We're Taking The Wrong Approach To Promote The Flu Vaccine

It seems no matter how we appeal to the population, there's a slim chance an increase in vaccination rates will occur.
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As expected, the number of flu cases has risen over the last few weeks. Not surprisingly, public health officials are doing what they can to promote the best ways to prevent infection, including promoting the influenza vaccine. But the results of their efforts continue to be plagued by the realization that the majority of the Canadian population doesn't seek vaccination.

The reasons behind this apparent rejection of this proven method to stay safe are many. One happens to deal with the effectiveness — or lack thereof — of the current year's offering. Even though studies have shown partial protection is provided even when the vaccine is having an off year, this can become a serious obstacle to acceptance. Getting past this requires far more than a general "You can trust it" message.

When issues such as poor effectiveness occur, figuring out how best to maintain the momentum while the flu circulates becomes a serious challenge. Usually, one of two directions is taken. The first involves providing a universal message in which the vaccine is seen as a part of population health. The other is to focus on those most likely to suffer serious symptoms and consequences due to infection, known as high-risk groups. These include the very old, the very young and people with pre-existing conditions such as diabetes.

While these routes at first may appear to be effective, they do not encompass the most critical aspect of an individual's decision to get the vaccine. It's known as the descriptive norm and it is defined as the perception of other people's attitudes towards a particular action. In other words, people alter their behaviour based on the perception of others.

Descriptive norms are highly useful in many areas separate from research and occur each and every week at the movie theatre. Reviews of a movie by prominent critics can sway people to either go see the film or save their money. Adding in the social community's perspective can increase the influence such that a film can turn into an instant blockbuster, cult sensation or bomb.

The potential for descriptive norms to help improve the uptake of the flu vaccine convinced a group of German researchers to find out if this approach would work. They attempted to find out which of the two messaging streams — universal or high-risk — would have the greatest impact on a population. Unfortunately, the results suggest public health officials may find themselves faced with a troublesome catch-22.

The team developed an interactive vaccination game in order to test the value of descriptive norms. The game took players through 30 rounds of vaccination (equivalent to 30 years of actual time) and asked them to decide whether to get the vaccine or forego that particular round. Depending on the choice, a person would be faced with a number of possible health consequences seen in the real world.

When the results came back, there was a major surprise in store.

As for the players of the game, they were given a health status. They were either healthy — in other words, low-risk — or had some kind of health complication, making them high-risk. Those in the high-risk categories ultimately faced more severe health consequences just like in real life.

To bring the situation closer to home, during each round, the players received one of three flu vaccine messaging options. Some received no messaging at all, which acted as the control. Another group heard a universal message in which the vaccine was shown to benefit the entire population. The third segment of players were given a message specifically directed at high-risk individuals.

With the simulation in place, the descriptive norms were tested. After certain rounds, information on the choices of others — vaccinate or not vaccinate — was shared with the subjects. If the researchers were correct, this information would have a positive effect on individual decisions and ultimately the population.

When the results came back, there was a major surprise in store. Descriptive norms for the most part had no effect on the choices. Neither did the universal message in comparison to the control. Only the high-risk messaging seemed to have any impact on the choices made.

This wasn't the worst of it, as there was a more shocking outcome from the test. The levels of uptake of low-risk individuals who received the high-risk messaging dropped. The levels went down at times below 20 per cent of the controls. For some reason, the message had the exact opposite effect and led to a near-zero net gain in terms of vaccine uptake across the board.

The results of this study provide a rather gloomy look for vaccine promotion. No matter which decision is made, there's a slim chance an increase in vaccination rates will occur. Descriptive norms seem to have no effect and any kind of promotional messaging might backfire.

As the authors point out, the study reveals a key point in the vaccine discussion. The choice for vaccination really is based on selfish rather than community-based rationale. In other words, vaccination is a personal choice and once a decision is made, it is very difficult to sway.

Moving forward, there may be a better option in light of this study. Much like most health decisions, the choice to vaccinate can be explored through meaningful and private discussions with local and trusted regulated health professionals. Once the information has been shared, the option can be chosen together, as a team. While this may not in the short term increase vaccine rates, as the years pass, we may finally see vaccination choice move from the current selfish rationale to one that benefits everyone.

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