Issue 14 / 18 April 2016

VACCINE hesitancy is a greater cause for concern than true vaccination objection, and doctors and scientists alike need to step up their communication strategy to deal with it, says a leading expert.

Professor Paul Van Buynder, public health physician and a director of the Influenza Specialist Group, told MJA InSight that he had “given up on the true vaccination objectors”.

“They are not going to be converted by a discussion about science. They are lost to the vaccination program.

“By trying to convince these people, we’re spending less time talking to those who are worried about vaccinations, and these are the patients who are much more likely to respond to a conversation about the science.”

Professor Van Buynder was commenting on research published today in the MJA which found there was only a small increase in the registered vaccination objection rate between 2002 and 2013. The authors analysed data from the Australian Childhood Immunisation Register for children aged 1–6 years. They wrote that the number of children affected by registered vaccination objection rose from 1.1% in 2002 to 2.0% in 2013. The authors also noted that children with a registered objection were clustered in regional areas, and that the proportion affected by objection was lower among children in areas in the lowest bracket of socio-economic status than in those of highest socio-economic standing.

The proportion not affected by recorded objection but who were only partly vaccinated for vaccines due at 2, 4 and 6 months was higher in lower socio-economic areas, which suggested problems of access to health services, missed opportunities and logistic difficulties.

The authors said that GPs should be “on the alert for appropriate catch-up opportunities for partially vaccinated children, as in most cases they are probably not up to date for reasons other than parental objection”.

Lead author of the study, Dr Frank Beard, public health physician at the National Centre for Immunisation and Surveillance, said the research was timely and highlighted that anti-vaccination groups were not having as great an impact as they might think.

“There has been far too much focus on vaccination objection, and we’ve now shown it’s only a relatively small population that make up this group”, he told MJA InSight. “It’s important not to lose sight of the other more significant factors that might reduce rates of vaccination.”

Dr Beard said that improving access to vaccination service providers was essential, as was establishing a national vaccination reminder system.

Professor Van Buynder said that he is noticing “worrying pockets” in the community where vaccination schedules were not being followed.

“There is also a trend of ‘designer schedules’, where parents pick out which vaccinations they will give their child, and skip others.”

Professor Van Buynder said it was vital that the medical and science community become more active and vocal on social media to get the vaccination message across.

“It is frustrating. If people have a leaky pipe, they call a plumber, but if they have a health concern they are more likely to look up mummy blogs online and [read that] the HPV vaccine causes ovarian failure.

“Unfortunately, some people get these gut feelings and they run with them,” he said.

Dr Beard added that it was essential to equip GPs with the resources to manage the problem within the consultation room.

“It is very hard to shift beliefs, but there is a lot of funding now going towards communications strategies,” he said.

Co-author of the study, Associate Professor Julie Leask from the University of Sydney, is at the forefront of developing communications materials for managing vaccine hesitancy.

Professor Van Buynder has also been part of a team that has worked on another project called mdBriefCase Australia, an online resource that provides practical support for GPs on a range of issues, including vaccine hesitancy.

This resource includes a range of case studies that could be applied to real life scenarios.

“We want to provide a learning experiences for GPs, where they can apply targeted messaging – because different situations will require different messages.”

Professor Van Buynder said he understood how time-restricted GPs were, and that they were already dealing with a broad mix of conditions at any one time.

“They can’t be expected to know all that I know about immunisation, for example, which is why it is important that we provide these easy tools that can be used in a short amount of time.”

He said there were some powerful stories of people who were previously against vaccination and had changed their position, and using these examples in public awareness campaigns could help counteract misinformation.

Last week, first-time mother Cormit Avital shared an online video where she revealed she regretted her decision not to be vaccinated for whooping cough after she passed the disease to her child.

“We need to use these sorts of stories to get the message across,” Professor Van Buynder said.

7 thoughts on “Call to improve vaccination communication

  1. Simon Hendel says:

    Celebrities need to be better educated and engaged to help spread accurate information about vaccines because their voices are heard and their views are listened to.  

    Robert Deniro recently did an interview with the Today program in the USA where he re-injected doubt around the link between vaccines and autism (https://www.youtube.com/watch?v=FJ7iPn39i08).

    He is a great actor and was clearly personally affected during the interview (he has a child with autism).

    He also perfectly demonstrated the trap so many non-scientifically trained people fall into when considering observations: Anecdotes, unless they can be reproduced or observed consistently across a large enough sample size are not evidence, they are coincidences.

    Deniro stated repeatedly that he was not anti-vaccine but that he wanted safe vaccines.

    We already have them. They are not – and nothing ever will be – completely risk free, but they have saved many lives and reduced considerable suffering.

    Deniro communicated his well-meaning but inaccurate message to more people and potentially with more impact in a 9-minute interview than many doctors would ever hope to do in a career – 105,609 viewers saw the YouTube link above.

    If only Deniro, and others like him, could be encouraged by quality scientific education and communcation to use his celebrity to spread the facts. Unfortunately he has shown that fundamental misunderstandings of science led to monumental misrepresentations by public figures with a strong voice.

    He was right about one thing though:

    “Let’s just find out the truth,” he said

    That is what science is all about. Communicating the truth, however? That’s not so easy.

  2. Elizabeth Hart says:

    Dr Hendel, you speak of ‘vaccines’ in general terms. 

    According to the current vaccination schedule, children aged from birth to 15 years will have at least 46 doses of vaccines via combined vaccines and revaccinations.[1]  (This does not include annual flu vaccinations.)

