Vaccine Scares Professional Response

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Vaccine Scares-Professional Response

• Helen Bedford
• Institute of Child Health
• London

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• Another cause, is the charge against vaccination
  of producing various new diseases of frightful
  and monstrous appearance . . . . . . . . . . . .
  Publications with such representations have been
  widely circulated, and though they originate
  either in gross ignorance, or in wilful
  misrepresentation, yet have they lessened the
  confidence of many, . . . in vaccination . . . .
  Report of the Royal College of Physicians
  
  April 1807

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Vaccine safety concerns

• Pertussis vaccine and brain damage
• MMR vaccine autism and bowel disease
• Multiple sclerosis hepatitis B vaccine
• Mercury in vaccines neurological damage
• Multiple vaccines immune dysfunction
• Contraceptives in tetanus vaccine

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The Independent. 27th Sept 2003
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Effects of MMR safety concerns

• Decline in MMR vaccine uptake
• 92 in 1995
• 78 in 2003 (68 in London 77 in Wales)
• Parents requesting separate antigens
• Local outbreaks of disease-2001/2
• Measles nearing endemic levels in UK-2003
• Small decrease in uptake of other vaccines

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Determinants of vaccine uptake

• Immunisation services
• accessible, well organised
• Health professionals
• well informed, enthusiastic
• Parents
• attitudes to vaccines and diseases

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Parents attitudes-the decision to immunise

• dynamic process
• range of influences
• personal/family experience
• media
• professionals
• vaccine advocacy groups internet

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Personal/Family experience

• family member damaged by vaccine
• personal experience of disease
• anecdotes about or personal contact with child
  with autism
• personal views on health and medicine-increase in
  alternative/complementary medicine
• own experience of the immunisation process

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Immunisation process

• mothers-emotional distress re injections
• value health professional who engages them and
  their baby
• lack of information
• And if you kind of ask them any questions they
  are really eager to get rid of you.
• adverse experiences-deferral of future visits and
  defaulting
• Harrington et al., 2000.

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Immunisation processparents views of health
professionals

• value advice from health visitors and GPs
• highly value HPs who discuss issues openly
• want more information-from independent source
• appreciate time and one to one advice

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Immunisation processparents views of health
professionals

• felt child not considered as an individual
  willing to have one autistic child rather than
  outbreak
• dont get written information
• health professionals are inconsistent
• feel pressurised into immunising
• loss of confidence and trust in health
  professionals and government agencies (BSE)
• GP targets

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Parents-attitudes

• range of influences
• personal/family experience
• media
• professionals
• vaccine advocacy groups internet

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Media triggers

• Secret and cover up
• Human interest
• High profile personalities
• Conflict
• Suggests further problems
• Many people exposed
• Strong visual impact
• Links to sex or crime (perhaps not!)

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Vaccine scares-the effect of the media

• protracted campaign against MMR by South Wales
  Evening Post
• July-Sept 1998 uptake declined by 13.6 in area
  covered by this newspaper compared with same
  period in 1997
• In rest of Wales for similar periods decline was
  2.4
• Mason Donnelly. J Epid Comm Health 2000 54
  473

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MMR in the media

• Recent study of media coverage of various
  scientific issues
• Coverage of MMR by media suggests
• a divided scientific community with two
  conflicting bodies of research
• The reality is a very flimsy link with autism and
  the great weight of evidence failing to find a
  link.
• ESRC 2003

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MMR in the media

• Mark Popescu- Editor of the Ten Oclock News
• strictly on the level of risk we probably
  over reported MMR.but I am also governed by
  whether the Government is involved.. whether
  the CMO is involved
• Several people interviewed pointed to the power
  of the Daily Mail in particular and said the
  story would run across all media as long as Daily
  Mail keeps running the story.
• Kings Fund 2003

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Parents-attitudes

• range of influences
• personal/family experiences
• media
• professionals
• vaccine advocacy groups internet

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Health professionals

• Attitudes Knowledge
• lack of training support for health visitors
  and practice nurses
• patchy, not always included in basic training
• updating lacking
• studies consistently show poorly informed
• contraindications
• need for second dose MMR
• significant proportion do not immunise own
  children

