Hit Me With Your Best Shot: Using Rhetorical Theory to Overcome Vaccine-Skepticism

By: Sarah Ondriezek

Vaccine-skepticism is nothing new.  Objection to vaccines began popping up in the early 1800’s as a response to the English government mandate that children receive the smallpox vaccine. At the time, people raised concerns about the efficacy of the vaccine, mistrust in the government, and the importance of personal liberty. The Anti-Vaccination League and the Anti-Compulsory Vaccination League were both formed in response to the smallpox vaccine, and similar groups (along with anti-vaccination journals) sprung up in the United States near the end of the 19th century.

Despite the fact that vaccines have eradicated deadly diseases for over 200 years, anti-vaccination sentiment has persisted. Proponents of the modern anti-vaccination movement have pushed back against the DTP (Diphtheria, Tetanus, and Pertussis) vaccine, the MMR (Measles, Mumps, and Rubella) vaccine, and even vaccine additive, thimerosal.  In the last decade alone, parental refusal to childhood vaccination has caused a resurgence of measles and whooping cough.  Interestingly, the reasons given for vaccine-skepticism remain similar to those during smallpox: vaccine efficacy, potential risk of harm from vaccines, mistrust in the government (or “Big Pharma”), and personal liberty.

As the world enters its second year of the COVID-19 pandemic, the proverbial light at the end of the tunnel comes in the form of a vaccine.  What has largely been lauded as an anecdote to the Sars-CoV-2 virus, has been, unsurprisingly, met with a great deal of distrust from anti-vaccination proponents. The refusal rate for COVID-19 vaccination in the United States has been estimated to be around 25%, placing the threshold for herd immunity in jeopardy and allowing the virus to continue mutating.

Coronavirus task force being formed.

Image from: Flickr

Dr. Anthony Fauci, the CDC, and other, highly visible public health officials/organizations have worked tirelessly in the media to address the importance of COVID-19 vaccination and to dispel misinformation about the vaccine. Everyone continues to work from the same Risk Communication template – how effective is this tactic in persuading the public to accept vaccinations?

The onus to overcome anti-vaccination sentiments eventually falls to health-care providers (physicians, physician assistants, nurses, etc.), who provide face-to-face care for patients. This is an area where vaccine rhetoric experts can offer tips and guidance to help healthcare providers respond to vaccine-hesitant patients in the most effective way.

Compulsion Vs. Persuasion

Created infographic on vaccine fact and fiction.

Historically, ensuring that the public is vaccinated has been approached in two ways: compulsion or persuasion. Vaccination compulsion techniques may take the form of: government ordinance, school or work mandate, or a patient being fired from a physician practice for refusing vaccination. These methods certainly have their benefits (ensuring that everyone who can be vaccinated is vaccinated) but are also accompanied by public backlash and an array of ethical dilemmas. Persuading the vaccine-hesitant is no easy task, as they hold fast to their concerns and beliefs.  The difficulty in this task aside, effective persuasion provides the vaccine-skeptical patient with the tools of empowerment to choose vaccination. This method of ensuring vaccine uptake has been growing in popularity as the preferred method for overcoming vaccine-hesitancy.  In the field of communications, vaccine rhetoric, under the umbrella of the rhetoric of science and medicine, has emerged as the focused-study of using persuasion to approach vaccine-skepticism.

Vaccine Rhetoric

One of the leading experts on vaccine rhetoric, Heidi Y. Lawrence, Ph.D.. approaches vaccine rhetoric from a material rhetorical approach. In her 2018 article, When Patients Question Vaccines, Lawrence focuses on the difference between objects (matters of fact, stable, known articles) and things (matters of concern, unstable materials that require discourse to understand).

Inlay terms: healthcare providers view vaccines as objects (stable, safe, effective protection against disease that offers high reward with low risk), while vaccine-skeptics view vaccines as things (unstable, potentially dangerous, misunderstood items that are up for debate). Interestingly, there is a lot of reciprocity between objects and things. Things require a rhetorical situation and discourse to become objects; objects require debate and discourse to be understood and recognized as matters of fact.

