Thursday, April 26, 2007

What Motivates Vaccine Skeptics?

Over my five years as Director of the San Francisco Immunization Coalition I have met many people who were skeptical about immunization and vaccines. In general, I believe it is my job whether I am on the clock or not to give people the most factual, objective, up-to-date and science-based information about immunization to help keep them informed. I definitely think that vaccine skeptics take many forms and lumping them all together is not a useful way to understand them or inform them. Vaccine skeptics have different motivations and it is important to know who they are in order to talk them in the most honest and productive way. Here are a few but not all the types of people that are skeptical of vaccines (based on my own experience):

Emotional - Many people are not motivated entirely by rational thought but rather more motivated by emotion. Things like hope, fear, anger, trust, and joy motivate these types of people more than facts, statistics, or science. “Anti-vaccination” web sites usually do a good job at appealing to the emotions in order to get their point across. Understand for emotionally motivated people it is important to gain their trust in order to effectively get your point across. If they do not trust you on an emotional level they will not listen to what you say. And graphs of decreases in disease will not motivate them.

Political – when it comes to immunization, politics is a double-whammy. Why? Well because vaccines for the most part are made by large, corporate, pharmaceutical companies and advocated for and distributed in large part by the government. Unfortunately this plays strongly against the beliefs of two distinct groups of people with strong political motivations:

1. Libertarian/Anti-Government – whether you are aware or not there are many people in the U.S. that do no trust the government. Most libertarians dislike government more the further away it is. In other words they trust the Federal government the least and their local government the most, but they tend to believe limited or no government is the best. Sometimes it is hard to believe what motivates these people and other times it is not. But libertarians tend to look with skepticism on any program that is developed by the government and do not believe in collectivist arguments. The argument that one person should get immunized in order to protect others does not always play well with people that believe strongly in pure individualism.

2. Anti-Corporation/Anti-capitalist – you certainly have met someone who does not trust corporations or the private sector. In the Bay Area there are many people of this stripe. In general, pharmaceutical companies have become demonized and scapegoated for many of the health problems in the U.S. It is no wonder that people who believe that corporations are evil aren’t thrilled about putting something into their own or their children’s body made by a large, multinational corporation. However, most of these people, not all, will drive their children around in a car produced by a large multinational corporation in fact putting their trust in Volkswagen, Ford, Volvo, or Honda. Sometimes it is important to point out these distinctions in order to put beliefs more in context.

Conspiracy Theorist – the best way to understand conspiracy theorists is to read the definition of conspiracy theory. Examples: The government is knowingly poisoning our children. The United States is trying to sterilize African babies with the polio vaccine. The interesting thing about conspiracy theorists is that if they believe one conspiracy theory they tend to believe many conspiracy theories. Another interesting thing is that everyone and I mean everyone walking around today believes something that is absolutely false. The sensational and competitive nature of our media environment makes conspiracy theories a way to attract readers and viewers. And therefore they are prolific in our culture. A lot can be said of conspiracy theories but the most important is that almost all of them are not true. I always ask parents if they really want to base their children’s health on a conspiracy theory. Sometimes the truth isn't very interesting.

Fear of Needles – I do believe that there are large groups of people that have a deep-seated and profound fear of needles. Most vaccines are injected and I do believe this causes a lot of the fear of being immunized. It is certainly not pleasant to watch you child poked with several needles and therefore it is hard for some parents to be enthusiastic about immunization. Needles and injections are associated with drug addicts and aliens who come to colonize the Earth in those old movies. Most people do not associate needles with health. Therefore I wholeheartedly encourage the development of different ways to administer vaccines that are as effective.

How many people would be as opposed to immunization if they were administered through a bowl of ice cream?

When I think about all the reasons people could be fearful and skeptical of vaccination I am always amazed that almost 80% of children in the U.S. are properly immunized and that almost all countries capitalist (United States, Europe, Australia, Japan, etc.) or socialist (Venezuela, Cuba, etc.), democratic or autocratic have extensive immunization programs. And I always seem to reach the same conclusion based on this – immunizations must work.

Tuesday, April 17, 2007

National Infant Immunization Week (NIIW) and Immunization Registries

As I have stated before on this blog I believe that immunization coalitions have a strong role to play in promoting, raising funds for and helping to populate immunization registries. Precise tracking of immunizations is key to our ability to immunize young children on time in the future.

