation or a similar distrust of chemical companies or ingredients in mattresses."

For many parents, she said, fear of the unknown outweighs fear of diseases they've never seen in their lifetimes.

How not to talk to an anti-vaxxer

Vigeant said when people tried to counter her beliefs with facts, it only made her more resolute. This is a well-researched psychological phenomenon. A 2010 study found trying to correct a person’s perception can have a “backfire effect.” When you encounter facts that don’t support your idea, your belief in that idea actually grows stronger.

Trying to convince someone that a deeply held view is flawed is an uphill battle. Human beings are hard-wired for bias. If you’re a new mom who believes vaccines cause autism, are you searching for research that shows whether they actually do, or are you Googling “vaccines cause autism” to find stories to affirm your belief? Likely the latter, which Charles Taber of Stony Brook University says is driven by “motivated reasoning."

“You have a basic psychological tendency to perpetuate your own beliefs,” he said “to really … discount anything that runs against your own prior views.”

It's why Vigeant was able to effectively use the Internet to find information that supported the beliefs she already held.

Vigeant also said when people who didn't share her views tried to persuade her that her beliefs were wrong, it felt as though she was being ridiculed. The scornful way in which she said facts were delivered was a barrier to her hearing them at all.

"When people were confronted with my anti-vaccine beliefs there was a lot of derision, a lot of attacks," she said. "We're called bad parents. That drives people away. It doesn't make them feel that their concerns are being heard, and it makes them retreat right back into that echo chamber."

What someone who is fearful of vaccines can hear

Arguments from someone who shares their identity: Vigeant says her beliefs about vaccines changed slowly. The seed was planted when a friend from South Carolina, where she gave birth to her daughter among a community of anti-vax parents, posted on Facebook that she had just vaccinated her kids. Like Vigeant, she also practiced attachment parenting. The post read, “I just had my children injected with toxins at the doctor’s office, but it’s okay, I gave them an organic lollipop afterwards.”

Vigeant said she watched as her friend gracefully chatted on Facebook with those fearful of vaccines, gently debunking myths, and always empathizing.

"Having someone from my own circle who believed in the same things I did questioning the dogma of not vaccinating was really helpful," she said.

Empathy, especially when it comes from someone with a personal connection: Susan Senator, an autism mom and author of Autism Adulthood: Creative Insights and Strategies for a Fulfilling Life, used to identify as anti-vax. Senator's oldest son, Nate, has autism. Her middle son does not. After she gave birth to her third and youngest son, Ben, she says she watched obsessively for signs of autism. She felt so many people around her had children who were being diagnosed (researchers say the disease was always there, but we're just doing a better job screening for it now). In 2018, the CDC found 1 in 59 children has been identified with autism spectrum disorder.

In an attempt to better understand what afflicted her oldest son and how to protect her youngest, Senator began to do her own research online, which is how she found the now-notorious 1998 Andrew Wakefield study in the medical journal The Lancet, which suggested the measles, mumps and rubella (MMR) vaccine may lead to developmental delays.

"Despite the small sample size, the uncontrolled design, and the speculative nature of the conclusions, the paper received wide publicity, and MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination," authors wrote in a 2011 paper on the fraudulent study. Wakefield's study has continued to stoke concern, despite being retracted in 2010. Wakefield has since lost his license to practice medicine.

But when Senator first read the paper, she could not have foreseen it would later be debunked. All she was thinking was that she was determined not to let what happened to Nate happen to Ben.

"It made me feel more pain, because I thought I caused this by letting him get a shot, and I vowed not to do that with Ben," she said.

Senator said she expressed her fears to her pediatrician who reluctantly agreed to stagger Ben's vaccines. At the same time, she was talking to her sister, who was also a pediatrician. Her sister was sensitive to Senator's fears but did her best to persuade her to follow the recommended vaccine schedule as outlined by the CDC. Around the same time, Senator said she saw several published studies disproving Wakefield.

"I guess I would like to say it was the research that changed my mind, but it was my sister, who had been with me at Nate's birth," she said. "That was the strongest influence on my thinking, that personal connection with her."

Advice from a pediatrician: Vigeant said shortly after seeing her friend's Facebook post in support of vaccines, she began studying at Portland State University, and took two classes which changed her thinking. One was Critical Thinking and the other was Science and Pseudoscience, both taught by the same professor.

"He asked people not just to think about why they believe what they believe, but to ask yourself instead how could what you believe be false?" she said. "What would it take to change the belief? If there's nothing that would change the belief, then it's not based on evidence. And I started to think, what would it take to change my mind on this?"

That's when Vigeant said she began to seek information outside of her core group. She began to talk openly with her pediatrician about her concerns and over time she saw the risks of vaccinating did not outweigh the risk of contracting a contagious disease. Today her daughter and son are fully vaccinated.

Caplan says pediatricians have some of the greatest influence over whether or not a parent chooses to vaccinate. And Reich said there is research on specific tactics that work best.

"There's evidence that pediatricians are more successful when they relate to parents as parents themselves to show, with empathy, that they understand what parents are dealing with," she said.

A 2013 survey by the American Academy of Pediatrics (AAP) found 87% of pediatricians have encountered parents who refused a vaccine, with the common reasons for refusal being that they were unnecessary or that they were concerned about autism. A 2016 report from the AAP advised pediatricians to "have compassionate dialogues with parents to clear up misconceptions around vaccines, provide accurate information about the safety and importance of vaccines, and strive over time to help parents make the decision to vaccinate their child."

Real stories about the risks of not vaccinating: A 2015 study by a team of psychologists from UCLA and the University of Illinois at Urbana–Champaign found that showing vaccine skeptics information on research that proves there is no link between vaccines and autism did nothing to change beliefs. But sharing pictures and descriptions of the diseases vaccines protect against did.

The approach that substantially increased support for vaccinations showed photos of children with measles and featured a paragraph from a mother whose baby suffered a life-threatening bout of measles.

“There was a reason we all got vaccinated: Measles makes you very sick. That gets forgotten in the polarizing debate on whether the vaccine has side effects," Keith Holyoak, senior author of the study, said in a statement after its release.

A bigger conversation about community

Doctors and sociologists say more must be done to help people understand that vaccinations aren't just about individual children.

"How do we make parents feel responsible for everyone's children?" Reich said. "There's a broader question about how to get people to think about their children as part of communities. ... That's a bigger conversation than the one at your pediatrician about whether or not to vaccinate."

Vigeant admits that when she decided not to vaccinate her daughter, she convinced herself she would be safe because most people around her were vaccinating. She believed she could reap the benefits of herd immunity – the resistance to the spread of a disease because a high number of people have been vaccinated – without having to expose her daughter to what she believed were unnecessary toxins.

"I thought if everyone is vaccinating, why do I have to take the risk? Which in hindsight was a very selfish idea," she said.

Vigeant says when she finds herself in conversation with someone who doesn't support vaccinations, she tries to talk to them the way she wishes people had talked to her.

"When I approach people now who hold beliefs that I used to hold myself, I try to start by asking questions. I ask them why they believe what they believe. I try to better understand them before giving my thoughts," she said. "These people care very much for their children, they just have very different ideas of what it means to do that."

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