BY JASON CHUNG (4)
This weekend, The Deductible ran two pieces regarding a practicing physician’s view of the vaccination issue and a patient advocate’s contrarian view of the subject. Both perspectives provided valuable windows into the complex views that some hold on the matter – complexity which may surprise public health advocates who view vaccination as a settled debate.
Unfortunately, the issue of childhood vaccinations is far from settled in some domains. And contrary to expectations, those leading the charge of vaccine skepticism don’t seem to lack affluence or education. In fact, researchers have found that the people most likely to refuse vaccinations for their children to be “white, well-educated and affluent”.
This is an abject failure in public health. Somewhere, over the course of the past few decades, public health practitioners and advocates have lost the ability to convey scientific facts on childhood vaccines in a compelling and persuasive manner.
Dr. Al-Agba suggests that this may be due to a growing disconnect between public health forces and those providing health care. With the growing and dizzying cadre of health care workers authorized to provide vaccinations either regularly or by emergency order – physicians, nurses, pharmacists, dentists, paramedics, medical and nursing students – it is true that the trusted relationship between doctors and the community seems to have been diluted.
This disconnect may partly explain the growing and unnecessary suspicion of experts within modern society. The proliferation of easy, if distorted, information on the Internet has made many a lay person an “expert” on scientific issues in their own mind and this has not been helped by the opaqueness of the current health care and pharmaceutical industries. Understandably, infamous reports of profiteering in health care, cases of greed among pharma executives and fraudulent innovations in health have made the general public suspicious of the status quo at the helm of America’s bloated, failing health care system.
This may be why community health advocates such as Ken Jaques demand proof that the safety of every permutation and combination of vaccines be proven before they are declared safe. It may also be why there is a persistent need for experts to prove their virtue and defend themselves from charges of greed and avarice as Dr. Al-Agba does in her piece.
In an odd twist, public health has paradoxically been both too confident and too timid in reaching fearful and hesitant parents.
While I categorically disagree with Mr. Jaques conclusions and interpretations regarding vaccinations, we share the concern that many public health actors have been haughtily blasé about the potential adverse effects of vaccines.
Vaccinations are overwhelmingly safe but the prospect of causing harm to their children via vaccination is real among the vaccine hesitant and it would behoove public health actors to be more forthright about the 30,000 VAERS (Vaccine Adverse Event Reporting System) reports filed every year. It would be especially helpful to do so while contextualizing the minuteness of that number among the 322 million illnesses, 21 million hospitalizations and 732,000 deaths prevented by the Vaccines For Children program between 1994 and 2013 as well as explain that there is no cause-and-effect relationship between the vaccines and adverse events in VAERS.
Proceeding this way would likely help parents come to grips with their fears by showing them that much like the fear of flying, fears about vaccines are irrational in the aggregate. Treat phobia with facts and understanding, don’t mock it.
Also, contrary to its dismissal of potential adverse effects, public health has been oddly fearful of demonstrating to parents what the effects of childhood diseases are actually like. As a pediatric colleague and I mentioned in a piece for CBC News, public health officials have utterly failed to remind parents what the horrific old days of unchecked childhood diseases were really like. Deaths, disfigurement, brain damage – these are all in play for the unvaccinated children who are more susceptible to childhood diseases as well as the infants who are too young to get vaccinated.
So why have we failed to warn parents effectively? Chalk that up to outdated attitudes among many public health officials who seem more afraid of being accused of fear-mongering than of epidemics, even though such concern is unwarranted and outdated.
Right now, we’re in a public health hell of our own making where science is communicated poorly, pseudo-science championed by celebrity, expertise is vetted by social media clicks and patients don’t know to whom to turn or trust.
Luckily, there is an answer, but clinicians must work hand-in-hand with public health officials for it to be effective. The answer is simply to tell the truth.
On a macro level, public health people must truthfully tackle anti-vaccination talking points head-on and occupy an honest broker role for society instead of merely getting sucked into an advocacy role. Don’t gloss over the potential if highly improbable harms of vaccines or soften the devastating effects of childhood diseases because they don’t fit your narrative, tone or goal.
On a micro level, clinicians must honestly engage parents about their concerns based on their knowledge of medicine as well as the child. That relationship is critical to helping young parents surmount their fears to make truly informed decisions.
The issue among the vaccine skeptics and the vaccine hesitant is not merely one of lack of information but one of trust. Right now, they are telling us that they can’t trust the experts. The only way to combat that jadedness is with openness and relationships. It’s time to vaccinate us against misinformation with the truth.
Jason Chung is Co-Founder of The Deductible.