The current concern about the poor take-up of the measles, mumps and rubella vaccine has its roots in the negative coverage brought about by research that was subsequently discredited. The way in which this research was picked up and framed by the media illustrates just how damaging the presentation of medical issues can be when linked to health scares.
Frames are ways of presenting issues that can summarise and encapsulate a set of views and way of seeing and interpreting the world. They derive much of their power from our brain's propensity to look for shortcuts and narrative in interpreting the huge amounts of information that we process. Frames trump facts in public communication - facts are not unimportant, but the way they are framed will in most cases determine who believes them.
So how and why did an unproven association between the MMR vaccine and autism become such a powerful frame for interpreting events? The key components are:
1. A 'heroic' figure who is depicted as challenging what is seen as a cover-up by the medical establishment - the surgeon Andrew Wakefield, whose original research paper in 1998, subsequently discredited, claimed a link between the MMR vaccine and the development of autism.
2. The story that was easy to tell through a number of personal 'tragedies' of children who now had autism, allegedly because of the vaccination.
3. The refusal in 2002 of the Prime Minister, Tony Blair, to reveal whether his child had been vaccinated.
4. A media that predominantly used the frame of a medical scandal to report the issue - fewer than one in three media stories reported the evidence that MMR was safe.
Put this together and there was a toxic frame that trumped medical fact and the rationale for vaccination. What was needed, therefore, was an alternative frame that would have helped to promote the safety of the MMR vaccine before the negative framing took hold.
It is only now - when we have another medical scare centred around the consequences of failing to vaccinate - that there has been a reframing of the case for vaccination in both the media and the public reaction to the story.
Why was this not possible before now? At the time the harmful consequences of measles and rubella were well known. However, it was no use merely counterpoising isolated medical facts in an attempt to trump a damaging frame. What was needed was a counter-frame that repositioned the authority of those making the case, coupled with a narrative about why mass immunisation works and illustrated with cases of what happens when children are not vaccinated.
The experience over MMR holds many lessons for sector charities trying to get health messages to the public, but the big one is not that the public or media has to become more scientifically literate (good though that might be). Using health scares and medical cover-up as a frame, even when they might be justified, can undermine the overall capacity to have positive health messages believed. Public educators have to get better at framing the scientific in ways that help understanding, chime with public sensibility and address legitimate fears so that we don't have to see the consequences before people believe the message.
Brian Lamb is a consultant and chair of the NCVO's campaign effectiveness advisory board