    Can you please clarify your position?  Do you believe parents should be coerced into having all these vaccine doses for their children, without considering the risks and benefits of each of these medical interventions?

    Reference:

    1. 1. I calculate at least 46 doses of individual vaccines ie breaking down combination vaccines and including revaccinations on the general schedule for children aged from birth to 15 years ie: 4 x Hepatitis B, 6 x Diphtheria, 6 x Tetanus, 6 x Acellular pertussis, 4 x Haemophilus influenza type b, 4 x Inactivated poliomyelitis, 3 x Pneumococcal conjugate, 2 x Rotavirus (possibly 3 doses, see note b on the schedule), 1 x Meningococcal C, 2 x Measles, 2 x Mumps, 2 x Rubella, 1 x Varicella (Chickenpox), 3 x Human papillomavirus. Total 46 doses of vaccines. Also consider many children are being vaccinated with annual flu vaccines. Plus Aboriginal and Torres Strait Islanders and other ‘at risk groups’ are recommended to get annual flu vaccines plus additional Pneumococcal conjugate (13vPCV) and Pneumococcal polysaccharide (23vPPV) vaccines. (Refer to the National Immunisation Program Schedule, from February 2016.)
  3. Simon Hendel says:

    Hi Elizabeth,

    My position is that parents should choose the safety of whatever intervention in question based on a balance of risks versus benefits and accurate well communicated evidence. Overwhelmingly, the best available evidence shows that childhood vaccines are important to prevent vaccine preventable illness and are safe – and that the risks of not vaccinating are potentially dire.

    My comments above are about the challenges of communicating scientific evidence in a way that it’s not misunderstood or misinterpreted. My point was that celebrieties play a valuable role in that communication given their voice. In this instance I was referring to the debunked hypothesis that vaccines – specifically the polyvalent MMR vaccine – causes autism, which it does not (http://jama.jamanetwork.com/article.aspx?articleid=2275444).

    I didn’t argue coercion at any point. There’s always choice.

    The challenge for scientists is communicating evidence in such a way that people are empowered to choose based on actual fact and not falsehoods or coincidences.

    I’m not sure I follow the significance of the individual number of vaccines you counted? There is no inherrent risk or causative link with adverse reactions simply because of the number of vaccinations in the total childhood schedule. 

  4. Elizabeth Hart says:

    Dr Hendel, you say: “I didn’t argue coercion at any point. There’s always choice.”

    The No Jab, No Pay law coerces parents to have all the vaccine products and revaccinations on the schedule, up to the age of five years[1], to access tax benefits and childcare.

    The No Jab, No Pay law contravenes healthcare providers’ duty to obtain legally valid consent before a medical intervention. For instance, The Australian Immunisation Handbook 10th Edition states:  “For consent to be legally valid, the following elements must be present…It must be given voluntarily in the absence of undue pressure, coercion or manipulation…It can only be given after the potential risks and benefits of the relevant vaccine, risks of not having it and any alternative options have been explained to the individual.”

    (My emphasis)

    Reference:

    [1] As advised by Dr Masha Somi, Assistant Secretary, Immunisation Branch, 11 March 2016.

  5. Simon Hendel says:

    I made no mention of no jab no pay in my comment. But nonetheless, it is inaccurate to describe it as coercion and unnecessarily dramatic to portray it in terms of breaching informed consent. There are consequences to the rest of the community if population immunity is not maintained. There are consequences, therefore, of choosing, once informed, not to vaccinate according to the standard schedule. These consequences relate to no longer being eligible for certain government payments. Vaccinating children is not mandatory and the overwhelming majority of parents, once informed, choose to vaccinate according to the schedule. This is not coercion, it is removing conscientious objection as a consequence-free objection.

    No jab no pay has not been around for long enough to make a conclusive statement about its effect. Within the legislation are a raft of measures, some more ‘stick’ and others more ‘carrot’ – I’m going to go through each bit of it in a comment here. There is enormous amounts of information available about no jab no pay, which I’m sure you have already read.

    Having said all that, my comment really had nothing to do with relative merits of No Jab No Pay, it has to do with encouraging and engaging celebrities to be fully informed when they communicate science and health information and the challenges that that presents. 

     

  6. Dr Tim Bailey says:

    Hear hear Simon, Hear hear. Well communicated. 

  7. Paul Langton says:

    We the broader medical community have contiinually made the mistake of assuming an acceptance of the scientific model of hypothesis testing and carefully defining the risk-benefits of interventions. Experience however should inform us that there is a proportion of the general population that does, and perhaps will always reject this model. I do not profess to explain why, but recognise that the issue exists. One consequence is that our simpistic idea that ‘more information/eductaion’ will solve the problem of vaccine sceptics / deniers is misplaced. Both personal experience and published trials have shown that education may improve the understanding of individual anti-vaxxers knowledge but at the same time reduce their intention to have their children vaccinated. Some of this is pure selfishness (my child doesn’t need to be vaccinated so long as most of the other are) and some is ‘conspiratory belief’ about some imagined collusion between big pharma, government and the profession.  Regardless, it is worthwhile recognising the distinction between hardened anti-vaxxers and those with an open minded vaccine hestitancy. Efforts to inform the former are wasted but time spent with the later may be fruitful. Our overriding concern should be with maximising the common good of public health, and the more of the populaton we can engage in this persuit, the better.

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