The World Health Organization listed “vaccine hesitancy” as one of 10 threats to global health in 2019. The disappearance of vaccine-preventable childhood infections from our everyday lives, coupled with disinformation campaigns on online platforms, in books and documentaries, have resulted in a significant percentage of our population that is reluctant to vaccinate their children. When I recently made a video on the topic, I was disheartened to find out that interventions aimed at increasing trust in vaccines either did not work or backfired, making parents even more reluctant. What did give me hope was a project called Boost Oregon, which emphasized active listening free of judgment.
I was thus delighted when a fellow science communicator recently told me that a similar project had been tested and implemented in parts of the Quebec healthcare system. It’s called EMMIE and I decided to look into it.
From substance use disorders to vaccine hesitancy
EMMIE is a French acronym for what I would translate as “Motivational Interview in Maternity for the Immunization of Children” (which, interestingly enough, spells out MIMIC). How it unfolds is simple. The day after giving birth in a hospital maternity ward, a mother is approached by a trained immunization advisor, who spends 20 minutes with her conducting a motivational interview on the topic of vaccines. This type of approach was initially created to help people overcome an addiction to a substance. It’s a type of dialogue that emphasizes empathy, respect for a person’s autonomy, and does away with argumentation. The immunization advisor uses open-ended questions, affirmative statements, reflective listening, and careful summarization to help the new mother deal with any vaccine resistance she may have and feel empowered to immunize her child. In a nutshell, it is the exact opposite of posting online memes calling parents who don’t vaccinate “dangerous idiots”.
This program is now being implemented in 15 hospitals in Quebec which together see over half of all births in the province. While this sounded great to my ears, the question I asked myself was, “Does it work?” Fortunately, we have data.
A step forward
A study called PromoVac tested this intervention in the Estrie region of Quebec with nearly 2,400 families which were split into two groups: roughly half took part in the motivational interview, while the rest were used as a control group. The interview resulted in a 15% increase in the intention to vaccinate. This intent did not fully translate to complete immunization, however. The children in the motivational interview group had a 9% increased chance of having received all their vaccines between 0 and 2 years of age compared to those in the control group. So a significant increase, but by no means a complete solution to the problem.
Percentage of children with a complete vaccine status during infancy (from Lemaître 2019)
A province-wide clinical trial called PromoVaQ, meanwhile, has just wrapped up and should yield even more reliable results.
The situation is grim. Complete vaccination coverage in Quebec as of 2014 was 71%, a far cry from the 95% target.
While the motivational interview does not look like the miracle solution we so desperately need, it is moving the needle in the right direction and leads to satisfied moms. (97% of the mothers who participated in PromoVac said they would recommend this strategy to other families.) And it’s a much-needed addition to a tool kit that, up until now, has been filled with paper hammers.
In-person motivational interviews, combined with the recent crackdown on antivaccine propaganda by major online platforms, may give us a chance against the diseases that simply don’t deserve to be in our daily headlines.
- A new intervention is being implemented in Quebec maternity wards to help parents who hesitate to vaccinate their children
- The intervention relies on open questions and empathy instead of shaming and argumentation
- The first major study on this intervention in Quebec resulted in a small but significant increase in childhood vaccinations
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