When Marie-Hélène étienne-Rousseau went into labor, she broke down in tears. It was September 2018, and her baby wasn’t due until December. Just before midnight, Tobie arrived, weighing just two pounds. His body was so tiny that his head could fit in the palm of her hand, and Marie-Hélène was terrified that he wouldn’t survive. Tobie spent only a few seconds in her arms before he was rushed to the neonatal intensive care unit. He needed a mask to breathe and was soon taken to surgery for internal bleeding. It would be months before he was allowed to go home.

While Tobie was still in the hospital, Marie-Hélène was shopping for diapers when she saw a headline about measles spreading in her province of Quebec. She hadn’t had Tobie vaccinated. It wasn’t even a question—he seemed too fragile. She hadn’t vaccinated her three other children, either; it wasn’t the norm in her community. Her friends and neighbors took it for granted that vaccines were dangerous and passed around horror stories about their side effects. Still, the fact remained: Quebec had already had two serious measles outbreaks that decade.

Today in the developed world, measles is on the rise for the first time in at least half a century, and its mortality rate is around one in a thousand. In the developing world, it’s closer to one in a hundred. Estimates suggest that from 2016 to 2018, measles deaths spiked worldwide by 58 percent, with over a hundred thousand casualties. These deaths could have been prevented by the vaccine, which has saved roughly 20 million lives in the past two decades. Although epidemiologists recommend two doses of the measles vaccine and a minimum immunization rate of 95 percent, around the globe only 85 percent of people get the first dose and just 67 percent continue to the second. Many of those who skip the shot simply do not believe in the science.

Government officials have tried to prosecute the problem, some warning that the unvaccinated could be fined up to a thousand dollars and sentenced to jail for up to six months. Many schools shut their doors to unvaccinated children, and one county even banned them from enclosed public places. When such measures failed to solve the problem, public officials turned to preaching. Since people held unfounded fears about vaccines, it was time to educate them with a dose of the truth.

The results were often disappointing. In a pair of experiments in Germany, introducing people to the research on vaccine safety backfired: they ended up seeing vaccines as riskier. Similarly, when Americans read accounts of the dangers of measles, saw pictures of children suffering from it, or learned of an infant who nearly died from it, their interest in vaccination didn’t rise at all. And when they were informed that there was no evidence that the measles vaccine causes autism, those who already had concerns actually became less interested in vaccinating. It seemed that no logical argument or data-driven explanation could shake their conviction that vaccines were unsafe.

This is a common problem in persuasion: what doesn’t sway us can make our beliefs stronger. Much like a vaccine inoculates our physical immune system against a virus, the act of resistance fortifies our psychological immune system. Refuting a point of view produces antibodies against future influence attempts. We become more certain of our opinions and less curious about alternative views. Counterarguments no longer surprise us or stump us—we have our rebuttals ready.

Marie-Hélène étienne-Rousseau had been through that journey. Visits to the doctor with her older kids followed a familiar script. The doctor extolled the benefits of vaccines, warned her about the risks of refusing them, and stuck to generic messaging instead of engaging with her particular questions. The whole experience reeked of condescension. Marie-Hélène felt as if she were being attacked, “as if she were accusing me of wanting my kids to get sick. As if I were a bad mother.”

When tiny Tobie was finally cleared to leave after five months in the hospital, he was still extremely vulnerable. The nurses knew it was their last chance to have him vaccinated, so they called in a vaccine whisperer—a local doctor with a radical approach for helping young parents rethink their resistance to immunizations. He didn’t preach to parents or prosecute them. He didn’t get political. He put on his scientist hat and interviewed them.

     Calvin & Hobbes ? 1993 Watterson. Reprinted with permission of ANDREWS MCMEEL SYNDICATION. All rights reserved.

MOTIVATING THROUGH INTERVIEWING

In the early 1980s, a clinical psychologist named Bill Miller was troubled by his field’s attitude toward people with addictions. It was common for therapists and counselors to accuse their substance-abusing clients of being pathological liars who were living in denial. That didn’t track with what Miller was seeing up close in his own work treating people with alcohol problems, where preaching and prosecuting typically boomeranged. “People who drink too much are usually aware of it,” Miller told me. “If you try to persuade them that they do drink too much or need to make a change, you evoke resistance, and they are less likely to change.”

Instead of attacking or demeaning his clients, Miller started asking them questions and listening to their answers. Soon afterward, he published a paper on his philosophy, which found its way into the hands of Stephen Rollnick, a young nurse trainee working in addiction treatment. A few years later, the two happened to meet in Australia and realized that what they were exploring was much bigger than just a new approach to treatment. It was an entirely different way of helping people change.

Together, they developed the core principles of a practice called motivational interviewing. The central premise is that we can rarely motivate someone else to change. We’re better off helping them find their own motivation to change.

Let’s say you’re a student at Hogwarts, and you’re worried your uncle is a fan of Voldemort. A motivational interview might go like this:

You: I’d love to better understand your feelings about He Who Must Not Be Named.

Uncle: Well, he’s the most powerful wizard alive. Also, his followers promised me a fancy title.

You: Interesting. Is there anything you dislike about him?

Uncle: Hmm. I’m not crazy about all the murdering.

You: Well, nobody’s perfect.

Uncle: Yeah, but the killing is really bad.

You: Sounds like you have some reservations about Voldemort. What’s stopped you from abandoning him?

Uncle: I’m afraid he might direct the murdering toward me.

You: That’s a reasonable fear. I’ve felt it too. I’m curious: are there any principles that matter so deeply to you that you’d be willing to take that risk?

Motivational interviewing starts with an attitude of humility and curiosity. We don’t know what might motivate someone else to change, but we’re genuinely eager to find out. The goal isn’t to tell people what to do; it’s to help them break out of overconfidence cycles and see new possibilities. Our role is to hold up a mirror so they can see themselves more clearly, and then empower them to examine their beliefs and behaviors. That can activate a rethinking cycle, in which people approach their own views more scientifically. They develop more humility about their knowledge, doubt in their convictions, and curiosity about alternative points of view.

The process of motivational interviewing involves three key techniques:

Asking open-ended questions

     Engaging in reflective listening

     Affirming the person’s desire and ability to change

As Marie-Hélène was getting ready to take Tobie home, the vaccine whisperer the nurses called was a neonatologist and researcher named Arnaud Gagneur. His specialty was applying the techniques of motivational interviewing to vaccination discussions. When Arnaud sat down with Marie-Hélène, he didn’t judge her for not vaccinating her children, nor did he order her to change. He was like a scientist or “a less abrasive Socrates,” as journalist Eric Boodman described him in reporting on their meeting.

Arnaud told Marie-Hélène he was afraid of what might happen if Tobie got the measles, but he accepted her decision and wanted to understand it better. For over an hour, he asked her open-ended questions about how she had reached the decision not to vaccinate. He listened carefully to her answers, acknowledging that the world is full of confusing information about vaccine safety. At the end of the discussion, Arnaud reminded Marie-Hélène that she was free to choose whether or not to immunize, and he trusted her ability and intentions.