Dr. Gregory Poland

Improving immunization rates in adults is going to require a public relations overhaul.

It’s time for new approaches. We devote hundreds of millions of dollars to programs to increasing immunizations, and most are neither highly innovative nor highly successful, and yet we keep doing the same things.

In some cases, immunization coverage is actually on the decline and outbreaks of previously controlled diseases, such as measles, are occurring.

Part of the problem is a failure to recognize that people form beliefs about vaccination often on the basis of emotional and psychological reasons.

By contrast, current materials used to educate patients about immunizations rely on the language of logic and consciousness, and ignore issues of perception and reality construction. These decisions about whether an individual gets vaccinated often are made by emotional projection, rather than by reason.

Our traditional messages aimed at promoting vaccination are challenged by myths circulating on the Internet and books written by celebrities who use emotional engagement to make their arguments against vaccination.

We’re all about figures and probability; patients are about figurative language and possibilities.

The problem is particularly apparent among health care workers. Only about a third of health care workers were vaccinated against the 2009-2010 pandemic influenza virus. Many remembered the H1N1 outbreak in 1976, when some people developed Guillain-Barré syndrome after being vaccinated. The perception was that new flu vaccines are dangerous. Yet none of our educational materials about vaccines addressed this perception.

Here are 10 suggestions for improving communication with and vaccination coverage of adults:

• Make transformation, not incrementalism, the new metanarrative. There is a whole science and methodology behind innovation and transformation, and we don’t use it. Public health could formally partner with academia to design and fund Requests for Applications for explicit vaccine priority areas for which transformation is the goal.

• Build trust. No sustained progress will be made without trust. We’re clearly losing the new generation of health care providers.

Increased transparency about the process for making recommendations – including what information is and isn’t available – would be a step in the right direction for trust building.

• Use new emotive education methods. Some argue this is manipulative and "not very scientific."

We have a choice. We can continue in our analytic framework and get the results that we always have, or we can use a more of the emotive framework like the anti-vaccine group does, and get the results that they have. This may mean abandoning much of what is currently being done in favor of using more emotionally compelling advertisements instead.

Many people are innumerate, make fear-based decisions, or use heuristics. Giving these people a standard vaccine information sheet is useless.

• Move from pediatrics to geriatrics. Vaccine-preventable mortality is about 166-fold higher in adults than it is in children, and yet this fact continues to be ignored.

We are becoming a nation of older people, and we had better focus our priorities, time, and resources on understanding immunosenescence, designing vaccines against diseases that primarily afflict the elderly, improving vaccine immunogenicity and efficacy in the elderly, and funding vaccine delivery for the elderly.

• Develop a priority matrix. This matrix should be displayed on a single page, mapping strategies and tactics in an explicit fashion as informed by risks, current status, feasibility, and over-the-horizon threats.

We should develop a doctrine for how vaccines get developed and delivered. It should help us focus priorities with periodic outside review, and include progress milestones with incentives and disincentives for achieving them.

A military model, in which someone is put in charge and given authority, would be useful in this scenario.

• Build 21st-century transformation teams. Entities that are successful in achieving transformation do so by building teams of experts from relevant fields, such as designers, anthropologists, sociologists, psychologists, communication experts, and social media experts. Success also is achieved by embracing cultural trends. Take for example, the popularity of iPods and MP3 players among college students. A podcast should be developed to promote HPV vaccination in this age group.

We have to stop being afraid to stand up to celebrities who promote misinformation and pseudoscience. These people should be exposed as being dangerous to the public health. It would be useful to develop something akin to a consumer report for antivaccine websites. We need to learn how to harness social media as effectively as they have.

• Tread carefully and use incentives. Not everyone is at equal risk for every disease, so mandates in the general public should tread carefully.

In addition, real incentives and disincentives (economic or legal, for example) for acceptance or rejection of vaccines among institutions, individuals, and payors, should be considered.

• Give some attention to the concept of "personalized vaccinomics." This is a concept of personalized vaccination based on the idea that one size and dose does not fit all.

