Public information campaigns are a complex undertaking; how the message is delivered matters at least as much as the content of the message itself. Moreover, getting it right is paramount since undoing the damage of misinformation is difficult indeed. In this regard, the debate over vaccination provides a difficult lesson—one in which the repercussions of poor messaging are, literally, a matter of life and death.
Vaccination rates have seen a steady increase in Latin America and the Caribbean. For example, in the case of the measles vaccine, from average rates around 75 percent in 1990, average vaccination has been hovering around 95 percent in the last few years. The increase comes thanks to very active campaigns by the governments in the region, and financial support and coordination of broader initiatives by the IDB. In turn, expanded immunization has contributed to significant advances in health indicators and substantial improvements in quality of life in the region (IDB, 2009).
Contrary to what happens in other areas of policy and outcome indicators, Latin America and the Caribbean do not fare worse than industrialized countries when it comes to immunization. (According to UNICEF data up to 2013, measles vaccination has not reached 95 percent in industrialized countries). In the case of the U.S., the vaccination rate for measles was 91 percent in 2013. The existence of pockets of population where immunization is almost nonexistent helps explain a recent measles outbreak in a country where the disease had been previously eradicated.
Perhaps even more controversial than the fact that vaccination is not universal in a country with the resources of the U.S. is the fact that a person’s choice of whether to vaccinate or not has become accepted as part of the political debate, despite the consequences it can have on the health and quality of life of the population. The issue is whether people have a right to avoid vaccination in spite of the negative externalities that the behavior has for the rest of the population, not only putting lives at risk but also significantly increasing the cost to the public health sector.
Why are people hesitant to vaccinate? This Harvard Kennedy Center article summarizes well the existing evidence. A 2014 report from the American Academy of Arts and Sciences explains the problem of noncompliance: “a combination of fraudulent scientific studies, irresponsible reporting, and well-meaning but misinformed citizen activists has led to a steady increase in the proportion of parents who have concerns about the recommended childhood vaccine schedule. While overall vaccine uptake rates in the United States remain high, these concerns have resulted in a significant expansion in the number of parents who are delaying, and in extreme cases even refusing, vaccines for their children.”
Even more worrisome, is that once these perceptions have been acquired, it is very difficult to modify the behaviors. As the article explains, according to recent research, providing messages to parents promoting vaccination and correcting misinformation regarding the potentially harmful effects of the vaccines did not increase the intent of parents to vaccinate their children.
These results are consistent with a message put forth in this blog in previous posts. People’s behavior is a consequence of their beliefs, and these beliefs can be shaped by information. Unfortunately, while information can lead to better outcomes (a concept we repeated over and over in IDB 2009) it can also lead to behaviors which are not compatible with the public good. Therefore, policymakers should be extremely cautious about the policies and the facts they support given that they may shape public opinion for the long haul. Once a campaign that is geared towards increasing welfare is launched, the credibility of the messages, the simplicity and clarity of their presentation, and their consistency matter a lot. As our research clearly demonstrates, the devil is in the details.