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Pro-Vaccine Communication: You’re Doing it Wrong

The views expressed are those of the author and are not necessarily those of Scientific American.

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© Glendon Mellow

A particular drum I like to beat, is about science communicators learning how to use images effectively. Give your blog post illustration some thought. Don’t just stick any old candied cherry on the top of your post: make sure it’s the right maraschino cherry. Then add sprinkles.

If you are having trouble finding good images to go with your post, remember: there are people trained to do this stuff. And there’s lots of resources to find them.

And nowhere is this failure greater in the world of #scicomm than in articles that are pro-vaccine.

To get this out of the way: I am a father and I believe understand the efficacy of vaccines is worth the relatively small risk compared to the disease-stricken, life-threatening alternatives. No evidence shows they cause autism. And all that is not what this post is about.

This post is about how poor image choice can undo other wise decent science communication.

Time for examples (click each image to return to the source).  So what’s wrong with these pro-vaccine posts and articles?

(Image by Dreamstime Illustration)

Ah yes. Dr. Headless will stab you now.

I found the next example due to a tweet from @IrfanDhalla, a concerned general internist and assistant professor on Twitter:

This doc gets it.

(Image by Colin McConall, Toronto Star File Photo)

Hurry and vaccinate! Act now!  I know some children do scream at needles, but there’s a lot you can do to quell their anxiety. Communicators can quell parent anxiety by not focusing on the upset kid, and focusing on the healthy kid. I know, other parents will hate me because our son hasn’t cried at his vaccines (he’s 2, so anticipation isn’t a big issue). So I don’t know what it’s like, and every kid is different. But is this image helpful?

Okay, so these images above are two examples from mainstream media, specifically the Toronto Star here in my hometown, Toronto.

What about the online pros? Sites by pharmacy and medical professionals like Science-Based Medicine, Ben Goldacre’s Bad Science and Respectful Insolence don’t bother with images at all, possibly shortening their own reach. Just the Vax hardly uses them beyond graphs.

From Double X Science.

More clinically-blue needles for your viewing squeamishness. Note there’s not even a sense of scale here to give you an idea of how teeny most actually are. Double X Science blogger Tara Haelle had a visual misstep here, but uses much more effective images in other posts.

Shutterstock on KevinMD.

The incredibly popular site KevinMD, above, uses Shutterstock to great effect – check out this typically-headless, awkwardly-posed photo focusing on the needle and skin in the most uncomfortable way possible.

A couple of years ago at ScienceOnline (#scio09, I believe) I raised this issue and a few people defensively reacted saying things like “it’s hard to find open source images of needles”. So don’t.

Don’t bother with pictures of needles. A lot of people are scared of needles.

Microsoft image from DoubleXScience.

Above, here’s an example of the typically adept images used by Tara Haelle at DoubleXScience. Note the lack of pointy or screamy things.

The anti-science, anti-vaxx crowd often uses emotional appeals and anecdotes to persuade people that they are right to be angry at needles, big scary pharma and doctors. In the text, it’s important that all of the well-written blog posts I’ve used as examples show facts about vaccines, and clear communication about health and risks. Walls of text are intimidating. Images can help. [Make sure to credit them - though that's a rant from the past and for the future #oneproblematatime].

And if you don’t know what to show, find an image-making expert and ask them. Surely your well-crafted blog post on the safety and importance of vaccines is worth getting it right: at least, don’t undercut your own message.

But whatever you do,  gawdammit, stop with the pics of screaming children, and the clinically blue needles. You’re freaking out the people you’re trying to persuade. That’s just bad science communication.

- – - -

*Typically on Symbiartic, we ask image-creator/artist permission to post their images, even when we don’t need to. For this post, I am claiming fair use, as I am reporting on the images in their context and not swiping them to make a different point. Clicking on each image leads back to the original articles.
**I’ve edited this post to show some more balance on effective image use from a site I enjoy and admire. The intent here was never to throw bloggers I respect under the bus: it was, to show how even the best science communicators can have a blind spot when it comes to images. Edits made after comment #8 below.

Thanks everyone for comments on all media so far, and to Matt Shipman for the recent discussion that brought this issue up again in my mind with burning energy.

