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Colleen Brown of Cleveland, Ohio, has been known to post on Facebook now and again about the dangers of not vaccinating kids—local news stories about schools closing because a student has been exposed to the measles, she says, that kind of thing. A few years back, she remembers, she shared an article on her Facebook page about a 2015 measles outbreak that originated at Disneyland and resulted in 125 new cases of the measles.

According to the Centers for Disease Control and Prevention, more than 20 percent of the patients treated in that particular outbreak were eligible for immunization but were unvaccinated “because of personal beliefs.” Sharing the story on Facebook resulted in one of the bigger disagreements Brown, 21, has had about vaccines with her sister, Colette Carroll, who lives a short drive away, in a suburb of Toledo. Carroll’s two daughters—Brown’s nieces—are unvaccinated.

The two sisters didn’t talk for a while after that Facebook post, according to Brown’s recollection of it. They both describe their relationship as pretty close otherwise, but radio silence after a disagreement over vaccinations has happened on a few other occasions, too. “It’s been really rough on our family at times,” Brown says.

Carroll, 27, sighed when I asked her about the Disneyland-story debacle. At the time, she says, she had just started to believe that parents should have a choice in whether to vaccinate their kids, she said, and she was sensitive about it. Her husband, Matt Carroll, 27, grew up unvaccinated. Matt says people who blame unvaccinated kids for putting other kids in danger of infectious disease are just using “scare tactics,” and believes that he and his children have stronger immune systems and get sick less often than their vaccinated peers. Colette had started to share his point of view around the time their first child, now 5, was born.

Today Colette still doesn’t love to see her sister, or anyone, post memes ridiculing anti-vaxxers, as people who don’t vaccinate their children are often called. But she makes an effort not to comment on Brown’s posts anymore or to call her on the phone to object. Colette, by her own description, has matured in the past few years. At this point, she and Matt “either just don’t say much about it or let it go,” as Matt puts it. Both sisters told me, on separate phone calls, that when they do talk to each other about the issue of vaccines, they both just want a little more respect for their point of view.

Vaccine hesitancy—the reluctance or refusal to immunize oneself or one’s children from a host of preventable communicable diseases—is once again in the national spotlight, as measles outbreaks in New York, New Jersey, California, Michigan, and Washington State have turned the public eye toward the small but vocal anti-vax community and the controversy about whether vaccinating children should be a duty or an option. In 2019, vaccinations can feel like just one more topic that people can’t stop fighting about, online and elsewhere. But the dispute over vaccines is unlike some of the other polarizing issues of our time: Because people with skeptical or hostile attitudes toward vaccination can be found all over the political and demographic spectrum, they sometimes share neighborhoods, schools, churches, and households with those who don’t agree with their views. As a result, tensions over vaccines can create stressful, uncomfortable situations—not to mention potentially hazardous environments—within social circles, congregations, and families.

Eve Dubé, a medical anthropologist and researcher at the Quebec National Institute of Public Health, studies the sociocultural aspects of infectious-disease prevention. In her work, she’s found a few effective strategies for how to have productive conversations about vaccination, many of which sound eerily like the ways relatives who find themselves on different sides of the aisle politically are encouraged to communicate about their differences.

Because vaccines are such a polarizing topic, Dubé says, “being harsh or not listening” is just plain “not helpful.” “People with really, really strong convictions against vaccinations are really few,” she says. “It’s not common. Most of the people who have doubts and concerns are feeling unsure,” perhaps because they’ve heard some troubling stories about injuries and illnesses believed to be linked to vaccines, or because they might believe that vaccines are being pushed on patients by the pharmaceutical industry.

As a result, Dubé recommends starting a conversation with open-ended questions. Family members who are concerned about their relatives’ hesitance toward vaccines, she says, might start with questions such as, How did you start questioning vaccines? What makes you uncomfortable about them? Have you had something bad happen to you that you believe was the result of a vaccination? The crucial first step, she says, is to “get at where this is coming from.”

And it’s important to remember, Dubé adds, that many people on both sides of the vaccine controversy are profoundly influenced by emotionally moving personal narratives about the consequences of vaccinating or not vaccinating. And many of the most charged narratives, she says, come from parents who tell of “adverse events that are assumed to be due to vaccines … People tend to see those stories and relate to the parents telling them.”

Sure, “there are cases of parents [whose] kids died of a vaccine-preventable disease, and they can share their story,” which would support the pro-vaccination point of view, Dubé says. But the majority of people whose lives have been positively affected by vaccines have no disturbing or inspiring story to tell, because, as Dubé puts it, when vaccines work, nothing happens—and that’s good news.

Compelling narratives can also have a much more potent effect on a listener, Dubé says, than a deluge of statistics and scientific facts. One of the worst things family members who disagree over vaccinations can do to one another is engage in what she calls “facts ping-pong,” in which “you push one side, and then the other will reply with, ‘Well, I saw this video on YouTube, and it showed blah blah blah.’”

“I think it’s really an emotional topic, much more than a scientific topic. And those people who are questioning vaccines, it’s kind of part of their identity,” Dubé continues, noting that populations that doubt the efficacy or safety of vaccines—despite plentiful, credible evidence that demonstrates both—often mistrust government or medical authorities on other subjects, too.

Of course, these tense family arguments get only more stressful when the actual safety of one or more relatives is, or is believed to be, at risk. One Manhattan parent told the New York Post, for example, that he’s refusing to attend his family’s annual gathering for fear of exposing his two kids, the younger of whom is eight months old, to their unvaccinated cousin during a measles outbreak. “Besides my child getting [measles], I don’t want to be the one who gives it to their kid. The virus can be on me. If I hug their kid, I can transmit it,” he told the Post.

However, fear of endangering someone they love is actually one of the few things that Dubé has seen change vaccine skeptics’ outlook. For instance, in one study she found that pregnant women were more likely to consent to being vaccinated when they considered it a protective measure on behalf of their fetus, rather than on behalf of themselves. She also recalls an interview she did with a woman who had refused to let her newborn baby’s vaccine-skeptical grandparents visit unless they’d had a flu shot, for fear that they might pass the flu virus along to the baby. Upon hearing that, the grandparents relented.

Colette Carroll and Colleen Brown will likely have to have a similar conversation someday soon.

Matt Carroll, Colette’s husband, is one of five children in his family; one of his brothers, he says, was vaccinated in accordance with the traditional vaccine schedule, but he and his younger siblings got only “one or two” vaccinations as kids. As adults, some of his siblings have vaccinated their kids, while others haven’t. Colette and Matt’s daughters’ unvaccinated status has never been an issue with his family, Matt says; the only time their daughters have been unwelcome anywhere was at a doctor’s office. “We went to a certain pediatrician that a friend had recommended and they did not allow us to take her there, because we refused to vaccinate her,” Matt says.

“That hurt a little bit,” Colette said.

Brown, who describes herself as “super germophobic in general,” is due to give birth to her first child in August. After her baby is born, she wants everyone who visits the hospital to have had a flu shot.

Brown hopes that she and her sister can have a respectful conversation about practical safety measures, one that doesn’t come across as an attack on Carroll’s family, or her parenting, or her children. “I respect her opinions,” Brown said. Still, she and her husband have talked it over, “and we don’t want our baby to be exposed to anything that could harm him.”

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