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Our Facebook Engagement will Determine our CoVid Vaccine Success

Posted by Matthew Rehrl @matthewrehrl, Aug 5, 2020

Over the past two months I've kept re-reading the May Nature Study “The online competition between pro- and anti-vaccination views” (https://www.nature.com/articles/s41586-020-2281-1) .

Its first author is a data scientist and physicist Neil Johnson. It basically maps out how the anti-vac folks go after the vaccine undecided versus how healthcare folks do, and the message is clear:

The anti-vaxxers totally dominate the discussion about vaccines on Facebook with the undecided.

To visually see this, look at how the attached image, and how the antivaxers (RED) dominate the Undecided (GREEN) and how peripheral the healthcare good guys are (BLUE).

If and when a vaccine becomes available next year, it, by definition, will only have less than one year of safety data, and it will likely be more like the flu vaccine in terms of only being partly effective. It's also likely to require 2 shots rather than one.

These factors will make it prime for attack by the anti-vaxxers online, and undoubtedly the groups that will be hurt the most will be the most vulnerable.

Put another way—if you think getting folks to wear masks was problematic, then we haven’t seen anything yet!

Anyway, although I have a few ideas on how to address this (one being we need to review, experiment and strengthen our digital networks with more attention to how to engage on Facebook during this upcoming influenza season) I think ts important for most marketing folks to take a good look at this article because it's unlikely most of the medical folks within your organizations will understand the Facebook culture as well as you do.

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Thank you for this important info. Will be keeping in touch!

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Very interesting and a timely topic! I agree, @matthewrehrl it is going to be quite a battle….unfortunately!

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A very timely thread. There are some other articles (I will see if I can find them over the next week) that discuss how certain kinds of messaging (by healthcare good guys) can actually create even more obstacles than they address. This is a most complicated issue. I highly recommend reading widely, particularly experiments in which different messages were tried and those that caused harm (ie., not only did they not reduce hesitancy, but they seemed to make it worse). I am in the early stages of preparing a second talk (this time for psychotherapists) re: detecting and responding to vaccine hesitancy.

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This is an amazing point. I think we are taught to invest our efforts in people who are already normally engaged. However with vaccines everyone needs to be engaged. I'm curious how to engage with the undecided.

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A couple of thoughts. First, I used to be rather anti-Facebook for healthcare, but after reading this, I have done a 180. I think healthcare needs to double down.

Second, I don't think individuals (either people or smaller orgs) can necessarily engage directly on Facebook against these folks. Too much downside risk.

Rather, I think a consortium, perhaps at the state level, might be able to. For example, use the misinformation messaging done by others as an opportunity to spread information, or coordinate healthcare messaging between different organizations. this requires rethinking what we normally think of as competitors.

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I agree Matthew. A coordinated and centralized effort on health promotion is likely to work best. Everyone will benefit will high uptake/acceptance. There is a document published by the Institute of Medicine (2010) entitled Priorities for the National Vaccine Plan that may be helpful to identify stakeholders. It pointed to the absence of a overarching vaccine communication strategy and the need for one (… 10 years ago). And i don't think anyone has introduced anything since then. At least I haven't found any evidence of it. The WHO also quite a bit online re: vaccine hesitancy. Consultation with Dr. Peter Hotez might also yield some ideas about next steps.

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Oh.. and the IOM doc had some great ideas of where time would be best spent when developing a National Vaccine Plan.

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I used to run clinical trials in a pharmaceutical career before re-training as a Psychologist. So, when Matthew said " [the vaccine] will only have less than one year of safety data", it highlights time as a factor. One of the issues in Pharma development is that Phase I-III studies are spread out, at least in part, due to funding issues (eg., how much money the company is willing to invest in novel compounds and how much of the R & D money can be devoted to a particular project). It will be important to compare how many Phase II and III studies have been conducted with a new COVID vaccine (and the size of these studies) vs. a typical vaccine development pathway. I suspect that these are going to be fairly comparable (but it's worth checking out). Companies may wish to run Phase IV trials, and a national strategy (or state-led strategy) for a post-release surveillance program and ensuring public trust in it will be very important. These programs take time to put together… so starting now would be a good plan.

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Nice summar @drpaulam. Perhaps the right term is to call this a "digital trust network"?

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Sure! That works!

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I am really finding this conversation fascinating. I'm curious, is there a internal working group at the Mayo that is coordinating an effort in this direction? I do think it will be critical to have a positive presence on social media for undecided people.

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Thanks for starting this topic, Matthew! One of the most thought-provoking takes I've heard about vaccine refusal from parents comes from sociologist Jennifer Reich, author of the aptly named book "Calling the Shots." I highly recommend watching her recent Ted Talk: https://www.youtube.com/watch?v=CTj_xoCuhPU

The crux of Jennifer's argument is: Vaccine refusal is a symptom of larger issues: 1. culture of individualism 2. the pressure we place on parents to be perfect 3. the idea that health outcomes are directly related to making the "right" decisions. Ultimately, we've turned vaccines into a consumer product focused on an individual (Jennifer highlights how ads say things like "one less woman with cervical cancer"), rather than a public good.