Glendon Mellow About the Author: Glendon Mellow is a fine artist, illustrator and tattoo designer working in oil and digital media based in Toronto, Canada. He tweets @FlyingTrilobite and is on Instagram. You can see Glendon's work-in-progress at The Flying Trilobite blog and portfolio at Follow on Twitter @symbiartic.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. Glendon Mellow 1:13 pm 02/9/2013

    Perhaps I should have added one more image.

    Link to this
  2. 2. Gaythia 1:22 pm 02/9/2013

    One of my favorite examples to cite in vaccine communication is what happened in Fort Collins, CO, when there were a number of cases of invasive meningococcal disease, in 2010. Even though there were some deaths, the local health department first offered assurances that vaccination was not necessary.
    That led to organization of a non profit group that initiated fund raising to pay for vaccination clinics, a yearly effort that continues to this day.
    I think it points to the fact that while frequently skeptical of supposed mainstream medical pronouncements, the public at large is not opposed to vaccination. And it turns out that a little reverse psychology can go a long way.
    And I agree, no needle photos.

    Link to this
  3. 3. Guy Chapman 1:58 pm 02/9/2013

    The BBC’s Dr Ranj (@DrRanj) produced a kids’ segment on visiting the doctor for vaccinations. Needless to say the antivaxers hated it:

    Call the whaaambulance.

    Link to this
  4. 4. tarasue 2:55 pm 02/9/2013

    The point brought up here – that the emotional substance of an image can influence the message – is a valid one, and there is communications research to support this point, though I find it negligent for a science writer to bring up that point without citing some of the research that supports the influence of imagery in framing a message. (I am not going to dig it up citations for a comment because it’s a comment, not my own blog post.) However, it’s worth noting that Mellow cites two images in my posts from DoubleXScience. The one he includes with a screenshot does not support his argument since the intention of that blog post is not to encourage people to vaccinate but to discuss a UN ban on thimerosal. I am a photojournalist and previous a photo editor in addition to being a science writer, so I’m very aware of the necessity of selecting appropriate images. I included that particular stock image because it includes images of the vials used with vaccines – and the thimerosal is in the vials. Had that been a post encouraging vaccination, its inclusion here would be a more supportive example. Meanwhile, he does point out that my other post, regarding the safety of the CDC schedule, provides a positive image – yet he does not provide a screenshot. Why not include a positive example of what you feel IS an appropriate image to accompany stories if your actual goal is to encourage more thoughtful use of imagery with articles? A good teacher – which most science communicators would regard themselves in some sense – knows that providing a positive model of the behavior you want to see is more effective than only pointing out the negative examples of what you want to discourage. If you saw the original site – my blog Red Wine & Apple Sauce – where those two posts first appeared, you would see another story on the new CDC schedule… with two smiling kids:
    Separately, the missing citation was a valid criticism that has now been corrected. It was an oversight that it was missing – no name had been provided in the Microsoft library, so I have added a credit to Microsoft.

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  5. 5. larkalt 2:56 pm 02/9/2013

    Recently there was a blog post on a social site I belong to, asking for help in coping with the death of a child the person knew. Death from flu.
    I think that Reality, that real people die from flu is powerful pro-vaccine info. One can post a picture of the person to make them more real to others.
    Along with the knowledge that, if you don’t get the flu vaccine, you are helping spread the contagion and you may indirectly cause someone’s death. Even if you don’t personally get sick, or you only get a little sick from the flu, you may still give it to other people (I’m not sure about the extent to which this can happen). If everybody got the flu vaccine who could, it would save thousands of lives every year!
    The same thing is true of whooping cough, which is coming back. I read about a 4-week old girl who died of whooping cough, see
    I looked at that and … there’s a picture of someone who will never have a chance at life. If the adults around this baby had been vaccinated for whooping cough (they weren’t necessarily aware of the need for the Tdap booster shot), this baby would be alive …
    Getting the vaccinations one needs is a matter of ethics, of protecting other people as well as protecting oneself.

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  6. 6. Glendon Mellow 3:17 pm 02/9/2013

    Thanks for the examples Gaythia and Guy!

    Link to this
  7. 7. Glendon Mellow 3:36 pm 02/9/2013

    Tara, you’ve brought up a lot of points, I’ll try to address.

    While the post I showed wasn’t explicitly about urging people to vaccinate, it is a post about the safety and efficacy of vaccines. A UN ban on thimerosol, at one time the bogey man of anti-vaxx crowds is still (in my opinion) a post within the same set of issues. You make a good case for simply showing the thimerosol as it is in vials.

