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In a series of blog posts, Mike Watson ( and I will propose a structured, evidence-based, globally applicable approach for building and sustaining acceptance of vaccination. An approach that will give national vaccination programs a triple-A rating for uptake: Access, affordability, awareness, acceptance, activation (yes, thats 5 in fact). And then provide a matrix of solutions for the development of a strategy that will help close any vaccination uptake gap.

The topic of vaccination acceptance has finally hit the global agenda, yet now that the problem has been widely acknowledged, we seem to be struggling to figure out what to do. You cannot understand what you cannot measure. Recent discussions overheard at many levels suggest that the natural scientists who populate the vaccination ecosystem are struggling to measure vaccination acceptance with natural science methodologies. This is not surprising, given that vaccination acceptance is about people, not microbes. Biology can tell us a lot about a virus, from its genome to its epidemiology, but these methodological approaches fail miserably to explain those weird irrational human behaviours that control our decisions.

If we cannot apply a natural sciences approach to a human problem, then what are we to do? Well, there is good news. Very good news. The social and behavioural sciences have, for quite some time, been doing a great job of measuring and understanding what influences human behaviour. It is time for vaccinologists to agree that the sciences we use have hit their limit with this new/old problem of trust in vaccination. And instead of trying to put a screw in with a hammer, we need to get a screwdriver (no offence meant to social scientists).

We claim no expertise in the social or behavioural sciences, which is exactly the point. Everything we are learning about the social and cognitive determinants of vaccination behaviour is coming from behavioural and social science experts and literature. We have happily acknowledged the limitations of clinical medicine, molecular biology, epidemiology and so on. We have accepted that we are odd irrational beings who can apply our years of training in empirical sciences to better justify post-hoc the decisions we have made through a trail of cognitive short-cuts that passed through the prism of our worldview.

And we now want to do things better, to actually have an impact, with the help of the social and behavioural sciences.

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Copyright TEDxBrusselsTEDxBrussels a couple of weeks ago. In the midst of exciting discussions about digital stuff, social networking, communities, collaboration and (inevitably!) innovation, Andrew Keen threw a bit of a spanner in the works, perhaps ensuring we didn’t all get sucked into a group think. He talked about the ‘cult of the individual’, digital narcissism, and the risks of us all becoming data.   My read between his lines was that in an increasingly digitised world, we risk increased abstraction of the individual, alienation rather than increased connectedness.   The following day there was a follow-up event, ‘TEDxBrussels meets the EU Commission’, to which they invited many of the speakers, Clara del Torre (Director, DG Research & Innovation), and others to further discuss the topics of TEDxBrussels through panel discussions and audience input.   I was on a panel with Alan Greene and Jeroen Raes which started out as a discussion on e-health but, rather ambitiously thanks to chair Wim De Waele, ended up trying to ‘redefine health’.   I believe health is about people (or Ambulatory Bacterial Colonies as Raes would have us imagine). Health is not about diseases, organs, treatments or new technology and tools. It is about people.   Not patients, people.   I heard an anecdote once of a man shuffled between specialists in a hospital and talked over – but never talked to – who finally cried in exasperation: ‘I am not a pancreas!’   As we talk excitedly about new technologies that are heralding in the the age of e-health it is important perhaps to heed Keen’s warning. When we become a patient, we have already begun to become abstracted. We may walk into a clinic as a person and leave as a disease, or at best an organ.   The risk of new e-health technologies, which aim to increasingly turn a person into a composite of health data, is that the person who enters the health system becomes increasingly pixelated and indistinct.   So as we stand on the ‘verge of the Century of Wisdom’, as Peter Droll (Head of Innovation Policy, DG for Research & Innovation) rather optimistically predicted, we should heed the words of the great Marshall McLuhan:

“We shape our tools, and afterwards our tools shape us”

If we can understand this principle as we develop new health apps, and incorporate the potential and desired behaviours into the design and implementation, then perhaps we will actually move from hype to hope.

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The truth is not out there, it’s inside us

By: Angus Thomson | 0 Comments

On: October 3rd, 2012 in Communication,Dogma’s,Ethos,Norms,Truth | Tags:

Truth is perception. I have already heard this from Marcus Aurelius, Gautama Buddha, and Gustave Flaubert amongst others. But an interesting article(open access) on the science of how we process, keep and correct misinformation by Lewandowsky et al laid out strong scientific evidence for this idea.


This paper looks at the sociologic and psychologic basis of the genesis, spread and stickiness of misinformation. Their analysis of the near-impossiblity of correcting misinformation once it has taken hold warrants a second post, but here I want to look closely at how we assess the truth of something we hear.

Whether you are concentrating or not, you probably evaluate only 4 things as you decide if something you hear is true:

  • Does it fit within my worldview?
  • Is the story coherent?
  • Is the messenger trustworthy?
  • Does it fit with what (I think) others believe?

Get to know your worldview – it is your lens on the world

We are resistant to accepting something that contradicts our beliefs because that throws everything else we have used to construct our worldview into question. This construct, made up of all the things we thought to be ‘true’ has a huge influence on our decisions. A recent paper, used the example of climate change to show that we all select facts to support our beliefs and values. But what was fascinating is that scientists are better at this process – our training in empirical science doesn’t make us more likely to believe the facts, only better at cherry picking them. At least when our cultural worldview is being challenged.


You should read Dan Kahan’s pithy blog post on the paper.


Indeed, when we have to process information that is inconsistent with our internal knowledge collection we experience negative feelings, and process the info less fluently.


Why narrative can change beliefs

We all like stories. More importantly, we are all likely to believe the stories we hear when they relate to our world. A coherent story gives us information that is easier to understand and process, easily remembered, and more likely to influence our dear beliefs and values.



Over two thousand years ago, Socrates noted the importance of ethos in convincing people of something. If a message is to be believable, we have to feel we can trust the messenger. The message also had to be delivered with pathos, because this emotional connection with the audience also increased understanding and trust, but that is for another post. A little disturbingly, ethos can be easily manufactured by simply repeating an unknown name over and over. It is a two-way street: a resonant or engaging message can increase the credibility of the messenger to the listener.


What does everyone else think?

We are strongly influenced by what we think other people think, do, and expect us to do. Social norms are strong drivers of behavior. I was reassured, as an Australian, by one example Lewandowsky et al gave. In Australia, the morons with strong negative views about Aboriginal Australians or asylum seekers overestimated public support for their distasteful beliefs by 70% and 80%, respectively. That bitter slice of the Australian population is probably less than 2%.


So, with apologies to the x-files, it seems the truth is not out there. It is embedded within each of us, within our internal, calcified world-view that seems to be composed of the accretions of our social, cultural and other experiences. I am not sure if that is scary or reassuring.


But it suggests that we must be prepared to make a huge effort if we are to follow Keynes’ wisdom: “When the facts change, I change my mind. What do you do, sir?


Credits: H/T Nurses who vaccinate – follow them on Facebook.

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