Eventually, phenotype/genotype databases will be large enough to make predictions about dosing needs (such as predicting which young women might respond to one dose of HPV vaccine, eliminating the need for all three doses), for example, so that the approach can be personalized.

• Ensure health care worker vaccine competency and compliance. Vaccine requirements for transmissible diseases among health care workers are needed, as are educational requirements for workers. A "nursing paradox" also needs to be addressed; studies suggest that while nurses spend the most time with patients and are the greatest influencers, they still tend to question the safety of vaccines more than any other health care worker category.

Several studies, including ones that I have conducted, show that there is very little in the way of vaccine education in nursing schools. It’s time to change that trend.

• Learn and utilize the science of motivation, change, and communication. This involves learning how people learn, how they think, and how they make decisions, and applying this through innovation. It also requires relentlessly exposing and rebutting dangerous and uniformed opinions for what they are.

Ample data demonstrate that we make fundamentally flawed decisions because of unconscious biases. It’s the way we’re wired. I think we would be wise to understand the role of cognitive bias and preferred cognitive styles in educating the public, and the power of emotive stories and parables.

Dr. Poland is director of the Mayo Clinic Vaccine Research Group, Rochester, Minn. He reported having relationships with the following companies: Merck, Avianax, Theraclone Sciences, Liquidia Technologies, Dynavax, PaxVax, and Novartis Vaccines and Diagnostics.

Improving immunization rates in adults is going to require a public relations overhaul.

It’s time for new approaches. We devote hundreds of millions of dollars to programs to increasing immunizations, and most are neither highly innovative nor highly successful, and yet we keep doing the same things.

In some cases, immunization coverage is actually on the decline and outbreaks of previously controlled diseases, such as measles, are occurring.

Part of the problem is a failure to recognize that people form beliefs about vaccination often on the basis of emotional and psychological reasons.

By contrast, current materials used to educate patients about immunizations rely on the language of logic and consciousness, and ignore issues of perception and reality construction. These decisions about whether an individual gets vaccinated often are made by emotional projection, rather than by reason.

Our traditional messages aimed at promoting vaccination are challenged by myths circulating on the Internet and books written by celebrities who use emotional engagement to make their arguments against vaccination.

We’re all about figures and probability; patients are about figurative language and possibilities.

The problem is particularly apparent among health care workers. Only about a third of health care workers were vaccinated against the 2009-2010 pandemic influenza virus. Many remembered the H1N1 outbreak in 1976, when some people developed Guillain-Barré syndrome after being vaccinated. The perception was that new flu vaccines are dangerous. Yet none of our educational materials about vaccines addressed this perception.

Here are 10 suggestions for improving communication with and vaccination coverage of adults:

• Make transformation, not incrementalism, the new metanarrative. There is a whole science and methodology behind innovation and transformation, and we don’t use it. Public health could formally partner with academia to design and fund Requests for Applications for explicit vaccine priority areas for which transformation is the goal.

• Build trust. No sustained progress will be made without trust. We’re clearly losing the new generation of health care providers.

Increased transparency about the process for making recommendations – including what information is and isn’t available – would be a step in the right direction for trust building.

• Use new emotive education methods. Some argue this is manipulative and "not very scientific."

We have a choice. We can continue in our analytic framework and get the results that we always have, or we can use a more of the emotive framework like the anti-vaccine group does, and get the results that they have. This may mean abandoning much of what is currently being done in favor of using more emotionally compelling advertisements instead.

Many people are innumerate, make fear-based decisions, or use heuristics. Giving these people a standard vaccine information sheet is useless.

• Move from pediatrics to geriatrics. Vaccine-preventable mortality is about 166-fold higher in adults than it is in children, and yet this fact continues to be ignored.

We are becoming a nation of older people, and we had better focus our priorities, time, and resources on understanding immunosenescence, designing vaccines against diseases that primarily afflict the elderly, improving vaccine immunogenicity and efficacy in the elderly, and funding vaccine delivery for the elderly.