    As to whether I’m negligent on showing research into effective image use, okay, I suppose only one link in the post isn’t enough. It is a regular topic on the blog and I concede we should feature the research more often.

    And that’s the other thing: we show positive examples of images in science communication all the time here on Symbiartic. So here’s one post where I feature negative examples. And now I’m not a good teacher. :-/

    To be clear: DoubleXScience far more often than not uses images very effectively. I tried to say this above. My aim with this post is to show how very often good bloggers and professional communicators have blind spots when it comes to images.

    Link to this
  8. 8. Glendon Mellow 3:38 pm 02/9/2013

    Thanks larkalt #5, it’s true that a human face on tragedy can often send a message that’s hard to ignore.

    Link to this
  9. 9. Glendon Mellow 4:28 pm 02/9/2013

    I’ve updated the post.

    Link to this
  10. 10. tarasue 4:41 pm 02/9/2013

    Glendon, thank you for responding to my points and for updating the post to include the positive example screenshot (which I realize you did link to originally). I do think (hope!) it helps illustrate your point and what *to do*. I was perhaps a bit harsh in calling you out on not including communications research to support your point. Please know I 100% support your argument in this post, and I believe it is an important drum to beat. Many science communicators focus so much on words that imagery is an afterthought — when, in fact, images often have a greater impact than the words. It’s great to see this concept getting highlighted, and I don’t mind serving as the example of the good or the bad when our site deserves either. (I actually appreciate your calling attention to the lack of citation/credit because that’s normally a sticking point of mine – I have stock images out there too :) I think you’re doing a fine job of teaching – especially as you incorporate feedback into your instruction! I appreciate your continuing to highlight ways in which science communicators can do a better job of framing their message, taking words AND images into account.

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  11. 11. wrathchild 5:40 pm 02/9/2013

    Interesting….As a teacher in a middle school I teach must students to be critical about graphs that are associated with articles, etc. What is the graph trying to tell you? Who created it? For what purpose? How are the graphs laid out? What are the scales like? What are the intervals? Biases? Never thought about the art work/photos that could go along with a piece of news as also being problematic…..I think you just gave me a GREAT media unit idea!

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  12. 12. Glendon Mellow 7:35 pm 02/9/2013

    Thanks for the discussion today Tara!

    Thanks for the comment Wrathchild! I can happily give you more examples f you’d like via email – the pyramids! Spiders! And more!

    Link to this
  13. 13. Glendon Mellow 7:36 pm 02/9/2013

    Also, there are some comments about this post in the ScienceArt Circle community on G+ I think are worth checking out.

    Link to this
  14. 14. Pauli 10:21 pm 02/9/2013

    You know the world is messed up when scientists have to take a course in “science communication.” Our culture, with it’s “anti-elitist” “anti-corporate” “respect my beliefs” culture, is partly to blame. You shouldn’t have to explain to some hufpo reader why that guy in the opinion section is wrong about “the conspiracy.” You shouldn’t have to explain to that hippie liberal-arts major why GMOs aren’t going to come to life and ruin the taste of his sandwich. You shouldn’t have to explain to that hillbilly bible-thumper why carbon dating isn’t “just another assumption.”

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  15. 15. Glendon Mellow 10:52 pm 02/9/2013

    I disagree Pauli: not all people in the sciences will be naturally adept or comfortable communicating to people outside their field (or even within it). Nothing messed up about that.

    That’s part of the reason this blog exists – art as the looking glass to science, sharing ideas and reflections on science in practice and evidence as ideas.

    And hey – you’re speaking with a hippie liberal arts major. (Okay, ex-gothy fine arts major, but still) Not all arts majors hate the idea behind GMOs just as not all scientists start out communicating effectively without a toolbox of effective methods.

    Link to this
  16. 16. The Ethical Skeptic 12:09 am 02/10/2013

    I have my high powered skeptic gun out looking for these Anit-Vaccination people. So far I have not found any but I am definitely ready to slay them with rationality and critical thinking once I find one.

    So far just a couple mom’s who want the Science done, so that they can be reassured that the vaccines are safe, but they appear to be pro-safe-vaccine/pro-science.

    I will keep on the lookout though, for these evil anti-vacciners.

