Audio long read: How to speak to a vaccine sceptic — research reveals what works
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This is an audio long read from Nature. In this episode, how to speak to a vaccine skeptic. Research reveals what works. Written by Helen Pearson and read by me, Benjamin Thompson. In her professional life, Sophia Newcomer analyzes vaccination trends and safety in the United States.

The epidemiologist at the University of Montana, Missoula, has investigated the factors that stop some people from completing their children's recommended immunizations. So it's no surprise that in her personal life, newcomer is asked questions about vaccines too. I'm a mom. I've had plenty of playground conversations, she says.

When people find out I study vaccines, they love to ask questions. What I try to do is listen and, as best as I can, share what I know. Questions and doubts about vaccines are on the rise worldwide. A major global study found that perceptions of vaccines' importance for children dropped in 52 of 55 countries studied during the COVID-19 pandemic.

In the United States, about 20% of parents are hesitant about vaccines. One reason for an outbreak of measles this year that has killed three unvaccinated people. Public health specialists worry that these trends could worsen, in part because of the influence of Robert F. Kennedy Jr., who has repeatedly questioned the safety of vaccines and inaccurately connected them to autism.

Kennedy was tapped this year by US President Donald Trump to lead the Department of Health and Human Services, the HHS, which approves vaccines and makes recommendations about their use.

The shift in public attitudes towards immunisations can leave scientists, physicians and many others feeling disheartened because vaccines are among the most cost-effective ways to prevent disease and have saved more than 150 million lives over the past 50 years. So what should you say to someone who has doubts? What kind of information or argument might help when talking to family or friends?

Fortunately, a surge of research on vaccine hesitancy over the past decade is starting to offer some answers. There is a lot that we can draw from, says Heidi Larson, who studies confidence in vaccines at the London School of Hygiene and Tropical Medicine. Researchers say that anyone can help to address vaccine hesitancy by listening to concerns and offering positive opinions.

If you think vaccination is a good idea, if you trust that, if you think it's a good way to protect your children, I think you can share that view, says Daphne Bussink-Vorend, who studies vaccine decisions at Radboud University Medical Centre in Nijmegen, the Netherlands. 1. Listen, do not judge. The first thing to do if someone expresses uncertainty about vaccines to you, say researchers, is not to judge or dismiss them.

It's wrong to assume that people are ignorant, irrational, or have naively swallowed online misinformation. A lot of people have genuine and legitimate questions and, quote, you're going to lose them if you immediately jump back and say, that's silly or that's not the fact, Larson says. Researchers distinguish between vaccine hesitancy, being unsure about vaccination, and anti-vaccine activists who campaign against it.

Instead, researchers agree, it's best to actively listen, ask questions and be curious about what's behind the concerns. I think that is sometimes difficult, but we should really be open to people's views and ideas, says Bussink-Vorund. Once we know what the issues are, what specific barriers are, then we can address them one by one, says Mohamed Sharif Rezaei, a public health researcher at the University of Cambridge, UK.

Researchers have identified a wide range of reasons that people hesitate about getting themselves or their children vaccinated. In 2014, an expert working group on vaccine hesitancy convened by the World Health Organization supported grouping these reasons into three buckets. Confidence – I don't trust the safety and effectiveness of vaccines or the health system delivering them.

Complacency. I don't need it because the risks are low. And convenience. I can't access it easily. Context is also important because people's culture and religious or ethnic background can influence their attitudes. One major European study pointed to the root of many concerns.

The study, called VaxTrust, examined why parents hesitated to vaccinate their children in seven European countries between 2021 and 2024, a period that spanned the COVID-19 pandemic. Typically, hesitancy, quote, starts with personal concerns about, what will this do to my child? How will it affect my health? says Pia Vuolanto, a social scientist at Tampere University in Finland, who led the study.

Particularly influential in seeding those doubts, Vualanto says, were anecdotal stories from friends and in the media that involved possible vaccine side effects. Previous cases were very important in shaping their views, she says, even though serious side effects are rare and data show that, for most people, the benefits of vaccines outweigh the risks.

A review published in 2023 measured the lasting damage one scare story can cause. The authors assessed 115 studies examining why parents in the United States hesitate over the childhood measles, mumps and rubella, or MMR vaccine.

The most common reason was fear of triggering autism, which stems partly from a prominent 1998 paper in The Lancet that claimed to show a link between the MMR vaccine and autism. The paper was found to be fraudulent and was retracted, and subsequent studies have convincingly shown that no link exists, although Kennedy and others continued to draw connections.

A spokesperson at the HHS says that the U.S. National Institutes of Health is actively investigating the root causes of autism and is confronting the issue of rising autism rates. Quote, End quote.

The HHS spokesperson added that, quote, blaming Secretary Kennedy for vaccine hesitancy ignores a broader and more complex reality. Trust in public health institutions declined during the COVID-19 pandemic, driven in large part by inconsistent messaging, shifting mandates and the failure to provide transparent long-term safety and efficacy data, end quote. Two, express your view.

It might sound obvious, but researchers say that it's important in a conversation to provide information or opinions. You need to elicit the concerns and then share accurate, reliable information, Rezaei says. Physicians and other healthcare workers are best placed to provide that advice.

A 2023 systematic review of studies, including 15 randomised trials, found that consistent, clear recommendations from trusted healthcare professionals that addressed misconceptions and noted benefits were strongly associated with increased vaccination during pregnancy, particularly when the recommendations were delivered face-to-face. It's, quote, one of the most important evidence-based strategies, says Razai, who led the review.