• Develop a priority matrix. This matrix should be displayed on a single page, mapping strategies and tactics in an explicit fashion as informed by risks, current status, feasibility, and over-the-horizon threats.

We should develop a doctrine for how vaccines get developed and delivered. It should help us focus priorities with periodic outside review, and include progress milestones with incentives and disincentives for achieving them.

A military model, in which someone is put in charge and given authority, would be useful in this scenario.

• Build 21st-century transformation teams. Entities that are successful in achieving transformation do so by building teams of experts from relevant fields, such as designers, anthropologists, sociologists, psychologists, communication experts, and social media experts. Success also is achieved by embracing cultural trends. Take for example, the popularity of iPods and MP3 players among college students. A podcast should be developed to promote HPV vaccination in this age group.

We have to stop being afraid to stand up to celebrities who promote misinformation and pseudoscience. These people should be exposed as being dangerous to the public health. It would be useful to develop something akin to a consumer report for antivaccine websites. We need to learn how to harness social media as effectively as they have.

• Tread carefully and use incentives. Not everyone is at equal risk for every disease, so mandates in the general public should tread carefully.

In addition, real incentives and disincentives (economic or legal, for example) for acceptance or rejection of vaccines among institutions, individuals, and payors, should be considered.

• Give some attention to the concept of "personalized vaccinomics." This is a concept of personalized vaccination based on the idea that one size and dose does not fit all.

Eventually, phenotype/genotype databases will be large enough to make predictions about dosing needs (such as predicting which young women might respond to one dose of HPV vaccine, eliminating the need for all three doses), for example, so that the approach can be personalized.

• Ensure health care worker vaccine competency and compliance. Vaccine requirements for transmissible diseases among health care workers are needed, as are educational requirements for workers. A "nursing paradox" also needs to be addressed; studies suggest that while nurses spend the most time with patients and are the greatest influencers, they still tend to question the safety of vaccines more than any other health care worker category.

Several studies, including ones that I have conducted, show that there is very little in the way of vaccine education in nursing schools. It’s time to change that trend.

• Learn and utilize the science of motivation, change, and communication. This involves learning how people learn, how they think, and how they make decisions, and applying this through innovation. It also requires relentlessly exposing and rebutting dangerous and uniformed opinions for what they are.

Ample data demonstrate that we make fundamentally flawed decisions because of unconscious biases. It’s the way we’re wired. I think we would be wise to understand the role of cognitive bias and preferred cognitive styles in educating the public, and the power of emotive stories and parables.

Dr. Poland is director of the Mayo Clinic Vaccine Research Group, Rochester, Minn. He reported having relationships with the following companies: Merck, Avianax, Theraclone Sciences, Liquidia Technologies, Dynavax, PaxVax, and Novartis Vaccines and Diagnostics.

Improving immunization rates in adults is going to require a public relations overhaul.

It’s time for new approaches. We devote hundreds of millions of dollars to programs to increasing immunizations, and most are neither highly innovative nor highly successful, and yet we keep doing the same things.

In some cases, immunization coverage is actually on the decline and outbreaks of previously controlled diseases, such as measles, are occurring.

Part of the problem is a failure to recognize that people form beliefs about vaccination often on the basis of emotional and psychological reasons.

By contrast, current materials used to educate patients about immunizations rely on the language of logic and consciousness, and ignore issues of perception and reality construction. These decisions about whether an individual gets vaccinated often are made by emotional projection, rather than by reason.

Our traditional messages aimed at promoting vaccination are challenged by myths circulating on the Internet and books written by celebrities who use emotional engagement to make their arguments against vaccination.

We’re all about figures and probability; patients are about figurative language and possibilities.

The problem is particularly apparent among health care workers. Only about a third of health care workers were vaccinated against the 2009-2010 pandemic influenza virus. Many remembered the H1N1 outbreak in 1976, when some people developed Guillain-Barré syndrome after being vaccinated. The perception was that new flu vaccines are dangerous. Yet none of our educational materials about vaccines addressed this perception.

