Mandatory Vaccinations

In the Oct 6 issue of the New York Times, Christopher Mele devotes an interesting article to risk communication in emergencies. In a nutshell, his argument is that – if one aims to communicate risks – one needs also to evoke fear. Mele’s point of departure is the recent evacuation of Florida, Georgia, North Carolina and South Carolina residents due to Hurricane Matthew. He reports that “even after all of the best practices in emergency communications are exhausted, 5 percent of the population will most likely remain in harm’s way, experts and researchers said”.  Actually, this figure is likely to be still over optimistic, for instance during 2013 Hurricane Sandy 49% of coastal residents who were under mandatory evacuation did not evacuate.  In 2014, a State University of New Jersey team led Dr. Cara Cuite, carried out a study on “Best Practices in Coastal Storm Risk Communication” concluding that effective communication should “stress the possibility that people who do not evacuate could be killed”.  This is better done by using implicit messages rather than direct, explicit, messages. For instance, if authorities ask people who do not evacuate to fill out a form on how to notify their next of kin, they communicate in a very effective way the actual possibility “that people who do not evacuate could be killed “without the need of warning them explicitly. Another important lesson concerns semantic, say, the specific words chosen to communicate.  In most cases, mandatory evacuation is excluded, since there is no way to enforce it. Yet, experts know very well that “a voluntary evacuation will have a lower rate of compliance than one labeled mandatory”. It is then critical to avoid using the expression “voluntary evacuation” and “make it clear that residents are being ordered to leave, even if no one is going to remove them forcibly from their homes”. 

It is possible to elicit from Mele’s arguments two general rules concerning risk communication, which could be adopted also in other situations, notably in outbreaks. 

First, in contrast to the standard risk communication account, one should focus on emotional responses rather than on mere rationality.  Risk communicators often aim to raise awareness and to provide the public with information, which is in principle laudable and it would be effective in an ideal world, ruled only by rational choices. Unfortunately, very rarely people make choices on a rational basis, even when they pretend doing it.  As a matter of fact, in real life “pure rationality” does not exist, is a fictional concept. Mental processes are an inextricable mix of logic arguments, emotional reactions, implicit and explicit memories, automatisms, conscious and unconscious processes. Very rarely – if ever – an action follows a rational decision; more often the so called “rational decision” is a post-hoc rationalization, used to justify decisions made in more or less irrational ways.  There is little that one could do to prevent this mechanism, notably in emergencies, when people are asked to take quick and momentous decisions. Among emotions, fear plays a pivotal role as one of the basic emotions that drive human behavior. There are two opposite mistakes that one could do in risk communication, over stimulating fear but also over reassuring people. Fear must be fine-tuned.

Second, if being able to deal with emotions is critical in risk communication, this implies that two variables become paramount, timing and words.  Timing is essential because human emotions are continuously fluctuating in each individual and they change over time. The same message could evoke completely different reactions according to the emotional context of the receiver and consequently a message could have very different effects according to the moment in which is delivered. There is not something like “the right message”; rather there is “the right message in the right moment”. Words are also very important. I’m saying “words” and not “contents”, because I’m referring to the very terms used rather than to concepts underlying words.  Words unavoidably evoke specific emotional reactions, which are – be careful – cultural bound and context dependent (say, one should avoid the mistake of thinking that the same words evoke the same reactions always, everywhere and in everybody). The word “mandatory” is a good example. At least in our society, if something is “mandatory”, for most people it is also important, while, if it is “voluntary”, it is not (or less). So to label something as “mandatory” does not imply necessarily that one is going to enforce it compulsorily. The term “mandatory” could be used also to transmit the importance of an action.  This is well illustrated by the wrong (in communication terms) policy to make most vaccinations “voluntary”.  To be sure, in democratic societies it is largely unthinkable to vaccinate compulsory people and notably children, yet the issue at stake is only in part the balance between voluntariness, persuasion, soft coercion, and compulsion. Words chosen by regulators communicate also the importance of a public measure. Health authorities and policy makers should pay more attention to the communicational implications of wording, even when choices seem to concern purely technical and normative aspects.