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Monday, June 1, 2015

S/D/Q Paradigm is in the mail to WA State legislators!

Hello all!

Karen and I are headed back to Olympia on Wednesday, June 10th (homeschooled kids in tow) for another day of conversations with WA state elected officials. In addition to those we spoke with on St. Patrick's Day, we've mailed the following description of the S/D/Q Paradigm to every member of the House Health Care & Wellness Committee and also the Senate Health Committee.

If you share with us your reason for wanting Washington State to stand up for Informed Consent, we will carry it to Olympia for you! [email:]

If your doctor has dismissed your or your child's adverse reaction, despite your clear description of the events, please share your experience. The assumption that the "medical exemption" is sufficient (because all doctors will respond appropriately and protect children at risk) is a dangerous one that puts too high of a burden upon medical professionals who average only 16 minutes per patient in the USA.

Please enjoy, consider, and share the SDQ Paradigm with your friends & family. It invites thought!

The S/D/Q Paradigm:
Simplifier/Delgator/Questioner:  A new paradigm for talking about vaccines

It has always been an unquestioned assumption that people fall on a continuum from “pro-vaccine” to “anti-vaccine”. Until quite recently, it has also been an unquestioned assumption that people could be moved along this continuum through education. However, recent studies are calling these assumptions into question. Multiple studies have found that pro-vaccine messaging has the paradoxical effect of decreasing confidence in vaccines among the so-called “vaccine hesitant” parents. Two such studies are referenced here:

This has caused some to conclude that the so-called “vaccine hesitant” are stupid, uneducated, or  anti-science.  However, this is not consistent with demographic data, which identifies so-called “vaccine hesitant” parents as having a significantly higher level of education than “vaccine compliant” parents.

We suggest there is a fundamental flaw in all of these studies: vaccine choices do not fall on a single continuum. Instead, we have seen evidence to suggest that how people decide is the crucial issue in need of exploration and understanding. With twenty-five years of observation under our combined belts, we have observed and defined three basic decision-making styles: Simplifier, Delegator, and Questioner. All three are valid, offer value to the community, and deserve our respect.

Simplifiers make decisions by simplifying a complex subject into a few basic rules. These are the folks who will say “All vaccines are safe” or “All vaccines are dangerous.” This is the only group where pro-vaccine and anti-vaccine are accurate labels. There aren’t a lot of these folks, but they are the ones you are most likely to meet at a public meeting when the issue of vaccine medicine is on the table. Simplifiers serve an important purpose in our democracy. At their best, Simplifiers are powerful advocates. Pro-vaccine Simplifiers create an environment that supports everyone’s access to vaccine medicine. As many public health strategies depend upon broad societal use of vaccine medicine, this is great for public health. However, society also benefits from the voices of anti-vaccine Simplifiers who publicize problems with vaccine medicine. This helps to guarantee the safety of the vaccine supply.  For example, our first drug safety law, the Biologics Act of 1902, was passed after Anti-vaccine Simplifiers raised awareness about a contaminated vaccine batch that killed a number of children.

Delegators are quite different. They make decisions by selecting an expert they find trustworthy and following their instructions. Delegators may do a great deal of research on selecting that expert, or none at all. While many Delegators choose to trust government-sanctioned entities, such as the CDC, or accept the advice of their chosen family doctor; others choose a friend, relative, book, celebrity, or religious leader as their expert. Either way, their vaccine choices reflect the opinion of their chosen expert. Since most government and medical experts align themselves with the CDC, most Delegators follow the CDC schedule.

Questioners tend to feel solely responsible for their final decision. Therefore, they focus on data collection, analysis, and all possible options. This research introduces them to the variety of information that science offers on the subject of vaccine medicine. Questioners develop a high level of comfort with ambiguity and the complexity of both vaccine science and the human immune system. Yes, Questioners often seek out experts as sources of information, but they shoulder the burden of making the final decision willingly, as a necessary cost of medical freedom. Their final decisions vary dramatically, with some Questioners seeking out vaccines that are not yet on the schedule, some Questioners choosing the CDC schedule, some Questioners choosing a custom vaccine schedule, and a few rare Questioners declining all vaccine medicine entirely.

Contrary to popular media hype, we would like to suggest that there is not a huge surge in “anti-vaxxers.”  Anti-vaccine Simplifiers are a tiny percentage of the population, as are pro-vaccine Simplifiers. These percentages have remained steady for more than a hundred years, and they’re not likely to change anytime soon. While they are a powerful force politically, Simplifiers can and should be disregarded for the purposes of public health messaging. There aren’t enough of them to alter the patterns of disease transmission and they are not going to change their passionate beliefs because of any public health campaign.

There is, however, a huge generational shift from Delegators to Questioners. Sixty years ago, patients rarely questioned doctors. Delegation was expected and made sense when the average citizen was lucky to have a high school diploma. Questioners were found mostly within professional scientific circles. With Questioners nearly as rare as Simplifiers, public health messaging was aimed exclusively at Delegators.  Appeals to authority were extremely effective, especially if paired with scare tactics about the hazards of disease and the danger of not trusting your doctor. Vaccines mandates were seen as just another form of expert advice.

These strategies still work very well for Delegators. However, these days up to 40% of parents are Questioners, especially in highly educated areas. The strategies that worked through the 1970’s don’t work now.

When you present Delegator-oriented messaging to Questioners, they are offended by the idea of simply obeying a doctor (even if they like the doctor) and suspicious of scare tactics. Unlike Delegators, Questioners want to be given lots of information. They are reassured by data, not frightened by it, and they accept ambiguity as normal in a field of medical science. They prefer honest uncertainty to oversimplification. We also find that Questioners reject the legitimacy of medical mandates, which is why heavy-handed legislation consistently meets with strong, morally-rooted objections. Even if a Questioner would have voluntarily chosen the behavior that is being mandated, they will stand up for their right to make that decision without coercion in any form.

In short, there is not an increase in anti-vaccine sentiment. There is a shift in how people make decisions about health care. Current public health messaging has failed to take this shift into account, creating (in some areas) alarmingly low vaccination rates. Old strategies of scare tactics, appeals to authority, and mandates will not succeed. These tactics are outdated and counterproductive.

So, what do we do? Rather than fearing independent thinking and a highly-educated population, we need to capitalize on it! It is time to develop new communication strategies that will meet the needs of both Questioners and Delegators. The main difficulty comes from the fact that Delegators become more confident when urged to trust an expert, but less confident when given lots of data. Questioners, meanwhile, become distrustful when urged to follow expert advice, but more confident when given lots of data. On the plus side, both Questioners and Delegators readily self-select messages that work for them. Given that advertisers routinely target niche markets with great success, it shouldn’t be too difficult to gently steer people towards the kind of messaging that will enable us to talk about the evolving subject of vaccine medicine in a rational and productive way.

To do this, however, we will need strong leadership from Olympia and - to gain the respect of Questioners - this means our state must make an absolute commitment to the medical ethic of Informed Consent.

The S/D/Q paradigm warrants further study as a valuable tool for public health.

For more information on the S/D/Q paradigm, please email us at or visit our blog:  

Our first article on the S/D/Q paradigm can be found at

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Welcome to the conversation. Knowledge changes. People respond best when this truism is kept in mind. In community, March & Karen