Her suggestions for improving vaccination rates take the long view: stop blaming parents for everything that goes wrong with their kids and find ways to show we're invested in other children and families (a move from individualism to collectivism). I'm still thinking through how this fits into a marketing plan, but I do think it's a valuable way to position any marketing materials. Shaming parents probably won't work. And it's best not to identify individuals as "anti-vaxxers" (the truth of the matter is many parents opt to vaccinate their child for some things and not others, so it's related more to individual choice than an overarching identity; plus, the identity creates an immediate us v. them set up).

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Excellent TEd Talk rec @jcattel. An important watch for everyone and I think she has a pretty good grip on one of the fundamental causes of the problem.

Also, great thoughts on the term "anti-vaxxer". I should have been more careful; its a term I use very rarely, and I generally reserve for anti-vaccination activists, who are trying to undermine vaccination; However, for individual patients, I think the much better term is vaccine-hesitant, and the rare vaccine refusers ( only about 3%). It's also important to point out that much of vaccine hesitancy can often be just mechanics, such as getting into the office on a busy day, or reasonable caution about any newer pharmaceutical. Here's a pretty good reference in the 2019 Canadian Family Physician on the topic: "Addressing vaccine hesitancy" .
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/
But even if Reich's diagnosis of the problem is right (and again, I think it probably is), i don't know what the solutions are, especially in the complicating context of a pandemic. Changing a "Culture of Individualism" to a "Culture of Community", particularly if it is accelerating, sounds like at least a generational change, which may be too long, particularly for the most vulnerable communities. I have some vague ideas about the creation of Digital Healthcare Trust Networks—particularly at the State, rather than Federal level, but haven't fully pinned my ideas down yet.

Incidentally, here's a good reference from the WHO (2016) with a media focus: "How to respond to vocal vaccine deniers in public" https://www.who.int/immunization/sage/meetings/2016/october/8_Best-practice-guidance-respond-vocal-vaccine-deniers-public.pdf

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@matthewrehrl

Excellent TEd Talk rec @jcattel. An important watch for everyone and I think she has a pretty good grip on one of the fundamental causes of the problem.

Also, great thoughts on the term "anti-vaxxer". I should have been more careful; its a term I use very rarely, and I generally reserve for anti-vaccination activists, who are trying to undermine vaccination; However, for individual patients, I think the much better term is vaccine-hesitant, and the rare vaccine refusers ( only about 3%). It's also important to point out that much of vaccine hesitancy can often be just mechanics, such as getting into the office on a busy day, or reasonable caution about any newer pharmaceutical. Here's a pretty good reference in the 2019 Canadian Family Physician on the topic: "Addressing vaccine hesitancy" .
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/
But even if Reich's diagnosis of the problem is right (and again, I think it probably is), i don't know what the solutions are, especially in the complicating context of a pandemic. Changing a "Culture of Individualism" to a "Culture of Community", particularly if it is accelerating, sounds like at least a generational change, which may be too long, particularly for the most vulnerable communities. I have some vague ideas about the creation of Digital Healthcare Trust Networks—particularly at the State, rather than Federal level, but haven't fully pinned my ideas down yet.

Incidentally, here's a good reference from the WHO (2016) with a media focus: "How to respond to vocal vaccine deniers in public" https://www.who.int/immunization/sage/meetings/2016/october/8_Best-practice-guidance-respond-vocal-vaccine-deniers-public.pdf

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i look forward to watching the talk. IMO the issue needs to be addressed at multiple levels – both sociological and psychological (social psych and health psych), by individuals, health clinics, and mass media. During the most recent Canadian measles clusters in 2019, there were intense calls from doctor's offices for patient decision-making tools. Perhaps you've seen them? A visual representation of statistical facts tailored for an individual to better understand risks (health risks, vaccine risks) and typically studied to ensure reliability and validity. I understood that they did not exist despite plenty of clinical data on MMR. It suggests an underestimation of vaccine hesitancy by health care systems – we can't be taken by surprise on this issue a second time around. Even if people are not vaccine hesitant (delaying or deferring established vaccines), there is usually a gradual level of acceptance that builds around any new medicine (early vs. late adopters), and a COVID vaccine will be no different. As the vaccine development is ongoing, these issues will need to be addressed in tandem. Are the members of this group able to influence their health care teams/organizations re: the need for a patient decision-making tool and its development?

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@jcattel

Thanks for starting this topic, Matthew! One of the most thought-provoking takes I've heard about vaccine refusal from parents comes from sociologist Jennifer Reich, author of the aptly named book "Calling the Shots." I highly recommend watching her recent Ted Talk: https://www.youtube.com/watch?v=CTj_xoCuhPU

The crux of Jennifer's argument is: Vaccine refusal is a symptom of larger issues: 1. culture of individualism 2. the pressure we place on parents to be perfect 3. the idea that health outcomes are directly related to making the "right" decisions. Ultimately, we've turned vaccines into a consumer product focused on an individual (Jennifer highlights how ads say things like "one less woman with cervical cancer"), rather than a public good.

Her suggestions for improving vaccination rates take the long view: stop blaming parents for everything that goes wrong with their kids and find ways to show we're invested in other children and families (a move from individualism to collectivism). I'm still thinking through how this fits into a marketing plan, but I do think it's a valuable way to position any marketing materials. Shaming parents probably won't work. And it's best not to identify individuals as "anti-vaxxers" (the truth of the matter is many parents opt to vaccinate their child for some things and not others, so it's related more to individual choice than an overarching identity; plus, the identity creates an immediate us v. them set up).

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Thanks for sharing that TED talk – she identifies issues very well.

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