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# 9.6 Changing parents' perceptions

Bellaby, P. (2003) ‘Communication and miscommunication of risk: understanding UK parents' attitudes to combined MMR vaccination’, British Medical Journal, 327, 27 September 2003, pp. 725–28. Reproduced by permission from the BMJ Publishing Group; Mary Evans Picture Library Ltd; P A Photos.

Vaccination has a heroic history in the control of communicable diseases. However, collective provision that is taken for granted today in Britain-not just vaccination, but also sewerage, clean water supply, and food safety-had to be fought for. In the mass mobilisation wars of the 20th century, several public health plans that had foundered for lack of public support in peace time came to seem necessary for the war effort. But mass mobilisation is not a normal state in healthy democracies. A consequence of peace is that public health measures that have not become part of infrastructure have often been challenged. For example, when rationing of food was lifted in 1954, nutritional standards and their rough equality achieved during the second world war were sacrificed for the sake of choice.27

The case of public reaction to MMR vaccination should be viewed in this broader historical context. Any attempt to restore the compulsion that failed in the late 19th century would almost certainly fail again. Instead, public health professionals and scientists should consider the lessons that experience with MMR offers and apply it in the future. The first is that challenge to authority, including the authority of science, should be expected in a healthy democracy. The second is that the establishment should disseminate evidence to the public in a transparent way that is sensitive to the ways of understanding of diverse groups. The third lesson is that communicating risk effectively to the so called masses, and so priming people to act appropriately, is about much more than providing even the best of information: it is a matter of two way communication and obtaining agreement. Concordance has to be the aim if compliance is to fall into place.28

## Summary points

The size of a risk does not necessarily relate to the controversy it causes.

Parents seem to neglect the most obvious risks to their children (such as road crashes), reject expert assessment (as over BSE), and amplify a virtually non-existent risk (autism from vaccination).

Yet public willingness to conform to public health programmes remains high, and parents' behaviour is not necessarily irrational.

Parents' behaviour is understandable if they are seen as acting to protect their children within a particular social context.

Competing interests: None declared.

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