OVERCOMING VACCINE HESITANCY

Transcription

1 OVERCOMING VACCINE HESITANCY Lisa Barker, MD St. Luke s Treasure Valley Pediatrics Impact of Vaccines MMWR Jan , JAMA. 2007;298(18):

2 The Good Old Days Vaccines save lives, therefore your child needs to be vaccinated..easy, right? No Longer Enough! What are we up Against? 2

3 Barriers for Providers Not enough time (no reimbursement) The media captures public attention Parents come in with bad information from the internet Anecdotes are powerful Objectives Define vaccine hesitancy Understand characteristics of vaccine-hesitant parents Develop communication strategies to respond to vaccine hesitancy Identify and respond to the most common concerns raised by vaccine-hesitant parents 3

4 UNDERSTANDING VACCINE HESITANCY What is Vaccine Hesitancy? A delay in acceptance or refusal of vaccines despite the availability of vaccination services 4

5 How Big is the Problem? 2009 Survey of Parents >50% of parents expressed concerns about serious adverse effects 11.5% had refused at least 1 recommended vaccine HPV was the most common Then, varicella, meningococcal conjugate, MMR 25% believed vaccines cause autism 90% believe that vaccines are a good way to protect children from disease 88% do what their doctor recommends Freed 2009 How Big is the Problem? 2010 HealthStyles survey Intent to vaccinate 93% - fully 5% - partially 2% - none 77% of parents have concerns about vaccines 32% - fevers caused by vaccines 36% - too many vaccines given at one visit 30% - may cause learning disabilities, including autism 26% - ingredients are unsafe 11% - prevent diseases that children are not likely to get Kennedy

6 School Exemptions in Idaho Exemption Rates <=2% 2< to 3.5% 3.5< to 5% > 5% Categorizing Parental Attitudes Unquestioning acceptor 30-40% Cautious acceptor 25-35% Hesitant fence-sitter 20-30% Late/selective vaccinator 2-27% Refuser - <2% Leask

7 Contributing Factors Personal experience Media/social networks Distrust in government, science, big pharma Decrease in vaccine-preventable diseases Interactions with healthcare providers Historical vaccination scares Grassroots movements Moral/religious convictions School entry requirements RESPONDING TO VACCINE HESITANCY 7

8 Communication Strategies Figure 3. Main reasons parents who planned to delay or not to get a vaccine for their child changed their minds Gust 2008 Communication Strategies Starting the Conversation 1) Initiate the Conversation presumptive vs. participatory format Presumptive: we have to do some shots today Participatory: what do you want to do about shots today? Try to stick with your original recommendation Opel

9 Communication Strategies Identifying a Specific Concern 2) Establish Honest Dialogue Avoid making assumptions Ask questions Do you have cultural or religious beliefs regarding immunization? Do you know anyone who has had a serious adverse event after an immunization? Do you have vaccine safety concerns? Listen to concerns Healy 2011 Communication Strategies Target your Education 3) Acknowledge Risk (corroborate) Promote partnerships Be open and honest Put adverse events into context Stress the positive benefits of vaccines 4) Discuss the science Direct, unambiguous language 5) Offer personal experiences/stories Healy

10 Communication Strategies Target your Education 6) Provide Information Sources Ask, What sources are most influential for you? Ask, Are you interested in more information? (be prepared) Offer information relevant to specific concerns Consider offering personal stories Communication Strategies 7) Other Suggestions Discuss state laws around childcare and school entry Make it easy to schedule a vaccination appointment Ensure ongoing communication 10

11 Things to avoid Missing cues Using medical jargon Patronizing Discrediting information sources Overstating vaccine safety Being confrontational Using scare tactics Categorizing Parental Attitudes Unquestioning acceptor 30-40% Cautious acceptor 25-35% Hesitant fence-sitter 20-30% Late/selective vaccinator 2-27% Refuser - <2% Leask

12 ADDRESSING SPECIFIC CONCERNS Top Vaccine Concerns of Parents/Families Overwhelming the immune system Desire for a non-standard immunization schedule Risk of infection is low Distrust of vaccine additives (preservatives, heavy metals) MMR and autism 12

13 DO IMMUNIZATIONS OVERWHELM THE IMMUNE SYSTEM? The number of vaccinations has steadily increased over the last century 2015: 14 total vaccines, up to 29 injections by age 2 Offit

14 But, the total number of proteins and polysaccharides in vaccines has DECREASED dramatically 2015: 150 Total Antigens Offit 2002 Important Points Infants today get more vaccines but fewer antigens to challenge their immune system We are giving smarter, safer shots The immune system has the capacity to respond to multiple antigens simultaneously Vaccines do not increase the risk of other infections Vaccines actually prevent the weakening of the immune system 14

