Can Aristotle Increase the Rate of Vaccine Compliance?

Can an Aristotelian examination of rhetorical strategy help us increase the number of children vaccinated? To find out, Vital interviewed Amanda Taylor, a Ph.D. candidate at the University of Minnesota who specializes in rhetorical theory and the history of medicine.

Amanda, thanks for agreeing to talk with Vital about rhetoric and public health. Many people would agree that certain debate strategies are more effective than others. Could you begin by explaining how scholars study rhetoric, how they classify arguments?

Sure. Arguments themselves come in a variety of forms. The Greek intellectual Aristotle outlined three categories of evidence in his fourth century B.C.E. treatise On Rhetoric: logos, ethos, pathos. These are roughly translated as appeals to logic, ethical appeals, and emotional appeals. Rhetoricians over the centuries have relied on this three-part approach to teach and evaluate persuasive communication.

A position comprised of factual and logical evidence depends upon logos as its operative persuasive technique. The persuasive effect of ethical arguments, ethos, comes from appeals to shared ethical standards, the strength of one’s ethical position, or from undermining the ethical character of the opponent. A position that seeks to provoke a sympathetic response on the basis of shared emotional experiences appeals to pathos.

The distinction between logos, ethos, and pathos could apply broadly to any number of debates. How might we classify arguments promoting the use of vaccines according to these three categories?

Most sources promoting the use of vaccines tend to rely upon logical appeals that provide links to factual information. For example, these arguments might refer to studies by the CDC or other public health organizations or to information about biology and scientific research in order to demonstrate that vaccines do not cause autism and very rarely have significant ill effects. The evidence shows that vaccines reduce disease outbreaks and improve the quality of life for individuals and communities on the whole.

Ethical appeals can take several forms. The argument, for example, that those who are immune-compromised and therefore cannot receive vaccines need others to vaccinate in order to protect them from a potential outbreak is an ethical appeal. Arguing that parents’ decision not to vaccinate is made easier when they live in wealthy, largely vaccinated communities that protect them from an outbreak is also an argument dependent upon ethos. One might also seek to undermine the ethical authority of a person who does not vaccinate his children by mocking his intelligence. Some comical arguments for vaccination take this approach, but are not necessarily effective.

An appeal to emotions, or pathos, can also take several forms. These types of arguments tend to be most effective when the person working to convince someone to vaccinate seeks to increase sympathy by showing pictures or telling stories about people who acquired vaccine-preventable diseases (VPD). When we feel sympathy for others, it can cause us to change positions.

What, in your opinion, are the reasons that some people believe vaccines cause autism despite evidence to the contrary?

The anti-vaccination movement has its source in Andrew Wakefield who miscommunicated scientific conclusions to a public audience. Though he continues to profess his belief in the link between vaccines and autism, the research indicates that the initial communication was deeply in error. His study came out in a respected medical journal, so, at the beginning, he seemed to have logical and ethical support for his claims. An increase in diagnoses has also triggered concerns about a possible connection between the vaccines and autism.

Of course, no parent wishes to harm her child, so concerns for children’s safety led parents to begin foregoing vaccinations. This decision has been further bolstered by other celebrity and political figures, including Jenny McCarthy, Jim Carrey, Alicia Silverstone, and the radical right-wing politician Michelle Bachman. Their celebrity status provides them with a platform, and media coverage ensures that millions of people hear their message, regardless of its accuracy.

Are there strategies that are more effective than others at convincing people to vaccinate?

A recent study resulting from the collaboration of psychologists at the University of Illinois Urbana-Champagne and the University of California Los Angeles suggests that appeals based on pathos, or emotion, might be the most effective. The study found that people responded the most favorably to appeals that explain the risk of vaccine-preventable diseases to their children. One group of participants was given factual information, which resulted in little change in belief. Another group, however, was provided with a paragraph from a mother’s perspective about her child contracting measles, pictures of children with measles, mumps, and rubella, and three short warnings from the CDC about the importance of vaccination for children. This group demonstrated a statistically significant change in their negative beliefs about vaccines. The emotional appeal—the attempt to increase sympathy in the reader—produced the best result.

This seems like an approach that might have broad efficacy in a variety of settings. Could you tell us more about how rhetorical strategy can effect change?

A good rhetor always thinks about her audience, and when it comes to really persuading vaccine opponents, the question of audience matters. Having a personal connection can facilitate an effective appeal, but even when interacting with a general audience, foregrounding shared perspectives may open up communication. A rhetorical approach that relies solely on an evidence-heavy approach to bludgeon acceptance into an opponent with mountains of research often only shuts discussion down, and insults and attacks usually only escalate hostility. Efforts to persuade just might succeed, though, if we go back to the root cause of why so many people have latched onto the anti-vaccination movement in the first place: they want the best for their children. And this is a common goal for us all.

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