    Link to this
  17. 17. Glendon Mellow 12:26 am 02/10/2013

    Ethical Skeptic, the post has more to do with science communication gone awry. Could have focused on images about evolution by natural selection (often focusing on the red in tooth and claw narrative) or backward DNA helixes. I chose vaccines because it’s not only an important issue, but because in my opinion, the stakes are high when people are turned off by images.

    The takeaway message here isn’t to go hunting for people who don’t understand vaccines or haven’t read the science that has been done.

    Link to this
  18. 18. Jerzy v. 3.0. 7:18 am 02/10/2013

    I think the article misses the main problem.

    Public is wary because there are multiple examples where health information is manipulated by commercial and/or bureaucratic interest.

    Making nicer pictures will not solve the underlying causes.

    Link to this
  19. 19. larkalt 9:13 am 02/10/2013

    Fear is a big selling point in the mainstream press. And drama. They want to have a dramatic story.
    Perhaps the negative images of huge needles, cold clinical settings, screaming children etc., were published for drama. To sell the article.
    But fear and drama could also be used in a good way! Horrendous images of babies with whooping cough turning blue. Horrendous images of dead babies with tons of tubes attached to them. Heart-wrenching stories with pictures of beautiful children now dead of flu, measles, etc.
    I watched the TV shows on the website and they are dramatic in that way. This is the website for that 4-week old girl who died of whooping cough. Her parents became pro-vaccine activists after that. It seems she got whooping cough because of the anti-vaccination movement. Her dad is a schoolteacher and she was born in a very anti-vaxxy area where there was a lot of whooping cough.

    Link to this
  20. 20. larkalt 9:20 am 02/10/2013

    Unfortunately pictures of children gleefully munching cookies after being vaccinated, wouldn’t help sell the story. No drama.
    Maybe, making the actual vaccination experience more positive with cookies etc. would help though.

    Link to this
  21. 21. Glendon Mellow 11:44 am 02/10/2013

    Jerzy, I agree the entire public perception of vaccines doesn’t hinge on visuals alone. But when poor choice of visuals undercut the message, it sure doesn’t help matters.

    Link to this
  22. 22. Glendon Mellow 11:46 am 02/10/2013

    Larkalt, it’s all about telling the best story to the audience, matching your purpose. Agreed. Slapping pictures of needles on blog posts just because it’s about medicine isn’t necessarily helpful.

    Link to this
  23. 23. larkalt 12:27 pm 02/10/2013

    Yes, the scary and dramatic messages sell. The professional communicators in the media know this, that’s why even a winter storm is hyped.
    Online, the blogs that attract attention have succeeded in some way, but not necessarily the right way.
    There’s one prominent pro-vaccination blog that someone described as a “Two-Minute Hate”. It’s basically rants against various flavors of alt-med. People seem to be attracted to it because they want to gather with some like-minded people and vent their aggressions.
    But I doubt it convinces many parents who are on the fence about vaccinations, because insults usually just entrench people in their position. I think there’s research supporting that.
    It did wake me up about the vaccination issue, but I wasn’t an anti-vaxxer.
    Skeptical or pro-vax blogs need to be about more than a club where like-minded people can pounce on any disagreement.

    Link to this
  24. 24. Glendon Mellow 5:46 pm 02/10/2013

    Larkalt, I appreciate the perspective, but the post isn’t primarily about vaccination.

    I chose to use vaccination because
    1)it’s a timely issue, especially in this season
    2)there are immediate health implications
    3)I feel like I’ve been seeing the same problem everywhere (anecdote alert!).

    This post could have been written about “ascent of man” imagery (see here), or science outreach neglecting artistic licence to its detriment (see here). The idea was to illustrate blind spots many of us have when it comes to image use and getting a message across. It was to consciousness raise.

    Being about vaccines is not incidental, but pro/con arguments about vaccines are not central to this post either. It’s about taking images seriously as a communication tool.

