Using Culture as a Blunt Instrument to Counteract Antivaccine Misinformation Campaigns

Introduction
This article discusses culture-based communication strategies that can be used to address the growing number of antivaccine misinformation campaigns that have contributed to a number of outbreaks in the United States and around the world. For the first time in 13 years, the Centers for Disease Control and Prevention characterized the 2017–2018 flu season as “widespread” and “high severity” with approximately 60,000 confirmed cases, which resulted in 79,000 influenza-associated deaths (Rolfs et al., 2019). Also, the World Health Organization recently reported a 300% increase in the number of measles cases worldwide compared with the first three months of 2018.

So, what gets in the way of a decision to vaccinate against infectious diseases?
Studies reveal that a significant factor that is contributing to recent outbreaks, such as the measles in New York, is the spread of misinformation in communities about the safety of the measles-mumps-rubella vaccine and others. Some individuals are deliberately targeting communities with inaccurate and misleading information about vaccines via social media (Broniatowski, 2018).

Studies have investigated differences in vaccine uptake between white and other racial or ethnic groups (e.g., Quinn et al., 2017a; Nowak et al., 2018; Santibanez, 2016), while only a few others have looked at intragroup differences among blacks and Hispanics (e.g., Moran et al., 2017; Cohen et al., 2012; Quinn et al., 2017b). To close that knowledge gap, Community Science conducted a national survey and a follow-up qualitative study to understand the factors that support vaccine uptake and hesitancy among young African American and Hispanic and white adults.

Findings
We found that young African Americans and Hispanic and Latino adults between the ages of 18 and 24 possess mostly negative views of the efficacy and safety of the flu vaccine. These negative perceptions are in part because of a lack of knowledge, misinformation, and a personal sense of invulnerability. Some also base their decisions on myths that lead them to not get a flu vaccine — for instance, thinking that the flu affects only the elderly or those with weakened immune systems, or that you can get infected in cold weather only if you are not wearing a warm coat. A lack of accurate information is compounded by a lack of trust in the institutions responsible for communicating the benefits and developing the flu vaccine, such as the government and pharmaceutical companies. This lack of trust leads to concerns about the safety of the contents of the vaccine and distrust of the motivations of the entities that make vaccines available to the public. This deep-rooted mistrust in the government and pharmaceutical companies, together with knowledge deficits and doubts about the efficacy of flu vaccines, makes convincing groups to vaccinate a more arduous endeavor that requires specific, culturally tailored communication strategies.

Thinking through Solutions
Exploring the barriers, motivators, personal health beliefs, and social context of the flu vaccination decision-making process has given us ideas for how to counter misinformation campaigns to encourage uptake among young adult African Americans and Hispanics and Latinos who do not regularly get the flu vaccine.

First, align messages to target a population’s age group and race or ethnicity. Many focus group participants reported that although there was news related to a flu epidemic during the 2017 flu season, they did not personally relate to the information. They often felt that the epidemic was experienced in places far away and among people who were vastly different from themselves, either because of race, geography, or age, or among individuals who had compromised immune systems. In other words, the people dying “didn’t look like them,” so the message was not interpreted as an emergency. Participants suggested communication efforts highlighting deadly flu cases in neighborhoods in which they live and that affected minorities of similar ages would be more effective in capturing their attention.

Second, weave familial responsibility into health messages. In Hispanic and Latino culture, where machismo still plays a big role, a key strategy is to highlight males’ role in the family unit and how getting vaccinated is a way to protect the family. This message could focus on how the flu vaccine can help them avoid missing days from work, ensuring they are still able to economically provide for their families and fulfill their role as the protector. Similarly, one group of African American participants suggested developing an advertisement featuring a single black mother who is unable to take care of her children because she has the flu. These types of personal accounts of people’s experiences (both good and bad) of how the flu or prevention of the flu affected their lives could be an effective way to capture young African American and Hispanic and Latino adults’ attention and encourage them to get a flu shot.

Third, identify appropriate messengers for specific racial and ethnic groups. The Hispanic and Latino participants defined the ideal messenger as people they respect and admire, such as an elder, teacher, counselor, or doctor. They also emphasized that messengers would be most effective if they were concordant with their race and ethnicity. It is worth noting that study participants did not identify a faith leader as the most effective spokesperson to deliver provaccine messages. This finding is contrary to studies with African Americans that found churches and faith leaders to be influential partners in communicating health messages (Frew et al., 2016). Across all Hispanic and Latino and African American groups, participants agreed that having provaccine messages delivered from a well-known sports figure with credibility of doing community-based work (e.g., LeBron James) could inspire trust and uptake of the vaccine, especially among young men.

The communication strategies discussed are but a start to begin to counter the antivaccine messages that are now prevalent in social media networks. For these messages to be effective, they must be disseminated not only on social media but also on more traditional communication mediums such as television and radio.

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