Reframing the Conversation about Child and Adolescent Vaccinations

"[P]ublic discourse about vaccination is at a crucial inflection point, and health practitioners and advocates have an important role to play in shaping that discourse."

The deeply rooted cultural emphasis on individualism and overemphasis on risk in public discourse about vaccination in the United States (US) are among the challenges health practitioners, advocates, and public health communicators face in vaccine-related communication. Developed by the American Academy of Pediatrics (AAP) and FrameWorks Institute, this strategic brief details five evidence-based framing recommendations for communicating about vaccinations that can be adapted for different audiences, speakers, and messages. The goal is to help practitioners and communicators advance a new story about vaccinations - thereby building understanding of and support for child and adolescent vaccinations.

While the recommendations outlined in the brief can help in one-on-one doctor-patient conversations, the focus is on how to frame childhood and adolescent vaccination more broadly in order to shift public thinking on the issue. The recommendations - which include discussion of the challenge, what to do, an example of what to say, and why it works - include:

1. Talk about the benefits of vaccination for the common good:
   • Lead with talking about how childhood and adolescent vaccination benefits the common good of society first and foremost, and then talk about the individual benefits, rather than the other way around.
   • Give concrete examples of the benefits of childhood and adolescent vaccination to whole communities and societies to contextualise what benefiting the common good looks like in practice.
   • Draw on the idea of vaccination for the common good to foreground the power of vaccination as a collective responsibility to keep everyone healthy.
2. Talk about improving vaccination access as a preventive public health measure:
   • Explore access to childhood and adolescent vaccination as a way to prevent future disease and ensure the health of our communities and society.
   • Be explicit about the ways that improving access to vaccination services for all children and adolescents is our collective responsibility as a society.
   • Point to the disparities in access to vaccination services, especially for children and adolescents, before talking about the disparities in uptake.
   • Provide examples of concrete polices that increase access to vaccinations for all children and adolescents to build people's understanding of systemic solutions.
3. Focus on how vaccines benefit children's and adolescents' long-term health and wellbeing:
   • Explain how vaccines prepare children and adolescents for their long-term health, wellbeing, and development, instead of talking about how vaccines protect children from harm.
   • Shift the focus from talking about vaccinations as being only about individual health to talking about vaccinations as a partnership among the parent, child, doctor, and broader community to ensure the long-term health and wellbeing of children.
4. Use a computer updates metaphor to explain how the immune system improves its performance through vaccination:
   • Use the language of computer software updates to explain how vaccines help the body's immune system operate efficiently and improve its performance.
   • Compare vaccines to computer updates to explain how vaccines help the body stay safe from "network" viruses.
   • Discuss the impacts that vaccines have on the immune system in terms of detecting viruses and responding to them, just like software updates on a computer.
5. Use a literacy metaphor to explain how the immune system learns how to respond to viruses through vaccination:
   • Describe vaccination as a process of gaining literacy to explain how the body's immune system learns to "read" the language of a virus through vaccination.
   • Talk about vaccines as "texts" that the body uses to practice learning how to read a virus.
   • Use the idea of literacy to explain how the immune system remembers how to detect and react to a virus after the vaccine has left the body, just like how people remember how to read after gaining their literacy skills.

Recommendations 1, 2, and 3 have been designed specifically to help shift the focus from the individual to the collective by tapping into widely shared values and talking about what's at stake in the issue. Recommendations 4 and 5 are metaphors that have been designed to shift the focus from talking about vaccines fighting a disease, which leads to people overemphasising risk, to explaining how the immune system prepares the body for the virus.

This brief synthesises the findings from several FrameWorks research methods. A total of 9,112 participants from across the US were included in all phases of the research. The Appendices provide more detail:

• A: Research Methods and Samples
• B: Metaphors Tested in On-the-Screen Interviews
• C: Framing Strategies Tested in Survey Experiments
• D: Sample Survey Items
• E: Select Results from Survey Experiments
• F: Framing Strategies Tested in Peer Discourse Sessions