    Link to this
  25. 25. larkalt 10:59 pm 02/10/2013

    I’m not sure where that came from, it doesn’t seem like a reaction to something I said.
    There must be a lot of research about persuading people. I looked at one paper about effective pro-vaxx strategies. One comment they made is that the anti-vax attitudes are rooted in “deep core” beliefs, thus hard to change. (beliefs about being “natural”, distrust of doctors, etc.) They also said that anti-vaxxers said they would vaccinate for “serious diseases”, so the idea that these diseases aren’t serious underpins their philosophy.
    Again, this suggests that videos of babies with whooping cough, personal stories about sick children would be effective.
    If you are serious about coming up with more effective pro-vax communication, you should read research, scientific research on persuasion or marketing research, rather than trying to re-invent the wheel.
    If pro-vaxx were advertisers, trying to sell something and make lots of money, you bet the pro-vaxx communications would be much more effective! It’s because there isn’t money in it that it’s so amateurish.
    People reinvent wheels all the time.
    BUT, we, not having anti-vaxx opinions anyway, can’t pull the knowledge of what might convince an anti-vaxxer out of thin air, or judge by our own reactions. Marketers don’t do this, they have focus groups. They do research.

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  26. 26. Glendon Mellow 11:13 pm 02/10/2013

    Good points Larkalt.

    I agree with with your comment that there should be research done on image use and effectiveness in vaccine (and I think wider health) campaigns. And thinking a bit like a marketer (unpalatable or foreign to some excellent bloggers, I’m sure) could be helpful.

    But it’s not reinventing the wheel to point out something that has visible communication problems. Articles about feathered dinosaurs using only images of raptors from Jurassic Park wouldn’t need a study done to see if the images were hampering the message.

    The idea that people wary of, or even neutral about vaccines are going to be reassured by faceless medical personnel wielding needles — well, let’s just say I’d be shocked if a study proved these images were helping the text they are often paired with.

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  27. 27. SatyaRC 12:25 pm 02/11/2013

    These ads have showed up recently on buses in Madison: (the banner across the top is the ad). I noticed because I think they are an effective way to message around vaccination. The first to photos are the UW basketball coach and the chief of police. The last is Bucky, the UW mascot.

    Link to this
  28. 28. 4:47 pm 02/11/2013

    Ha! Great post, Glendon! When you gather all the terrible images together it makes for a hilarious show… props to Tara for the happy baby pic. Now we’re talkin’!

    too funny.

    Link to this
  29. 29. txbodhi 10:34 pm 02/11/2013

    (removed by blog author)

    Link to this
  30. 30. Glendon Mellow 10:07 am 02/12/2013

    Thanks for the link, SatyaRC! Those are some fantastic examples of how to show vaccination in a positive healthy way. Right on.

    Thanks Kalliopi! Glad you liked my commentary. :-) Priase from the Master.

    #29 txbodhi – that was poetic, but useless nonsense. No thanks.

    Link to this
  31. 31. bucketofsquid 11:31 am 02/15/2013

    Many years ago I started doing genealogy research. This included not just finding public records but also walking graveyards. It was appalling how many of the pre-1900s headstones were for children and babies. I started researching this and soon discovered that prior to good sanitation and modern medicine the average mortality rate of under 18 year olds was roughly 80%. I’m not sure how much of that 80% was from violence or starvation but the bulk of causes I found were contagious diseases.

    I know several families with children that have Autism spectrum disorders. When the anti-vaccine craze hit I knew it was wrong so I made 2 pictures to put things in perspective. The first picture was vaccinated children. It had 5 headstones because that is our approximate child mortality rate according to the feds. It had 1 child standing apart from the other 94 and labelled Autistic.

    The second picture was 80 headstones, with one labelled Autistic, and 10 children of whom 1 was labelled as blind, deaf and weak boned. The families didn’t like it but they stopped being silly about vaccines.

    Link to this
  32. 32. Glendon Mellow 12:43 pm 02/18/2013

    Were these pictures painting, bucketofsquid?

    Link to this
  33. 33. Glendon Mellow 6:30 am 08/24/2013

    Capricorn45, I deleted your comment because I can’t tell if it’s a Poe. If not, please go read some science instead of McCarthy. If it was a Poe, you have a bright future ahead of you at The Onion.

    Link to this
  34. 34. BioDataGanache 1:22 pm 11/3/2014

    Curious what you think of the use of humor in pro-vaccination communication? Or really any other highly-polarizing scientific topic. I drew this comic, which I think is effective in its message. But I’m thinking that its message wouldn’t really sway anyone in the anti-vaccination community. Maybe it’s enough just to make the middle-of-the road people more aware? Any thoughts welcome.

    Link to this

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