Vaccine Hesitancy- Current Issues and Controversies including HPV vaccine. Dr Brenda Corcoran National Immunisation Office

Transcription

1 Vaccine Hesitancy- Current Issues and Controversies including HPV vaccine Dr Brenda Corcoran National Immunisation Office

2 What is vaccine hesitancy? An expression of concern or doubt about the value or safety of vaccination Indecision and reluctance Continuum between vaccine acceptance and vaccine refusal X Pro vaccine/ anti vaccine

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5 Consequences Public health impact delayed or selective vaccination => increased periods of risk exposure Polio outbreaks a public health emergency: World Health Organization 'Extraordinary' situation requires a co-ordinated international response, UN agency says By Amina Zafar, CBC News Posted: May 05, :06 AM ET Last Updated: May 05, :49 PM ET Outbreaks of vaccine preventable diseases

6 Survey ,819 people 67 countries Overall vaccine importance is positive Global average 12% (disagree that vaccines are safe) Less positive in Europe 7 out of 10 least confident countries 41% in France

7 Ireland

8 Who are vaccine hesitant? US estimates 1 in 4 parents Widely heterogeneous group

9 Who are vaccine hesitant?

10 Factors Confidence do not trust vaccine or provider Complacency - do not see need for or value vaccine Convenience - lack of access

11 Trust September 2015 August

12 Visiting anti-vaccination websites for 5 10 minutes can increase perceptions of vaccination risks and decrease intentions to vaccinate My son is my science Jenny McCarthy

13 The Narrative Bias The more narratives people read, the higher is their perception of risk, Narratives regardless of the information contained in simultaneously presented statistical information on the base rate of vaccine adverse events. Risk perception Intention to get vaccinated

14 Influences

15 Actions Omission bias Make non vaccination an action Default = Vaccination Make clear to parents that they deviate from the recommendation Action = non vaccination Use narratives Cawkwell PB, Oshinsky D. Med Humanit 2016;42:

16 Debunking the Myths Understand the specific concern Not all the same Listen Don t bring up new concerns Avoid the familiarity backfire effect Don t repeat the myth Give the facts Avoid the overkill backfire effect Focus on the most important arguments Use clear, simple language

17 Actions Stay on message Vaccines are safe and effective Recommended by independent experts Higher safety standards than drugs Present risks and benefits accurately Consequences of not vaccinating Clear language Herd immunity not relevant for tetanus

18 Communication Participatory versus Presumptive What do you want to do about your child s vaccinations? X Today, your child is due to have 3 injections Are we going to give the vaccines today? X He really needs to have all these vaccines today

19 Who are the Targets? Evidence is strongest for fence sitters Keep trying with hardliners

20 HPV vaccine uptake 2010/ /2017 Target 80% ~15,000 girls not vaccinated in 2016/17 Estimated uptake 1 st dose only

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22 Domino effect International Contagion Japan Denmark Ireland??? Erosion of staff resilience Other vaccine contagion Evidence slight reduced uptake of other school vaccines

23 Concerns Vaccine safety Vaccine safety Vaccine safety Vaccine causes serious side effects Lack of information not given patient information leaflet Consent process too rushed Distrust in Irish health services link to Pharma Anti establishment agenda

24 95% Target Wakefield article Source: HPSC Those who cannot remember the past are condemned to repeat it. G Santayana

25 Health Professional Vaccine Deniers

26 HPV vaccine effectiveness and safety

27 HPV vaccine and cervical cancer facts Cervical Cancer in Ireland Every year 6,500 women need hospital treatment pre-cancerous lesions > 280 (many young) women need treatment for invasive cancer 90 women die Best way to prevent cervical cancer = HPV vaccination + cervical screening Vaccine prevents precancerous growths and cancer Screening detects pre cancer or cancer of the cervix

28 HPV vaccine facts Gardasil HPV vaccine in use in over 25 European countries, the US, Canada, Australia & NZ >100 million people vaccinated worldwide >230,000 girls in Ireland long lasting protection 10 years + protection without any loss of immunity expected to provide life time protection HPV vaccine has not been withdrawn in any country

29 HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects The safety profile studied for >13 years in >1 million people during clinical trials and since the vaccine was licensed in No increase in the rates of any serious long term condition including autoimmune diseases and chronic fatigue syndrome in vaccinated girls. Since the programme started in 2010 to 31 March 2017 HPRA has received 1082 suspected adverse reactions/events most of these reports are expected side effects 14 chronic fatigue syndrome 10 post viral fatigue 3 an auto immune condition Much less than expected

30 HPV Vaccine Facts There is no document that states there are more than 20 known side effects of Gardasil HPV vaccine Side effects seen after use => Scientific evidence of causation pain, redness or swelling in the arm headache nausea a mild fever Itchy rash/ hives fainting serious allergic reactions very rare Side effects reported during general use => No scientific evidence of causation There is no evidence of any long term side effects

31 Chronic fatigue syndrome (CFS) known for over 200 years commonest cause of prolonged school absence Professor Alf Nicholson Clinical Lead Paediatrics 3-4 times more common in females and younger adolescents 10,000 cases in Ireland estimated prevalence rate in Ireland % 220,000 girls vaccinated (660,000 doses) => at least cases expected Reported numbers much lower than expected

32 CDC

33 Does HPV vaccine work?

34 Liaison Actions The Irish Cancer Society National Cancer Screening Service Professional bodies Department of Education/ Schools National Parents Councils Politicians Global

35 Actions Health professional training Prioritise immunisation in healthcare education minimal immunisation teaching at undergraduate and postgraduate level opportunistic education sessions > 2500 in 2016 Fact sheets/ articles in journals ICGP elearning modules Pharmacies

36 Information for parents Focus groups Offer vaccine again Actions Information for 6 th class parents Short information videos Revised parents leaflet (with quotes) More time to consent

37 Actions Increase awareness of vaccine National and local radio advertising Social media listening Social media campaign vaccinated girls international experts Alliance of health care and other supportive bodies women s rights childrens rights cancer charities youth groups influencers

38 Political support

39 Media

40 Impact Uptake stabilising No decline in HPV2 ~4% increase in HPV1?

41 I have met with a number of the people who believe that the Gardasil vaccine harmed them and I recognise their symptoms as real but there is no evidence linking them to the immunisation. It is a natural human reaction to anchor unexplained things to moments that you remember in your past but that does not mean that one thing triggered the other. I have never found one connection between the Gardasil vaccine and the symptoms reported by these girls. Professor Karina Butler Professor of Paediatrics Chair, NIAC

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43 More information