'it's OK to Ask' about Immunization: A Vermont Story

Background: Vermont has been recognized for years as one of the healthiest states, but we face challenges. Childhood vaccination rates have been falling, while the percentage of children entering Kindergarten with an exemption from mandated vaccines has been climbing. In 2010, 83% of children were fully vaccinated at school entry, 11% were missing vaccinations but admitted provisionally, and 6% had a religious or philosophical exemption. A number of communication efforts have been made to help reverse the trend, including ‘It’s OK to Ask,’ a web-centered social marketing/media campaign. This presentation will describe the context, audiences, strategies and collaborations to promote immunization, and results to date.

Program background:  Strong anti-vaccine sentiments were heard publicly during 2009 H1N1 flu forums, yet nearly one-third of Vermont’s population got vaccinated – notably school children. But resistance to other vaccines for children persisted, and in 2010 the Vermont Department of Health collaborated with the University of Vermont to research attitudes of vaccine-hesitant moms. In 2011, as vaccine “choice” voices grew louder, the Health Department began a quality improvement process to improve childhood immunization rates, identifying communication as a key strategy. The 2012 legislative session saw a heated battle over removing the philosophical exemption, as an anti-vaccine coalition organized to counter the bill – which did not pass. Pertussis was now on the rise among school children and by December, the Health Department declared the numbers epidemic and organized Tdap vaccine clinics. This brought under-vaccination to public attention, silencing anti-vaccine voices for the moment. Meanwhile, based on state and national research, the Health Department decided to focus on “fence sitters” – those truly undecided, questioning parents. In July, we held focus groups with pregnant women and moms who questioned vaccines. Key insights were confirmed: the right balance of information affects perception, today’s parents have little history with the diseases vaccines protect against, alternative vaccination schedules are popular, healthcare professionals are trusted advisors, but parents seek full information to make their own decisions. ‘It’s OK to Ask’ was launched in April 2013 to provide a safe and non-judgmental place for parents to go for credible and reliable information about immunization. The overall goal is to raise childhood vaccination rates by transforming vaccine hesitancy into confidence in the decision to vaccinate. Our communication strategy has four objectives: to engage, generate content, focus on fact-based messaging, and achieve a gentle, upbeat and personal tone of voice.

Evaluation Methods and Results:  Short-term evaluation measures for the website – oktoaskvt.org – and social media are continuous analytics: likes/followers/views/visits, reach and engagement have been promising. Annual evaluation measures are rates for school vaccination, provisional admittance and exemptions. In 2012/13, 7% of children were admitted provisionally, the lowest rate in five years. The exemption rate is slightly lower than in 2010, at 5.5%. 

Conclusions: The 2013/14 school year data will be the first that can be related to the campaign.

Implications for research and/or practice:  Use of strategically designed web-centered social marketing and media campaign is a promising practice for this audience.