Using a material approach to develop practical vaccine rhetoric strategies opens the door for successful communication between patient and healthcare provider (actually creating a rhetorical situation in a provider’s office).

Pulling from Lawrence’s 2018 article, and other existing research on the topic, I’ve developed a list of evidence-based tips to assist healthcare providers in addressing their vaccine-hesitant patients.

Rhetorical triangle

List of Tips- The 5 R’s

  1. Refute claims swiftly and directly – offer a counterargument that directly refutes the claim.  If a patient says, “I don’t want to vaccinate, because vaccines cause autism,” respond only to that claim.  Offer that there is no evidence to support the claim, and that the doctor who originally touted this had his medical license revoked.
  2. Resist the urge to be pedantic or patriarchal – keep in mind that the patient views the vaccine as a ‘thing’ and not an ‘object.’ Instead, be open, understanding, and use this space to bridge the gap between ‘thing’ and ‘object.’
  3. Recommendation of healthcare provider – includes the prevention benefits of a specific vaccine and personal endorsement of vaccine. For instance, when recommending the HPV vaccine, the prevention benefit can be stated as, “The vaccine prevents various types of cancer.”
  4. Respond & identify with a patient – a person’s concerns are very real to them and should not be dismissed. Listening carefully to concerns, using empathy, and identifying with opposing viewpoints opens up space for a dialogue that is respectful and built on mutual understanding. Sometimes, this is all a patient needs to be open to persuasion.
  5. Remember to use Rhetorical Appeals – Logos, Pathos, and Ethos (see diagram above) should be used in every patient interaction.


The best way to combat vaccine-skepticism is by applying a rhetorical framework based on expert research in the field of vaccine rhetoric. While a great deal of information exists to combat anti-vaccine rhetoric on the internet and in mass communication theory, the first-line response typically comes from a healthcare provider. We must arm our physicians, advanced practice providers, and nurses with the right tools to overcome anti-vax disinformation and rhetoric.

Addressing the Digital Divide in Healthcare

All humans face a degree of vulnerability, but some experience the burden of more numerous or severe vulnerabilities than others. We can explain the extra burden that some face as special vulnerability. Special vulnerability can be temporary or permanent and can occur at any point in a person’s lifetime. It can arise from one or a combination of physical, psychological or social factors. It can happen to anyone at any time due to the mortal human condition.

There are a countless number of reasons why people can experience special vulnerability, but those related to healthcare access can be some of the most grievous. Access to healthcare has an inextricable impact on health including quality and quantity of life. Quality and quantity of life are basic needs that must be met before any other opportunities can be achieved or vulnerabilities overcome. This means that promoting healthcare access is essential for a well-functioning society and satisfies our moral obligations to protect those who, like us, are or may become especially vulnerable.

Promoting health care access involves studying and removing barriers to access. Barriers to healthcare access include, but are not limited to, transportation issues, access to specialty providers, access to ancillary services, language barriers, cultural barriers, and access to technology. While there are many factors that contribute to access, barriers to accessing technology are becoming increasingly prevalent and pressing for modern healthcare delivery in the United States. US health policy and innovation are moving toward a more technologically advanced healthcare delivery system, and many vulnerable patients have not been able to keep up. This means that technology-dependent communication messages can miss vulnerable populations that need them the most.

Health communication leaders can and should make sure that vulnerable populations get the health messages that they need. When vulnerable individuals face barriers to technology access, health communication leaders should develop integrated, multi-level approaches to communicate key health messages. This can include engaging the community by talking to community members, tapping into community resources, and using multiple media platforms. It can also include developing better tools for communicating with patients including shared decision-making and cultural competency.