Here are 10 suggestions for improving communication with and vaccination coverage of adults:

• Make transformation, not incrementalism, the new metanarrative. There is a whole science and methodology behind innovation and transformation, and we don’t use it. Public health could formally partner with academia to design and fund Requests for Applications for explicit vaccine priority areas for which transformation is the goal.

• Build trust. No sustained progress will be made without trust. We’re clearly losing the new generation of health care providers.

Increased transparency about the process for making recommendations – including what information is and isn’t available – would be a step in the right direction for trust building.

• Use new emotive education methods. Some argue this is manipulative and "not very scientific."

We have a choice. We can continue in our analytic framework and get the results that we always have, or we can use a more of the emotive framework like the anti-vaccine group does, and get the results that they have. This may mean abandoning much of what is currently being done in favor of using more emotionally compelling advertisements instead.

Many people are innumerate, make fear-based decisions, or use heuristics. Giving these people a standard vaccine information sheet is useless.

• Move from pediatrics to geriatrics. Vaccine-preventable mortality is about 166-fold higher in adults than it is in children, and yet this fact continues to be ignored.

We are becoming a nation of older people, and we had better focus our priorities, time, and resources on understanding immunosenescence, designing vaccines against diseases that primarily afflict the elderly, improving vaccine immunogenicity and efficacy in the elderly, and funding vaccine delivery for the elderly.

• Develop a priority matrix. This matrix should be displayed on a single page, mapping strategies and tactics in an explicit fashion as informed by risks, current status, feasibility, and over-the-horizon threats.

We should develop a doctrine for how vaccines get developed and delivered. It should help us focus priorities with periodic outside review, and include progress milestones with incentives and disincentives for achieving them.

A military model, in which someone is put in charge and given authority, would be useful in this scenario.

• Build 21st-century transformation teams. Entities that are successful in achieving transformation do so by building teams of experts from relevant fields, such as designers, anthropologists, sociologists, psychologists, communication experts, and social media experts. Success also is achieved by embracing cultural trends. Take for example, the popularity of iPods and MP3 players among college students. A podcast should be developed to promote HPV vaccination in this age group.

We have to stop being afraid to stand up to celebrities who promote misinformation and pseudoscience. These people should be exposed as being dangerous to the public health. It would be useful to develop something akin to a consumer report for antivaccine websites. We need to learn how to harness social media as effectively as they have.

• Tread carefully and use incentives. Not everyone is at equal risk for every disease, so mandates in the general public should tread carefully.

In addition, real incentives and disincentives (economic or legal, for example) for acceptance or rejection of vaccines among institutions, individuals, and payors, should be considered.

• Give some attention to the concept of "personalized vaccinomics." This is a concept of personalized vaccination based on the idea that one size and dose does not fit all.

Eventually, phenotype/genotype databases will be large enough to make predictions about dosing needs (such as predicting which young women might respond to one dose of HPV vaccine, eliminating the need for all three doses), for example, so that the approach can be personalized.

• Ensure health care worker vaccine competency and compliance. Vaccine requirements for transmissible diseases among health care workers are needed, as are educational requirements for workers. A "nursing paradox" also needs to be addressed; studies suggest that while nurses spend the most time with patients and are the greatest influencers, they still tend to question the safety of vaccines more than any other health care worker category.

Several studies, including ones that I have conducted, show that there is very little in the way of vaccine education in nursing schools. It’s time to change that trend.

• Learn and utilize the science of motivation, change, and communication. This involves learning how people learn, how they think, and how they make decisions, and applying this through innovation. It also requires relentlessly exposing and rebutting dangerous and uniformed opinions for what they are.

Ample data demonstrate that we make fundamentally flawed decisions because of unconscious biases. It’s the way we’re wired. I think we would be wise to understand the role of cognitive bias and preferred cognitive styles in educating the public, and the power of emotive stories and parables.

Dr. Poland is director of the Mayo Clinic Vaccine Research Group, Rochester, Minn. He reported having relationships with the following companies: Merck, Avianax, Theraclone Sciences, Liquidia Technologies, Dynavax, PaxVax, and Novartis Vaccines and Diagnostics.