Maximizing Protection vs. Increasing Rates

It has been about four years now since I have told anyone that our Coalition works to 'increase immunization rates'. In my presentations, on our websites, in our marketing materials, in our meetings and campaigns we talk about maximizing immunization or disease protection not necessarily increasing rates. There are two very important reasons for this.

Reason One: Increasing immunization rates does not sound all that appealing or important to most people. If anything it sounds to people quite robotic and inhuman. For most people with the exception of some public health geeks (no offense here – I have the highest regard for public health geeks as I am one myself) raising immunization rates doesn’t mean anything. It is simply bean counting. In some ways it actually feeds peoples stereotypes that all we want to do is push more vaccines. ‘What do your immunization rates have to do with my life or my children?’ Now if you say you are going to help maximize immunization protection or improve protection from disease that sounds better. If we have learned anything from politics recently it is that words are important. The phrases you use to describe what you do say a lot about you. And it is proven that people react very differently to different words. In a focus group asking people about which was more positive my money would be on protection over rates any day.

The second reason and most importantly for me - as I am a public health/science geek myself - is that raising immunization rates is inaccurate. That is not my job. That is not what I do. Now immunization rates may increase as a result of what I do, but I am not focused on that. My job is to help protect people from disease. If there was no disease I could care less about immunization. So the focus of what we do should be on the diseases and using immunization as a tool that works to protect people from those diseases. Also, simply raising rates is an unrealistic goal.

Why? Because we could spend trillions of dollars and never have 100% of people vaccinated – it’s impossible and a waste of resources. Some people have contraindications, some people are not the right ages for certain vaccines, and some people are not at risk for specific diseases, and some people simply refuse to be vaccinated. Now given that set of cards we can target immunizations to help protect the most people from the most disease.

We are the experts when it comes to what disease are really effecting or would be affecting people’s lives if they didn’t get immunized. And most diseases (not tetanus) have a herd immunity threshold that allow us to protect a group of people even if not everyone in that group is vaccinated. So we are more maximizers and optimizers rather than blind vaccinators.

The moral of this blog is to stop using the words 'increasing immunization rates' and start using the terms maximizing/ optimizing/ improving/ broadening immunization or disease protection. In the end it sounds better and is far more representative of what we do.

What is Immunization Infrastructure and What Does It Have To Do With

When I tell people about my job and I let them know that my Coalition works on improving immunization infrastructure. Soon after I mention this word I see that people’s eyes kind of glaze over with a mixed sense of confusion and boredom. I find the word infrastructure is one that has this effect on people.

However, I still continue to use it because building immunization infrastructure is one of the most important things our Coalition does. But what does it mean?

It means creating a system or a structure so that vaccines can be administered correctly, timely, and optimally to the appropriate individuals in order to maximize protection from communicable diseases.

Infrastructure involves education, awareness, relationships, legislation, networks, tools, money, and reality. This all sounds very obscure. Let me give you an example.

Right now in the U.S. pertussis is a disease that is very common. It is common because the immunity from the DtaP that children receive starts to wane as they become teens and adults. So the disease has found a large reservoir of people who are not immune to pertussis. We know this is true. Pertussis is no fun to get as an adult but it can be deadly for a newborn.

Since 2004 in California we have had 13 newborns die because they contracted pertussis from an adult who was infected. How do we stop this? Simple – a safe and effective booster shot called Tdap given to teens and adults which will most likely reduce the amount of cases of pertussis in the general population reducing the amount of cases transmitted to newborns and basically saving babies' lives.

Unfortunately there does not exist an infrastructure to immunize teens or even adults. This immunization infrastructure has to be built. This means making providers and the public aware that they need to get a Tdap booster to fully protect them from pertussis which is quite common. And it means creating places where they can get these vaccines.

Working with providers, school clinics, pharmacies, teen clinics, and emergency rooms to make sure they can get the vaccine, store it safely, administer it properly, and get paid for administering it. This means helping establish relationships between providers, the general public, vaccine makers, and State and local health departments. Immunization Coalitions can help do all this.

And this is what creating immunization infrastructure is all about. Immunization Coalitions identify barriers or gaps in the infrastructure and work on ways to fill them. Single entities like hospitals, health departments, or school districts can not build infrastructure alone – they need organizations that stretch across all of these sectors bringing diverse partners together for the common cause of protecting people from disease.