The latest scary statistics about the resurgence of the measles virus, due – at least in high-income countries – to vaccine refusal, highlights the various ‘cognitive biases’ that lead people to base their decision-making on unfounded fears and beliefs rather than top-level scientific evidence.
They act as a timely reminder that it takes a lot more than facts to change people’s minds and move them to action.
According to a new report from UNICEF, an estimated 169 million children worldwide missed out on their first dose of the measles vaccine between 2010 and 2017, with the predictable result that ‘widening pockets of unvaccinated children have created a pathway to the measles outbreaks hitting several countries around the world today’.
Shockingly, the UK ranks third worst (after the US and France) for first dose refusal among the top ten high-income countries; more than half a million UK children missed out on their first measles vaccine dose between 2010 and 2017.
Irrational decision-making based on fear
Measles is a serious, highly contagious disease, carrying a risk of potentially fatal complications. And this regrettable situation provides the clearest possible illustration of irrational decision-making, based on fear, misinformation and mistrust, tirelessly stoked by ‘fake news’ promoters on social media.
In 1998, when measles was on the verge of being eradicated in the UK, former doctor Andrew Wakefield published a study in The Lancet, linking the measles, mumps and rubella (MMR) vaccine to autism.
The study was eventually retracted, its claims roundly debunked and Wakefield disgraced and struck off the medical register. But there was no way to squeeze the toothpaste back into the tube. Despite a mountain of scientific evidence that the MMR vaccine is safe and not linked with autism, a significant minority of parents have refused protection for their children.
Surfing the internet in search of explanations for this deeply worrying trend, I chanced upon a weighty World Health Organisation guidance document: How to respond to vocal vaccine deniers in public. It sets out broad principles on how to combat anti-vaccine arguments, based on public health research and the techniques of persuasion and communication. And its findings and recommendations are relevant to any expert seeking to combat misinformation with evidence.
Four biases that work against reason
The report identifies four cognitive biases that enable ‘deviation from a rational standard’.
Negativity bias makes people more likely to trust scientific studies reporting health risks than those suggesting safety;
Confirmation bias is the tendency to look for and interpret information in a way that confirms one’s existing beliefs;
The backfire effect paradoxically fosters false knowledge when a misconception is repeated as part of an attempt to debunk it;
Narrative bias is the tendency to be persuaded by personal stories that ‘explain complex interdependencies in a simple, coherent and emotional manner’.
This last point reminds me of a radio interview with a high-ranking UK vaccine expert I listened to a few months back. Expressing his acute exasperation with the way journalists seek to create ‘balance’ by interviewing people with opposing points of view, however justified, he asked how his factual approach could possibly compete with a mother telling a heartrending story about how her child had apparently developed autism after MMR vaccination.
Key principles of persuasion
The WHO offers some very good ideas about how experts can compete on this battleground – and these chime perfectly with my own training approach. It boils down to these key principles, which can be applied to any situation where you are trying to make a persuasive argument:
- Prepare three (oft-repeated) key messages you really want people to know and remember, being as positive as is consistent with truth and avoiding alienating jargon. Illustrate your arguments with compelling metaphors and support them with stories and anecdotes that appeal to hearts as well as minds;
- Communicate what has already been achieved (in this case by vaccination) and what more needs to be done to achieve the final goal. Convey your own confidence that this goal can be achieved;
- Highlight the scientific consensus around the issue. This has been shown to increase belief in scientific facts;
- Use inclusive terms like ‘we, as parents’ to underline your shared identity with the audience. Express your own moral convictions and reveal enough about your character to allow the audience to identify with you personally;
- Don’t repeat the opposing arguments because of the potential ‘backfire effect’ (see above) and the chance that your remarks could be taken out of context and used to support those arguments. And never question your opponents’ motivation, which has the unhelpful effect of taking the focus away from the facts.
Experts (and there are many of them) who believe that dry, data-heavy PowerPoint presentations offer solutions to communications problems will always find it hard to compete with the narrative skills and emotional fire power of fake news advocates. Only by meeting them on their own ground can they have an even chance of winning the argument.
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