15 I HEARD IT WOULD BE SAFER TO SPACE OUT THE VACCINES Why is the schedule like that? The ACIP reevaluates the immunization schedule yearly Each vaccine dose is scheduled using two factors: Age when the body is most responsive Goal of protecting children at the earliest possible age Offit

16 Dangers of an Non-Standard Schedule Not founded in science Cumbersome = more room for error Increased number of office visits = increased noncompliance ACIP schedule is based on optimizing the body s response to a vaccine Leaves children vulnerable to acquiring serious, potentially fatal diseases HAVEN T THE DISEASES BEEN ELIMINATED? 16

17 Herd immunity When a critical portion of the population is immunized against a contagious disease, most members of that community are protected against that disease No single vaccine is 100% effective Some people cannot be immunized because of underlying medical problems Vaccination only works when a HIGH PERCENTAGE of the population are vaccinated When you immunize your child, you re not only immunizing your child. That child s immunity is contributing to the control of the disease in the population Dr. Elizabeth Edwards Pertussis Caused by the bacterium Bordatella pertussis Uncontrollable violent coughing Most often affects infants and young children Prior to vaccination, ~200,000 cases per year Now, ~10,000-40,000 cases per year 17

18 In the news: Whooping cough Caused by the bacterium Bordatella pertussis Uncontrollable violent coughing Most often affects infants and young children Prior to vaccination, ~200,000 cases per year Now, ~10,000-40,000 cases per year 18

19 Pertussis Prevention Tdap during each pregnancy (27-36 weeks gestation) Family members and direct caregivers should receive Tdap Initiate the DTaP series on time The success of the measles vaccine 19

20 Measles cases DO VACCINES CAUSE AUTISM? 20

21 Autism Neurodevelopmental disorder More common in boys than girls (4:1) Increasing incidence worldwide In the 1980 s 1/10,000 kids diagnosed with autism Now, 1/150 American 8-year-olds has some form of autism Possible Causes of Autism Genetics Abnormal brain growth Environmental triggers Prematurity Older parents Closely spaced pregnancies 21

22 Vaccines and Autism - Theories MMR vaccine causes intestinal damage 1998 Case Series (published in Lancet, retracted 2/10) Thimerosal mercury toxicity? Multiple vaccines overwhelm the immune system, triggering a neurologic response causing autism WHAT ABOUT ALL THAT OTHER STUFF THAT S IN VACCINES? 22

23 Other vaccine components Aluminum Added to help the vaccine stimulate a better response Present in higher levels in food, air, water, breast milk, formula Monosodium glutamate (MSG) Used as a stabilizer in a few vaccines Antibiotics Added to some vaccines to prevent the growth of bacteria during production and storage Other vaccine components Formaldehyde Used to inactivate bacterial toxins (diphtheria, tetanus) Thimerosal Mercury-containing preservative used in multi-dose vials Ethyl mercury processed easily in the body, not harmful 23

24 SUMMARY Summary Vaccine hesitancy is on the rise Vaccine hesitant parents fall along a spectrum of opinion There are many powerful influences guiding today s parents internet, social media, etc. But, a child s healthcare provider has the most impact on a parent s final decision on immunization Parents ask tough vaccine questions now you have the tools to answer With careful conversation and partnership, we can guide and educate hesitant parents 24

25 Resources for Families Healthcare Provider Websites American Academy of Pediatrics American Nurses Association CDC Every Child by Two Vaccine Education Center (CHOP) CDC: Provider Resources for Vaccine Conversations With Parents Books Vaccines and Your Child by Paul Offit, MD Do Vaccines Cause That? By M. Myers, MD Mama Doc Medicine, by Wendy Sue Swanson, MD On Immunity, by Eula Biss References Gust et al. Immunization attitudes and beliefs among parents: beyond a dichotomous perspective. Am J Health Behav 2005;29(1):81-92 Gust et al. Parents with doubts about vaccines: which vaccines and reasons why. Pediatrics 2008;122: Healy et al. How to Communicate with Vaccine-Hesitant Parents. Pediatrics 2011;127:S Kempe et al. Physician response to parental requests to spread out the recommended vaccine schedule. Pediatrics 2015;135 Kennedy et al. Confidence about vaccines in the United States: Understanding parents perceptions. Health Aff June 2011 vol. 30 no Leask et at. Communicating with parents about vaccination: a framework for healthcare professionals. BMC Pediatrics 2012; 12:154 Offit et al. Addressing parents concerns: do multiple vaccines overwhelm or weaken the infant s immune system? Pediatrics 2002;109: Singer A. Making the CASE for vaccine communication: a new model for talking to parents about vaccines. November Accessed June 7,

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