For these reasons our Coalition has decided to focus a lot of our energy for this year's NIIW activities on the immunization registry in San Francisco. We are sending a letter and an informational flyer to all immunization providers in San Francisco letting them know about the immunization registry, its benefits, and how they can join the growing list of providers using the registry to track immunizations. In addition, we are trying hard to recognize the providers in San Francisco that are currently using and actively entering and checking immunization records via the immunization registry.

How are we doing this? We have purchased travel mugs and printed our logo and appropriate immunization registry information on it (registry help desk phone #, registry website address). Inside each mug will be a $5 Starbucks card. On Monday of next week Coalition members will be going personally to each provider in San Francisco whose staff are utilizing the immunization registry and delivering our mug and gift card to the staff. This will remind them of the important role they are playing in helping improve the tracking and delivery of immunizations in the Bay area. We have found that keeping current registry users satisfied is as important as recruiting new ones. And NIIW is a good time to thank current users and reach out to new ones!

Wednesday, April 11, 2007

Immunization Coalitions, Vaccine Safety, and Immunization Registries

One thing I have tried to emphasize, as Director or the San Francisco Immunization Coalition is that Coalition’s can work on improving the safety of vaccines as much as we work on improving and increasing access to them. And continually improving the safety of vaccines will in itself increase people’s willingness to be immunized or have their children immunized.

While the U.S. vaccine supply is probably the safest, most technologically advanced and best monitored in the world, vaccines like everything else can always be made safer. One critical area where Coalition’s can have an impact on the safety of vaccines is the development of immunization registries.

By becoming engaged advocates for the advent of computerized immunization information systems or registries, immunization coalitions can help improve the safety as well as the efficacy of vaccines. Registries provide a more systematic and precise way to administer and monitor the vaccines given to patients. Our local registry comes with a software that advises the immunization provider of the vaccine recommendations, has popup alerts regarding past reactions to vaccines, and endows the immunization provider a tool to give the vaccines at the correct intervals – the intervals that were deemed as the most safe in research studies.

Registries allow for the quick and systematic retrieval of data including lot# in event of a vaccine recall. Registries allow for different providers to share and easily retrieve the immunization record of someone in their clinic/practice - which will reduce the over immunization or re-immunization that occurs when people lose their immunization record. This not only reduces the chances of adverse reaction it reduces wasted vaccine. Some registries automatically create VAERS reports, which facilitate and improve reporting of adverse reactions to vaccines. All these things improve the safety of vaccines. The complexity of the vaccination schedule combined with the mobility of today’s patient population make sophisticated immunization information systems essential to the safety of vaccines.

I even say in talks that people who are skeptical about vaccination should be advocating for registries if they are ingenuously worried about the safety of vaccines.

My next blog will talk about the different ways that Coalition’s can advocate for, support, provide input, and expertise for the development of immunization registries.

Wednesday, April 4, 2007

Not All Conferences Are Boring

Since I have been the Director of the San Francisco Immunization Coalition I have had the pleasure of attending the National Conference on Immunization Coalitions three times, 2003 in Scottsdale, Arizona, 2005 in Norfolk, Virginia and 2006 in Denver, Colorado. Of all the conferences I have been to throughout my career I felt the National Conference on Immunization Coalitions was the most dynamic and practical I had ever been to. The reason I believe these conferences were so positive for me is simply the type of people immunization coalitions attract.

In general, the participants at these Coalition Conferences - who came from all over the country and few from Canada - tend to be dynamic, personable, thoughtful, innovative, and generous of spirit. These are people who have a real desire to get out of the standard way public health bureaucracies operate and into the community. They are people who seemed like they wanted to find new ways of doing business all in an effort to better protect people from disease. These were my people. After the first conference I felt a real feeling that I was in the right career.

As a result of these positive experiences in the past with the National Conference on Immunization Coalitions I was very excited when I received a call from the National Conference Planning Committee asking if my Coalition would like to be the host for the 2008 National Conference on Immunization Coalitions. I was even more excited when my Advisory Board agreed that we would do it. So see you in San Francisco in 2008 coalition people!