But first some background....
The IPWG was formed back in 2007 as a sub group of the larger BC Immunization Committee to oversee immunization promotion in the province. The group is funded by the MoH and the funds are administered by the PHABC.

The IPWG and the entire BCIC committee structure is designed around a collaborative committee structure with RHA, BCCDC, BC Pharmacy Assn and Ministry representation.

This slide refers to ImmunizeBC and I Boost Immunity. We often refer to them as two sides of the same coin with one side being education (ImmsBC) and the other being advocacy (IBI). Ultimately these sites act as force multipliers for each other. IBI will refer its visitors to ImmunizeBC for the credible information about immunizations and likewise ImmsBC will refer its visitors to IBI who would like to be more active in their community.

Many of you may already be aware of ImmunizeBC.ca as it has been around for about 8 years and is the main government of BC branded site site for immunization education and information for the public.

THEN BOUNCE OUT TO THE IMMUNIZEBC SITE TO BRIEFLY SHOW IT TO THEM AND HIGHLIGHT A FEW INTERACTIVE FEATURES LIKE THE FAQ AND TEXT MESSAGING APPLICATION (notes below)

In recent years ImmunizeBC has had placed more emphasis on trying to engage with the public in a way was more open and honest and met people where they were at. As such we introduced things like a Chat with a Nurse, an interactive FAQ and text messaging immunization reminder application.

IBI is the result of many of the things that we learned along the way with ImmunizeBC as we came across people who were passionate about immunization and were looking for a way to be more active in their community. What we lacked was a mechanism to do facilitate this. To better understand how we cam eup with the idea for IBI, it first makes sense to think about how we have done health promotion in BC when it comes to immunization historically..

The road to an advocacy movement started with what we called at the time the BC ‘modern family’: we did photoshoots that captured real BC families that emphasized diversity – family types, ethnicities & backgrounds. The idea was that these assets could be used for multiple campaigns. It was easy to find these families. we found them them on Craig's List.

These families had stories and wanted to share them. We thought, maybe there are others out there who would also be willing to share? This led to the idea that what if we could give a ‘voice’ to the silent majority to change the tone of the ‘immunization conversation’ from the ground up.

What we lacked was a way to do it. How do we harness the 'knowledge of the crowd'?

We often refer to the many campaigns we have run over the years as sprints to the finish line. Because they are top down, time-limited and intensive. Think of the flu campaign every year. Or when a new vaccine gets introduced. We ramps up materials, media buys, press releases all to make as big a splash as possible.

They are useful but often only have a temporary results.

We have always been troubled by the ephemeral nature of campaigns structured like this. But what does the research say?

Microcosm - in the real world we talk to one another and this is where misinformation about vaccines take root. It's snippets of misinformation that if not dealt with in their infancy, (aka in a small peer group), can grow like a virus. This misinformation is ubiquitous and easily available.

Anti-vaxxers are the squeaky wheel. Their stock and trade are personal stories and anecdotes because they don't have the science or data to support their ideas. The internet is a perfect medium for them because it is like the wild west - they can say anything with impunity and not be held to account for their claims.

Rather than try to ignore this movement or the medium they use, we started thinking about ways in which we could our beat them at their own game on their own turf. But how?

IBI is an online peer-to-peer program based on the idea that giving the silent majority of people who vaccinate a platform to speak up and feel proud about their choice is long overdue. It’s a platform that encourages conversations between friends, co-workers and families in the ‘immunity community’ about why vaccination is so important.

This is a screen shot taken from our Booster site.

IBI also believes in the power of stories. Stories matter and we know that there are thousands of stories in BC alone of people who have lived through or in some cases of family members who have lost loved ones to vaccine preventable diseases. If you take a moment I bet there are a lot of stories in this room based on your experiences as a health care provider.

There are lots of stories there and they are the fuel for this campaign. Do you have a story you can tell about why you think immunization is effective?

We are trying to build a network of immunization supporters in every city and town in BC. Full stop. Not just of people like yourselves who immunize for a living, but of anyone who we know is a supporter of vaccination, period.



Anyone can be a Booster, from healthcare professionals, stay-at-home parents, retirees, students, farmers, bankers, and so on. What Boosters share is a passion about preventing sickness, disability and death caused by vaccine-preventable diseases.

defn: obtain information or input to a particular task or project by enlisting the services of a number of people either paid or unpaid typically via the internet.

A fundamental principle behind IBI is crowdsourcing. What are we crowdsourcing? Knowledges, experience, stories.

Break to demo the site.

What is I Boost Immunity? It's vision is old school grass roots outreach & activism meets the new word of mouth – social media

Goal: create a virtual online network of immunization lay and HCW advocates – “Boosters” in every city and town in BC. This will not happen overnight. This is no magic pill. This is not a sprint, its a marathon. We are in it for the long haul.

Our mission is to engender a sense of belonging, ownership and pride about immunization. People should not feel that they need to "come out" as pro-vaccine. If anything it should be the opposite.

Macro - In the online world this misinformation can spread faster than ever.

The internet has been a democratizing force but it has a dark side too. Anyone can say anything and pretend to be a legitimate and credible source of information. If others don't have the media literacy skills to 'fend off' these 'free radicals' of bad information from questionable sources, then misinformation can take hold and spread.

This idea is analogous to the notion that if someone doesn't get immunized, their body may not be able to fend off the early foreign invaders like virus or bacteria that can then propagate and spread.

http://zapatopi.net/treeoctopus/
Truth bias. This website isn't real but it sure looks convincing!

Novelty wins most of the time - the expression don't let the truth get in the way of a good story.

The internet and comments especially can feel like one giant opportunity to smear others who don't agree with you. The internet can be like a mean old aunt who has nothing good to say about anybody.