Engaging the Community

1. Ask the vulnerable community. Talk to community leaders about effective ways to reach your vulnerable audience. Focus groups and one-on-one interviews with members of the vulnerable community can also elucidate community-specific needs.

2. Tap into community resources. There may be existing community resources that can be used to deliver your message. Find out if there are ways that you can synergize with community organizations to deliver your message.

3. Use multiple media platforms. If you are using technology to deliver your message, consider adding additional media platforms to your campaign. This could include the use of communication platforms like radio, television or community forums.

Tools for Communicating with Patients

1. Implement shared decision-making techniques. Train providers and staff on shared decision-making techniques. Through shared decision-making, staff and providers can learn about specific challenges that their vulnerable patients face and determine ways to address these challenges individually.

2. Engage in cultural competency. Incorporate cultural competency into your organization’s culture. Make sure that the organization’s executive and upper-level leadership are committed to cultural competency. In addition, providers and staff should be trained on cultural competency and incentivized to engage in culturally competent interactions.

Ultimately a collaborate, integrated and multi-level approach will get key messages to those who need them the most. Communication leaders should make a concerted effort to use these approaches and reach all who need essential health messages. The lives of the vulnerable depend on it.

Natalie Dick, MHA

Treat with Care: A Culturally Competent Checklist for Healthcare Providers

Cultural Competence

What it means to be healthy differs among cultures. It’s not just about the absence of disease; it’s the feeling of overall well-being. Cultural competence means an organization is able to function within the context of cultural beliefs, behaviors, and needs. It is imperative that healthcare workers always consider this when treating patients. Everyone is different. That means their bodies are, too. It does not work to have one universal treatment plan. By being aware of a person’s values, individuals can receive care personalized to them: which means the patient is more likely to go through with treatment and will have a better physician-patient relationship.

For Example…

A Jehovah’s witness cannot accept a blood transfusion due to how that person interprets the bible. As a result, it is up to a doctor to think outside the box, communicate with the patient, and come up with a treatment plan that will help the health the patient while staying within the person’s own beliefs. Since this is a poignant issue, UPMC even decided to start a bloodless campaign to consider these patient’s needs. After taking the time to communicate with people of this belief, UPMC actually felt more empathetic toward them and wanted to help. This proves that communication is key.

Health Communication

When interacting with patients it is important to remember key heath communication concepts. A patient cannot be treated correctly if a physician does not communicate with him or her and understand what his or her needs are. In the beginning of an appointment, it could be helpful if physicians went through a quick checklist of questions to begin to understand the patient in front of them. By utilizing a checklist and showing care, the patient in return will begin to trust the physician and open up to him or her.

Recommendations in becoming a more culturally competent health system

  • Provide translators
  • Research beliefs
  • Initiate cultural health campaigns
  • Provide cross-cultural training
  • Shared decision making among family members
  • Reach out to community health workers
  • Patient surveys to measure health literacy
  • Programs for patients on learning about the health system
  • Hire and promote minority workers

Remember: your set of beliefs are not the same as everyone’s set of beliefs. Take a step back, clear your mind, and be empathetic toward the patient. Take the time to research what the patient believes and understand what that patient’s personalized treatment options should look like. This will build the patient’s trust and will provide more personalized care which means more successful survival rates.

Sharing is Caring: The Power of Storytelling in Non Profit Campaigns

A Future of Sharing

How would you feel if I told you that sharing something as personal as your health and sicknesses on social media could someday help track the spread of disease? You might say that’s a little crazy, but would you do it if it meant keeping others healthy? Would you want others to do it if it meant keeping you healthy? Patrick Tucker thinks that soon the CDC will use our ever-posting social media habit to determine where illnesses are and where they’ll spread next, making Minority Report a thing of the present.

Although we’re not yet there, some health non-profit organizations have utilized this same idea of sharing personalized stories during campaigns, so people can talk about personal experiences and connect with others to spread information about certain diseases.