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Parents-attitudes

• range of influences
• personal/family experiences
• media
• professionals
• vaccine advocacy (activist) groups

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Vaccine advocacy groups

• set up to
• provide support to parents who believe child
  damaged by vaccines
• in response to lack of information
• Some e.g. JABS use media very effectively
• difficult to engage a dialogue
• information can be inaccurate misleading

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Resource list provided in recent article on MMR
in Junior

• Vaccination Information Service (VAN UK)
• MMR The Facts
• National Autistic Society
• The Informed Parent
• Allergy-Induced Autism
• Alexander Harris
• World Health Organization
• JABS

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Other sources of information

• VAN UK (Vaccination Awareness Network)
• Your child will receive 18 vaccines by the time
  it is 16 weeks old (more for some ethnic groups),
  read the VAN UK factsheets to see how many
  chemicals, metals and viruses are being put into
  your new baby and what side effects they can
  cause!! Is this a risk worth taking for diseases
  where the incidence and/or death rates declined
  by over 90 before any jabs where introduced?
•  

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Complications of 1st Dose of MMR Vaccine v
Measles disease
per million children
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Autism-a fright factor-1

• Involuntary
• Inequitably distributed
• Inescapable
• Unfamiliar or novel source
• Man-made rather than natural
• Hidden and irreversible damage
• Small children

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Autism-a fright factor-2

• Dread disease/condition
• Identifiable victims
• Poorly understood by science
• Subject to contradictory statements
• Apparent unexplained increase in prevalence
• No effective treatment
• Loss of acquired skills

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Parents perceptions of risk

• If he has whooping cough, he catches it and
  thats
• that-but if he has the injection (and was brain-
• damaged), Id feel responsible.
• Because I have actually chosen positively to
  go down that course of action, and that results
  in a injury to them. It is just unthinkable
• you hear about autismyoure praying before you
  go in and when you come out

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Professional response

• Training and support for health professionals
• standards for training being developed by HPA
• not just the facts but how to talk with parents
  and answer challenging questions
• updates important

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Professional Response

• Information needs to be out there
• e.g. MMR myth buster pack
• Green Book (now on the Web)
• Tailored to individual needs
• Tiered
• verbal
• leaflets
• fact sheets videos
• scientific papers

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Professional Response

• Advise parents on accessing and using available
  resources
• guidance on which websites and interpreting
  information
• who produced it?
• presented in an unbiased form?
• vested interests?
• signpost to original data?
• dated?
• uncertainties acknowledged?

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Professional Response

• Be familiar with other sources of information
• Informed parent
• JABS
• What Doctors Dont Tell You
• equipped to answer particular issues, concerns
  raised

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Professional Response

• BUT facts are not enough
• Delivery-empathetic,
• Specific to concerns
• Immunisation advice specialist shared between
  practices?
• Imaginative ways of working with parents
• groups

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Professional Response

• Communicating risks of vaccines v diseases
• considerable research into communicating
  risk-little focused specifically on vaccines
• percentages rather than figures?
• use examples that have real meaning
• pregnancy childbirth
• one case in a small town
• use personal experience of seeing the diseases

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Professional response

• Be proactive with media
• write letters/articles for local and national
  papers
• get media trained
• offer self as local spokesperson for radio and TV
• but know your limitations
• work with pro vaccine advocacy groups

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Conclusions

• Parents strongly held beliefs and attitudes
  shaped by numerous influences
• Decline in MMR rates serious but not as
  significant as media would suggest and majority
  of parents still choose MMR
• Health professionals viewed as main source of
  information for many parents
• A well informed confident health professional can
  have a major influence on parents views

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Resources

• MMR mythbuster pack
• MMR the facts
• http//www.mmrthefacts.nhs.uk/
• Drug and Therapeutics Bulletin 2003 41 (4). MMR
  vaccine-how effective and how safe (independent
  review by Consumers Association). Also leaflet
  for parents.
• Bedford H., Elliman D. Childhood Immunisation
  The Facts. 2001. HPE (new edition out shortly)
• Websites WHO CDC Bandolier