Public health struggles with vaccine refusal
TORONTO – The current vaccination debate brings to mind the folk tale in which the wind and the sun compete to see who can remove a cloak from the shoulders of a traveller striding down a country road.
The wind went first, funnelling gale-force gusts at the man, who only clutched his cape more tightly. The sun won the bet by beaming warm rays at the man.
A friendly pediatrician likely isn’t going to be enough to persuade parents who oppose vaccines to change their minds. But public health authorities know for certain the forceful approach does not work.
In fact, the one thing they are pretty clear on is they do not know how to win the trust of parents who believe vaccines are more dangerous for their children than the diseases they protect against.
“You know, I think the science on how you ‘convert’ such individuals, for lack of a better word, is still lacking,” admits Dr. Monika Naus, a measles expert at the British Columbia Centre for Disease Control.
“It is a real conundrum,” agrees Dr. Kumanan Wilson, an Ottawa-based researcher who has studied vaccine rejection.
When the news broke that the measles virus was spreading in Toronto, Ontario’s Health Minister Dr. Eric Hoskins urged parents to “look at the evidence.”
“They need to educate themselves. They need to talk to their friends and colleagues, a health-care professional, a family doctor,” Hoskins said, stressing the importance of keeping vaccination rates high enough to achieve herd immunity — where there are so few susceptible people in a population that a virus cannot spread within it.
But people who study the anti-vaccination phenomenon know parents who forgo vaccinating their children do educate themselves. They read mountains of evidence and talk at length about the issue to friends.
The problem is the information sources they are mining challenge the safety of vaccines and only serve to reinforce their beliefs.
Some religious communities eschew vaccines. But the other main group of people who reject vaccination are educated individuals who are drawn to alternative medicine and feel they know best what their child needs.
Wilson says this latter group tends to distrust conventional medicine and Big Pharma. They also tend to believe there are more risks to vaccines than public health authorities admit.
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It is generally believed that the very success of vaccines — the fact that some diseases are never or rarely seen anymore because of the protection vaccines offer — means some parents no longer view conditions like measles or pertussis (whooping cough) as a real danger. They see syringes, not diseases, as the threat to their children’s health.
Wilson did a study a few years ago to see if making the threat real would persuade vaccine-resistant parents of their value. He divided some vaccine opponents into two groups, giving one a lecture on measles and having the other speak to a person who survived polio.
Meeting a polio survivor did not have the effect you might imagine.
“We found 25 per cent who saw the polio survivor actually became more anti-vaccine after the presentation,” says Wilson, who works at the Ottawa Hospital.
“They thought this was a bias presentation and (wanted to know) why we didn’t bring in people with injuries from vaccines and that this was supported by the pharma industry.”
Studies in the U.S. testing approaches aimed at eroding vaccine resistance found similar results, says Dr. David Goldfarb, a pediatric infectious diseases specialist at McMaster University in Hamilton.
“Unfortunately nothing that was tried in these studies actually changes people’s minds and, if anything, all the interventions seem to make them more likely to refuse or be more concerned about the vaccine,” he says.
Media coverage didn’t help either, as researchers at the University of Washington in Seattle found during a pertussis outbreak that hospitalized children and dominated headlines in the city.
“When they looked at vaccine rates in those counties where there was a lot of media exposure, they didn’t improve,” Goldfarb notes.
Some in the field suspect the heated debate occurring now will not sway entrenched anti-vaccination parents.
And they worry about its impact on parents who are called vaccine hesitant; they don’t completely reject vaccines, but they fear them and may pick and choose the ones their children receive, leaving them unprotected against some diseases. Public health officials don’t want to see hesitancy give way to wholesale rejection.
Naus says vaccination rates suggest there hasn’t been a lot of growth in the number of children who are not vaccinated in this country. But nor have there been gains on the pro-vaccine side.
“There doesn’t seem to be a strong trend, but our vaccine coverage has also reached a plateau,” she says. “We’re certainly not seeing year-over-year increases in vaccine coverage.”