How should health officials reverse an anti-vaxxer movement?
TORONTO — Dr. Paul Offit has seen it all: whooping cough that spread through California, a deadly measles outbreak that killed nine children in Philadelphia, meningitis that claimed toddlers’ lives.
By 2000, measles was virtually wiped out in North America, according to the internationally-recognized pediatrician. Flash forward to 2014: outbreaks of measles are being reported across Canada and into the United States. So what changed?
Google ‘anti-vaccination’ and you’ll enter the Wild West of medical debate.
Anti-vaccination movements are widespread across the United States and even in Canada. Some theories suggest there is a link between autism and vaccinating children. These allegations have been debunked, though.
Understanding the anti-vaccination movement
Pamphlets and awareness campaigns may not be enough to counter these claims. Doctors say they need to be savvier in reconsidering their approach.
“This is not a simple task because a lot of parents for anti-vaccination are aware and opinionated. They believe the risk of being vaccinated is greater than the benefits,” Dr. Marc Ouellette said.
He’s the scientific director of infection and immunity at the Canadian Institutes for Health Research.
Ouellette says the CIHR is pouring research money into better understanding who the anti-vaxxer movement is made of and what they believe.
READ MORE: The real war on vaccines
Offitt said there seems to be a trend: “Upper middle class, college or graduate-school-educated professional who’s used to believing that they can master any subject simply by Googling a word on the Internet,” he described.
Paging Dr. Google
The Internet is the key, according to Dr. Ran Goldman. He’s had his hands full at the B.C. Children’s Hospital. The province has been rocked by outbreaks of measles — literally more than 300 cases in the Fraser Valley alone, cases he calls “very troubling.”
But he’s cognizant of where the health care system may have gone wrong in reaching out to parents.
“The anti-vaccination movement is using very proficiently the online platform. They’re able to spread stories that are usually very rare or very powerful and not always based on any scientific evidence,” Goldman said.
That’s why he spearheaded the website medschoolforparents.com, a free resource for parents in Canada and worldwide. It’s not just about vaccinations either.
“Jenny McCarthy reaches 250,000 people on one YouTube video. Physicians can use the same medium to get to the same parents and explain the scientific evidence behind immunization. We didn’t play catch up on time,” he said.
Make it mandatory
Across North America, health officials are grappling with deciding whether health care workers should be forced to get the flu shot. In a handful of U.S. states, the same thing is happening with kindergarteners.
In 2010, Connecticut, for example, became the second U.S. state after New Jersey to force parents who want to send their kids to daycare to give their children at least one vaccine at the six-month mark.
“Eliminate religious and philosophical exemptions,” Offit said. That’s the case in Croatia; if you don’t have a medical exemption, you must be vaccinated.
Offit says his wife, who is also a doctor, tells parents she can’t keep seeing their children if they aren’t vaccinated. Showing them how critical it is to her is often enough to persuade families to reconsider.
Forcing healthy people against their will to get vaccinated is wading into murky waters, though.
Dr. Arthur Caplan, head of medical ethics at New York University, says that health officials need to tread carefully and “introduce ethics in requirements.”
“Vaccination is not about you and your kid. It’s about protecting the vulnerable,” he said referring to pregnant women, newborn babies, the elderly, and patients who have had organ transplants or are going through chemotherapy, for example.
“If you care about your neighbor and you want to be a good citizen, you have to look after people who can’t vaccinate and can die,” Caplan said.
Families who don’t vaccinate should also be held liable, he suggested.
“If I can show that you give my kid measles or you got a disease from out of town and we can trace it back to you, you should be held responsible,” he said.
Is there really a movement?
The national vaccine uptake in Canada is about 95 per cent, according to the Public Health Agency of Canada.
Based on 2011-12 government data, MMR (measles, mumps and rubella) first and second doses were at 95 per cent, polio at 95 per cent and DPT (diphtheria, pertussis and tetanus) at 88 per cent.
Herd immunity varies by disease; for measles, it should be at about 95 per cent uptake for the two doses, said Dr. John Spika, PHAC’s director general of the centre for immunization and respiratory infectious diseases.
He doesn’t believe there is an anti-vaccination “movement” per se. In Canada, only one per cent of Canadians sampled refused immunization. Another four per cent haven’t immunized their kids according to schedule.
“But (those numbers) haven’t really grown from what we can tell,” Spika told Global News. The federal agency has been tracking immunization coverage since the 1990s.
Offit suggests there’s an ebb and flow to the vaccination cycle.
“You didn’t have to convince my parents to get vaccinated. They saw what these diseases could do. When they were growing up, diphtheria was the biggest killer of teenagers in America. They saw what vaccines could do, and they were easy converts,” Offit told Global News.
Right now, the pendulum may be swinging in the favour of anti-vaccination, but as cases rise that’ll change, he said.
Ouellette said that’s his concern: in 2009 at the height of H1N1, a healthy 13-year-old boy, Evan Frustaglio, died of the influenza.
“Suddenly, everyone was queuing for the vaccine. It often takes practical examples,” Ouellette said.
“There has to be a way to best communicate [the risk] before there’s a death,” he said.
© 2014 Shaw Media