March of Dimes: Share Your Story

The campaign, ShareYourStory, by March of Dimes brings to life a safe online community in which the “neighbors” are families who all share in one particular struggle: a sick newborn. Members of this virtual “neighborhood” are able to share the struggle  they are having, offer and receive support, and spread information.

“ShareYourStory is home to all of us who have not had that picture-perfect pregnancy, who struggle with little ones in the Neonatal Intensive Care Unit, or forever hold their child in their heart. It is where I found hope for the future,” said community member Lauren Wilson, from Hawaii.

The shareyourstory campaign easily connects to social media platforms so that they can be circulated to an even wider array of people. By using avatars and enabling videos and stories, the campaign to improve the health of babies becomes human, personalized, local, and gives the families a way to see the faces of the people that they connect with on a daily basis. The dedicated website, shareyourstory.org, brings families to a blog forum where they can post and react to others’ posts. Yesterday, for example, twenty members posted and commented on each others’ stories, questions, and messages.

The Power of Storytelling

Stories are so powerful because they withstand the tests of time. They spread from person to person, community to community, through families and friends; they change, but what is at the heart of a good story remains the same. By using storytelling as the main mode of communication in a campaign, organizations are able to tap in to human emotions and create common bonds.

Each campaign uses the very powerful tool of empathy. This is something that needs to be employed more in our health systems in order for patients and physicians to have a strong trusting relationship. Now, don’t confuse sympathy with empathy. Where sympathy leads to disconnect, empathy drives connection by staying out of judgement and communicating to a person that he or she is not alone. The problem with sympathy is that it always tries to show people the “good” in something bad. Health care providers need to be able to deter sympathy and understand this difference.

“You never really understand a person until you consider things from his point of view…Until you climb inside of his skin and walk around in it” ” -Harper Lee, To Kill A Mockingbird.

If physicians can step in to their patients’ shoes, then they can start treating patients as individuals instead of just another number. Interacting with patients not only helps create bonds, but allows physicians and healthcare providers to learn about individuals on a personal level. When a patient sees that their physician cares for them as a fellow human, it allows space for open dialogue between patients and physicians which leads to better, personalized care.

American Diabetes Association’s campaign, This is Diabetes, uses the hashtag #thisisdiabetes, to encourage individuals or friends and family to post their own video of a personal story and struggle they deal with from the disease. What this campaign encourages is spreading awareness about parts of the disease that many people would not be aware of otherwise and what kinds of crippling effects diabetes has on other aspects of a person’s health and the other lives that disease touches.

The National Multiple Sclerosis (MS) Society‘s, Together We Are Stronger Campaign uses similar tactics to inspire individuals living with MS to share their story through video and offer insights. It connects people together with different ways of dealing with the disease, educating people on the disease, and coming up with new ideas for a cure.

‘Empathetic Storytelling’

I call these campaigns  ‘empathetic storytelling,’ since they connect humans on a common health issue and provide support. They reverse the negative connotation that comes with the idea of spreading disease. Instead they spread information about a disease through words and symbols. By spreading words, instead of sicknesses, the information that is shared and reshared can help the listeners prevent their own risk of developing a disease, or even find a treatment.

Recommendations for Empathetic Storytelling For Health & Nonprofit Campaigns:

  • Utilize multiple channels and social media networks
  • Appeal to emotion, but don’t go too far (Think about the dog shelter commercials, how many times do you change the channel as soon as you see a sad dog come on your screen?)
  • Stories don’t always have to be sad, share some hope for the future
  • Mix words, pictures, and videos
  • Share your own story, this connects you to your audience
  • Create a powerful hashtag
  • Provide useful information (an audience needs to know about the cause in order to participate in the campaign)
  • Be cohesive and consistent, all the channels or networks you utilize should include the same information, hashtags, and look (branding, colors, etc.)
  • Try to stay away from medical jargon, in a health campaign it may be easy to use scientific words, stop and think about your intended audience (what is their knowledge, or lack thereof, on the topic)