But the goal, he stresses, should be enabling someone to make their own informed decision, not telling them what to do. Quote, I think that's a really effective way of gaining people's trust. End quote. One method of doing this in a non-judgmental way is called motivational interviewing. This involves an empathetic, respectful conversation between a healthcare worker and a prospective vaccine recipient that aims to strengthen their motivation.

It typically starts with a recommendation to vaccinate, but if someone expresses ambivalence or reluctance, a health worker might ask, why are you unsure? Then acknowledge the concerns and offer information tailored to address them. If a parent expresses worry about the MMR vaccine and autism, for example, the healthcare worker might say, more than 500 studies around the world have demonstrated that there is no link between the vaccine and autism.

The frequency of autism is the same in vaccinated children as it is in non-vaccinated children. What do you think? This compares with a more didactic approach of, the vaccine is safe, I assure you, or you should update your child's vaccinations.

Several studies have suggested that motivational interviewing can change behaviour. In one trial in Quebec, Canada, parents of around 1,100 babies received a session using motivational interviewing on the maternity ward after their children were born. Seven months later, 76% of children in the experimental group had received all the recommended vaccines, compared with 69% in a control group that did not receive the intervention.

This and other results convinced the government in Quebec to roll out the programme to all parents of newborns, starting in 2017. The programme led to a nearly 7% increase in vaccination coverage after 24 months. People who are not health professionals can share such messages too, researchers say. They don't have to know detailed facts and figures from studies. It also helps to get personal.

For those who are just a little bit unsure, often sharing your personal experience of why you vaccinated, why you trust vaccines, is enough, says Vuolanto. 3. Be honest. Transparency and acknowledging uncertainties is key, researchers say.

A systematic review of methods for combating vaccine misinformation in 2023 found that communicating with certainty, rather than recognising that there are unknowns about risks or effectiveness, could backfire. Communicating the weight of evidence and scientific consensus about vaccines seems more promising.

Rezaei says that for well-established vaccines, such as MMR, it's important to state that, quote, they are absolutely safe and there's no questions about that, end quote. But when vaccines are newer, scientists have fewer data. Many people had concerns about COVID-19 jabs after they were released in 2020, partly because the compounds were developed and approved quickly, and some people worried that they might not be safe or effective.

When speaking about newer vaccines, Rezaei suggests saying that the technology they're based on has been tested and that healthcare mechanisms in place should mean any potential side effects will be detected and highlighted quickly. The key point, he says, is that, quote, the risks of not taking the vaccines, despite these uncertainties, would be worse than taking the vaccines for the vast majority of people, end quote.

But conversations are unlikely to change the views of hardened vaccine sceptics, researchers say. There is no amount of data that will convince these people, says Ev Dubé, who studies vaccine hesitancy at Laval University in Quebec City. This group is thought to be small, however.

In many high-income countries, she says, roughly 2% of people are strongly opposed to vaccination, compared with 20% or so who are vaccine-hesitant. Although estimates fluctuate widely with time, place and type of vaccine. 4. Be flexible. One approach, such as motivational interviewing in person, is not going to solve a problem as complex as vaccine hesitancy alone.

At the end of the day, there is no single magic bullet, Larson says. Many people, for example, skip vaccinations mainly because of logistical barriers rather than doubts. An analysis of more than 16,000 children across the United States showed that 27% of them started but did not receive the full set of early childhood immunisations in the first two years of life.

The pattern, quote, has very little to do with parents' attitudes about vaccines, says newcomer who led the study. Quote, rather, it has to do with issues and challenges with health systems and clinics, end quote. In this case, improved vaccine reminders and immunization services could help. Researchers also think that misinformation encountered online contributes to vaccine hesitancy, and so they are developing methods to tackle the problem there.

One potential approach is pre-bunking, in which people are taught to spot techniques that are commonly used in vaccine misinformation, such as emotional testimonies and anecdotes saying that vaccines are harmful. The aim is to inoculate people so that they can resist persuasion by misinformation when they later come across it online.

Pre-bunking, in the form of a 10-minute online game, boosted people's ability to distinguish misinformation and accurate information in a set of randomised trials published as a preprint last year. But psychologist John Rosenbeek at King's College London, who led the study, says that the team has not been able to show that pre-bunking increases the number of people who take up vaccination. Behavioural change is very hard, he says.

And what should people do if they find friends or family posting vaccine misinformation online? Rosenbeek and others suggest adopting similar tactics to those used in real life. Don't be dismissive. Try to engage in a conversation and share accurate information. Researchers, including Rosenbeek, have created a website to help people to counter vaccine misinformation in conversations.

But researchers know that the headwinds are strong, particularly in the United States, where they fear that Kennedy is undermining confidence in vaccines. Since assuming leadership of the health department, he has announced plans to study the debunked idea that vaccines are linked to autism and has moved to restrict access to COVID-19 vaccines.

And the NIH has cancelled nearly half of its research grants related to vaccine hesitancy, including newcomers. Newcomer says she now lacks funds to continue analysing her data. Larson worries that scientists, quote, are light years behind, end quote, anti-vax activists. These are, quote, highly organised, orchestrated, highly funded people trying to undermine vaccination as a programme, she says. And that's hard.

To read more of Nature's long-form journalism, head over to nature.com slash news.

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