The anonymity of the internet is also can be used ot our advantage. If we can get the right folks to speak

Research found that messages were not effective against people who were vaccine hesitant. We have always known this about COs but does this mean that it also now applies to those that are on the spectrum of vaccine hesitancy?

Parents were randomly assigned one of 4 interventions text based, myth busting, images of sick children and a dramatic story all designed to see if it influenced people to change their minds about vaccination. Nothing worked.

http://pediatrics.aappublications.org/content/early/2014/02/25/peds.2013-23...
Conclusion: "I don't think our results imply that they shouldn't communicate why vaccines are a good idea. But they do suggest that we should be more careful to test the messages that we use, and to question the intuition that countering misinformation is likely to be the most effective strategy.”

The Impact of Social Networks on Parents’ Vaccination Decisions - http://pediatrics.aappublications.org/content/131/5/e1397
The results strongly suggest that social networks, and particularly parents’ people networks, play an important role in parents’ vaccination decision-making. It found that 95 percent of parents consulted with people they knew before deciding whether to vaccinate their kids. It also found the more likely you were part of a network that supported vaccination, the more likely you were to vaccinate. The opposite is also true – the more likely you were part of a social network that did not support vaccination meant that you were less likely to vaccinate.
In other words, we may be able to influence anti-vaxxers by influencing the people that influence them.

From the study conclusions: "It is also essential that interventions aimed at increasing vaccine acceptance not focus exclusively on parents, or parents and their children’s health care providers, but rather focus on communities more broadly so that the other people parents are likely to consult, such as their spouses/partners, family members, and friends, are also
included."

Medical Daily article - http://www.medicaldaily.com/vaccines-children-how-do-we-convince-anti-vaxxe...
Parent to parent advocating is the most successful in convincing people who are on the fence. Spokesperson from Voices for Vaccines advocating for emphasizing shared community value - What they did advocate as a possible solution was to try more "bottom up approaches" that emphasized positive aspects of vaccination as a "shared community value" much like seatbelts and not littering is.

I have always found that the comments section of vaccine articles are much more interesting than the article itself. Why? Because this is where real battle is unfolding between anti and pro vaxxers. We found that there are a LOT of really smart people out there.

This got us thinking. What if we could harness the potential of these really smart people - to "direct the rider" to "shape the path".

But is it more influential? It turns out that maybe so. In one recent study they found that people were equally persuaded by the PSA and the online comments after. The kicker is that if the comments were made by a health care provider then they were more persuaded by the online comment than the actual PSA. Mind blown.

Summary of study: https://news.wsu.edu/2015/02/02/online-comments-influence-opinions-on-vacci...

Journal study titled: Reexamining Health Messages in the Digital Age: A Fresh Look at Source Credibility Effects

They conducted two experiments. In the first, they showed 129 participants two made-up PSAs. One from the CDC, one from National Vaccine Information Council (NVIC).

The PSAs were followed by comments from fictitious online commenters who either expressed pro- or anti-vaccination viewpoints. Participants weren’t told anything about who the commenters were, and unisex names were used to avoid potential gender biases.

After looking at the PSAs and comments, people responded to questionnaires that rated their likelihood to vaccinate themselves and their family members, as well as their opinions about vaccination.

The researchers found that the participants were "equally persuaded" by the public service announcements and online comments.

"People were trusting the random online commenters just as much as the [public service announcement] itself."

In the second experiment, participants were told the fictitious commenters were an English literature student, a lobbyist specializing in healthcare issues and a medical doctor specializing in infectious diseases and vaccinology. The researchers determined that participants found the doctor’s comments to be more impactful than the PSAs.

“We found that when both the sponsor of the PSA and the relevant expertise of the online commenters were identified, the impact of these comments on participants’ attitudes and behavioral intentions was greater than the impact of the PSA and its associated credibility,” the researchers wrote.

They recommended that advertisers clearly identify the expertise of the commenter – for example, a medical doctor specializing in a related field of medicine.

That is to say that it isn't comments that matter, it is dialogue that matters. But how influential are comments/dialogue in relation to the piece that sparked the discussion? It turns very influential at least according to ene study. In one recent study they found that people were equally persuaded by the PSA and the online comments after. The kicker is that if the comments were made by a health care provider then they were more persuaded by the online comment than the actual PSA. Mind blown.

Fictional PSAs were followed by comments from fictitious online commenters who either expressed pro- or anti-vaccination viewpoints. Participants weren’t told anything about who the commenters were, and unisex names were used to avoid potential gender biases.

After looking at the PSAs and comments, people responded to questionnaires that rated their likelihood to vaccinate themselves and their family members, as well as their opinions about vaccination.

The researchers found that the participants were "equally persuaded" by the public service announcements and online comments.

"People were trusting the random online commenters just as much as the [public service announcement] itself."

In the second experiment, participants were told the fictitious commenters were an English literature student, a lobbyist specializing in healthcare issues and a medical doctor specializing in infectious diseases and vaccinology. The researchers determined that participants found the doctor’s comments to be more impactful than the PSAs.

“We found that when both the sponsor of the PSA and the relevant expertise of the online commenters were identified, the impact of these comments on participants’ attitudes and behavioral intentions was greater than the impact of the PSA and its associated credibility,” the researchers wrote.

They recommended that advertisers clearly identify the expertise of the commenter – for example, a medical doctor specializing in a related field of medicine.

I don't want you to think of me as this guy...

This is a more appropriate image don't you think?

We need to harness the untapped potential in this room and all over BC that is just waiting to be unleashed. That is the untapped knowledge and goodwill that we know thousands of British Columbians have towards immunization. It is the power of the crowd that we know are out there just waiting to be asked.

If we do this right, we will be shaping a shared community value that is immunization in the right direction. In addtion to higher immunization rates the result will be you getting fewer immunization questions.