Could a spoonful of sugar help the vaccine go down?

By Maria-Elizabeth Baeva, MSc Candidate, Jefferies Lab

We’ve tried shaming them, we’ve tried mocking them and we’ve tried giving them cold hard facts: but it seems like nothing can convince anti-vaxxers to go get their infants vaccinated.

Or is there?

Patch Adams (bottom), played famously by Robin Williams (top) in the titular 1998 movie. Although he became known for making his patients laugh, his philosophy was one of empathy and kindness in a clinical setting. (Image from Time magazine, accessed February 4th 2020; Universal/Getty Images; Carlo Durna Araujo—Corbis)

My personal interest in this story comes from a strange hobby of mine to seek out vaccine hesitant folks on Facebook and then private message them. I try and understand how their fears and concerns override what (at least to me) seems like an obvious fact: if you vaccinate your children, the likelihood of them being ill from a preventable illness drastically decreases.

Provincial health care has also been struggling with this dilemma. Measles requires a 93-95% population vaccine rate in order to establish herd immunity – underneath this percentage, outbreaks become more likely. After noticing in 2014 that vaccination rates among 2-year-olds in Quebec varied between 71-85%[1] , Gagneur et al. decided to use an innovative, patient-centered technique called motivational interviewing (MI) to educate and persuade mothers of newborns to have their child vaccinated. As described in the study, MI is based on the principles of “1) empathizing with the client, 2) developing a discrepancy between their current and desired behavior, 3) dealing with resistance without antagonizing, preserving effective communication, and allowing clients to explore their views, and 4) supporting self-efficacy”. Interestingly, this technique was originally developed to assist with substance abuse recovery.

When this technique was first tested in 2013, there was a 15% increase in the intention of mothers to vaccinate at 2 months old[2]. This result is reaffirmed with Gagneur et al’s 2018 study, which showed an overall increase in vaccination rates of 3.2, 4.9 and 7.3% at 3, 5 and 7 months of age, respectively, compared to controls [3]. Although these results may appear modest, the authors are optimistic considering this was compared to current standard of care (an informational pamphlet on vaccines given post-delivery) that were not approached to participate in the trial. Additionally, the authors provide evidence that the control group appears to have had a higher intention to vaccinate than if the participants were randomized. A higher percentage of mothers in the control group already had a child, which is positively correlated with a higher intention to vaccinate. Given these studies, the team has recently completed a randomized clinical trial with the hopes of definitively demonstrating the validity and efficacy of this technique[4]. Results are yet to be published.

The practicality of this approach should also not be understated. The interventions were carried out by nurses to consenting mothers 24-48 hours after delivery and lasted approximately 20 minutes. Ultimately, this study shows that if we’re serious about increasing vaccination rates, people will “listen to reason” if we show them dignity, respect and empathy. Maybe Mary Poppins was onto something when she cheerfully proclaimed that a spoonful of sugar helps the medicine go down. Since I can’t send those anti-vaxxers some sugar over Facebook, I can sweeten my discussion with MI techniques instead.

  1. Boulianne N, A.D., Ouakki M, Dubé È, Serres G De, Duay M. , Enquête sur la couverture vaccinale des enfants de 1 an et 2 ans au Québec en 2014. Quebec, 2015.
  2. Gagneur A, P.G., Valiquette L, De Wals P., An innovative promotion of vaccination in maternity ward can improve childhood vaccination coverage. Report of the Promovac study in the Eastern Townships. . Library and National Archives of Canada 2013, 2013.
  3. Gagneur, A., et al., A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health, 2018. 18(1): p. 811.
  4. Gagneur, A., et al., Promoting vaccination in the province of Quebec: the PromoVaQ randomized controlled trial protocol. BMC Public Health, 2019. 19(1): p. 160.