Background: Marin County, California has one of the highest rates of vaccine refusal in the country. The reasons for this are not socioeconomic, but rather appear to be based on fixed, false beliefs that the MMR vaccine causes autism, contains “toxins,” has mercury, or is associated with outcomes other than measles immunity. Exhaustive educational attempts via doctors, school officials, the CDPH (California Department of Public Health), the CDC (Centers for Disease Control) and some main stream media outlets have had minimal impact on the understanding of vaccine ingredients and safety in this vaccine refusing cohort. We assessed the impact of a poster created by two fifth grade students with educational information about measles and the MMR vaccine on beliefs about vaccine safety on attendees of an elementary school science fair at a school in Marin County with a 7.1% personal belief exemption rate.
Methods: Two fifth grade students were given educational material about the measles and the MMR vaccine and set about creating a poster containing information they thought would be helpful. The poster board was a standard Office Depot tri-fold display board with a red background (the color was chosen by the students).
The two children were given a power point presentation on measles created by a board certified infectious diseases physician and selected the information that they felt was relevant. Information about measles on the poster included the annual number of measles cases, measles-related hospitalizations, and measles-related deaths pre-vaccine (Image 1), and information about the contagious nature of the virus as well as an artistic rendering of the virus (Figure 2).
Information about the MMR included the impact of vaccination, specifically reducing the risk of acquiring measles if exposed from 90% to 1-3%, a graph of the impact of vaccination on the number of cases of measles annually in the United States (Figure 3), information on vaccine safety, and the fact that the measles vaccine has never contained mercury (the parent advisor suggested the mercury information although the children questioned this as they had no idea why they should mention something that had never been in the vaccine in the first place).
Data on percentage of children requiring vaccination for herd immunity and the MMR vaccine rate at the school were also included (parental suggestion). Science fair attendees were asked to vote with pennies in jars on whether the poster had any impact on vaccine safety beliefs. The jars were marked as follows: A) No, I already thought it was safe B) Yes, I feel safer and C) No, I still have concerns. Adults and children voted independently. No IRB approval was obtained as that was not a requirement of the school science fair.
Results: Many adults and children spent time reading the entire poster and several high-fives were received from parents and school staff. A total of 29 adults and 22 children voted. Detailed voting results are found in Table 1.
Discussion: The 13 children who voted that they felt safer after reading the poster all were accompanied by a parent who read through the poster with them suggesting that parents can do a lot to help their children understand vaccine safety. The four children who voted that they still had concerns appeared more focused on the idea of a shot than any long-term consequences, either negative or positive. It appeared as if some of the eleven adults who voted that they felt safer may have been trying to reward the young scientists for their efforts rather than a true change in beliefs and so more research may be needed to understand whether numbers for this sub-group represent a true impact on knowledge or bias. The lack of responses from adults in the category “No, I still have concerns” was a curious finding leading the investigators to wonder if parents who oppose vaccination based on non-scientific beliefs are simply not the kind who attend science fairs. Alternate theories for the lack of voting in this category include peer pressure, that parents who oppose vaccination might not be open to information and thus simply passed the poster board by in favor of the volcano exhibit two posters down, or felt uncomfortable expressing their views in public as coincidentally the very morning of the science fair the school district e-mailed a letter indicating all unvaccinated children will be out of school for 21 days if there is a case of measles at the school.
Conclusions: Preparing and presenting a poster board on measles and the MMR vaccine greatly increased the knowledge on this subject of the two fifth grade students who did the work. Their conclusion was, “Why wouldn’t people get the shot?” The poster may have also impacted the knowledge of measles and the MMR vaccine of 13 kids and some parents attending the science fair in a county with a high rate of vaccine refusal. More studies on peer-to-peer education about vaccine safety in elementary schools are indicated. Other methods of reaching parents with vaccine concerns are greatly needed.