Recognizing Vaccine Success and Addressing Vaccine Hesitancy

Transcription

1 Recognizing Vaccine Success and Addressing Vaccine Hesitancy Rosalyn Singleton, MD Adapted from presentation prepared by Carrie L. Byington, MD HA and Edna Benning Presidential Professor University of Utah Chair, AAP Committee on Infectious Diseases September 27, 2016

2 Objectives Discuss the successes of vaccination and the changes in the epidemiology of vaccine preventable infections Explore the roots of vaccine hesitancy Discuss potential options for addressing vaccine hesitancy

3 Vaccines Work!

4 MMWR Oct 1, 1999

5 Causes of infant mortality, selected years, USA. Myron E. Wegman J. Nutr. 2001;;131:401S-408S 2001 by American Society for Nutrition

6 Haemophilus influenzae type b (Hib) in Alaska Hib was the most common cause of meningitis in U.S. infants/young children. 3-6% died and 15-30% suffered permanent brain damage or hearing loss. Alaska Native children had Hib rates up to 6 times higher than general U.S. 700 Hib incidence, children <5 years old, Alaska, Cases/100, Native Non-Native Year

7 Hepatitis A Success Before Vaccine: Alaska had the highest hepatitis A infection rate in US most years. After Childhood Vaccination: No hepatitis transmission in Alaska. Hepatology 2016;63:

8 Success of Vaccines in US Routine childhood immunizations in the 2009 US birth cohort 42,000 deaths prevented 20 million cases of disease prevented $13.5 billion in direct health care costs saved $68.8 billion in societal costs saved The Vaccines for Children (VFC) program, operating since 1994 has eliminated racial and ethnic disparities in immunization coverage All US children have an opportunity to enjoy the benefits of vaccines Zhou, HF Pediatrics 2014 and Walker, AT MMWR Apr 2014

9 One Price of Success may be Forgetting

10 Unintended Consequences of Vaccine Success Low disease burden with resulting low disease awareness More attention paid to vaccine risks than benefits Low tolerance for vaccine risks A complicated immunization schedule with many vaccines to be given

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12 Dubé, E Institut National de Santé Publique du Québec, Canada

13 Vaccine Hesitancy is Not New In 1736, I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.

14 The Vaccine Confidence Project A 67- Country Survey September 2016 ~ 10% in US 41% France

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20 What Limits Confidence of Vaccine Hesitant Parents? Concerns about vaccine safety Concerns about the need for vaccines They also express a wish to preserve parental freedom of choice to decide what they want for their child

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22 Communication Strategies Elicit Concerns Why are you Concerned about vaccines? What are you most concerned about? Provide Accurate Information Present in a positive manner Show confidence in vaccines Reassure Personalize the Message

23 Communication Strategies Corroborate: Acknowledge the parents concern and find some point on which you can agree. Set the tone for a respectful dialogue. About Me: Describe what you have done to build your knowledge base and expertise. Science: Describe what the science says. Explain/Advise: Give your advice to the patients, based on the science.

24 Tools Needed for Addressing Hesitancy and Increasing Confidence in Parents and Providers One study demonstrated that messages about vaccine safety were ineffective In some groups of parents may even reduce the intention to vaccinate Recent medical graduates are more skeptical of vaccine efficacy when compared with older graduates In one state, more than one- half of medical providers were willing to consider untested immunization schedules for at least some vaccines Nyhan, B Pediatrics April 2014; Mergler, M Vaccines 2013; Wightman, A Pediatrics 2011

25 Appeal to science? Nyhan B, Pediatrics 2014;133:e

26 Provider Interventions Parents were randomized to the following interventions: 1. Information on the lack of evidence that MMR causes autism 2. Information about the dangers of diseases prevented by MMR 3. Images of children who have diseases prevented by the MMR 4. A dramatic narrative about an infant who almost died of measles 5. Control group Results 1. None of the interventions increased intent to vaccinate 2. Refuting MMR/autism link decreased intent to vaccinate among parents with the least favorable vaccine attitudes. 3. Images of sick children increased belief in vaccine/autism link 4. Narrative about an infant increased belief in vaccine side effects.

27 What Works? A Strong Recommendation Don t ask: What do you want to do about vaccines today? But Tell: Johnnie s due for his DTaP and Polio today Opel DJ. Pediatrics. 2013;132:

28 Vital Role of Provider Confidence Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe Important Statements I am confident in the safety and efficacy of vaccines Presumptive Delivery Strategy These are the vaccines we will be giving today The current schedule is the only recommended schedule Tested Decreases time the infant or child is at risk for diseases Personalized message

29 Common Barriers and Opportunities Correcting Misinformation Providing information about the US processes to ensure vaccine safety Understanding Herd or Community Immunity Demonstrating vaccines are normative Empowering parents to protect their children

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34 us/advocacy- and- policy/aap- health- initiatives/immunization/pages/immunization- Social- Media- Toolkit.aspx

35 Goal: Increase childhood immunization coverage by partnering with providers and agencies Our Resources: Vaccine Photo Book I Did It By 2 T- shirts Posters and Health Fair Displays Growth Charts Funding: Grants/donations Contact: Tamar@a2p2.org

36 Free AAP Member Benefit Edwards, KE and Hackell, JM Pediatrics September 2016

37 Challenges of Addressing Vaccine Hesitancy Providing information may be ineffective for those with fixed views Addressing vaccine hesitancy is time consuming 53% of MDs spend minutes per visit 8% spend 20 minutes or more Loss of income due to inefficiency Addressing vaccine hesitancy leads to decreased job satisfaction

38 Dismissal There are constraints on the freedom of a pediatrician to dismiss families for failure to vaccinate (or for any other reason) Consistency, transparency and openness regarding the practice's policy on requiring vaccines is mandatory Certain practice settings may limit the ability to dismiss a patient due to lack of availability of alternative sources of quality care Dismissal for failure to vaccinate must be done in a manner consistent with applicable state laws prohibiting abandonment of patients The individual pediatrician may consider dismissal of families who refuse vaccination as an acceptable option

39 Dismissal The decision to dismiss a family that continues to refuse immunization is not one which should be made casually, nor should it be made without understanding and respecting the reasons for the parents' point of view

40 Advocacy Non- Medical Exemptions

41 Medical versus Nonmedical Immunization Exemptions for Child Care and School Attendance Policy statement published by AAP September 2016 The AAP supports medically indicated exemptions to specific immunizations as determined for each individual child The AAP views nonmedical exemptions to school- required immunizations as inappropriate for individual, public health, and ethical reasons and advocates for their elimination Joins AMA and IDSA

42 Summary Vaccine hesitant parents are a heterogeneous group A variety of strategies are required to address hesitancy, increase confidence, and preserve the health gains realized by our national vaccine programs Communication and Advocacy are vital