Losing the anti-vaccine fight, and what we should do next

in Patient | 16 responses

The fight versus anti-vaccine proponents is a losing one.

Orac, a general surgeon who blogs over at Respectful Insolence, is on the front lines of the debate. In this post, he writes about how vaccine supporters are facing an uphill battle:

One problem is that vaccines have been so successful that parents rarely see the full, ugly consequences of the diseases against which vaccines defend anymore. The other problem is that normal people can’t adequately judge risk. They cannot understand that they do many, many things with their children that pose far more risk to them than vaccination ever could for a lesser benefit. For example, the risk of dying in an auto collision is several orders of magnitude higher than of a serious adverse event from a vaccine. The risk of death from playing baseball (hardball) is also several orders of magnitude higher than injury from a vaccine . . .

Also, and I’ve alluded to this before, anti-vaccinationists have a compelling story that no physician or scientist can fight against. Indeed, as Orac says, competing against the likes of Jenny McCarthy is a “no-win situation.” Especially since they have Oprah on their side.

I agree with his take that it’s impossible to change the minds of those already convinced that vaccines cause harm. He suggests refocusing our efforts not on these people, but for those where are undecided.

Comments

AnnR
I’ve seen a couple of things in the mainstream media about Oprah’s quackish causes.
Maybe the tide will turn.
There need to be more stories about how the lowered ‘herd’ immunity harms everything. A lot of these folks justify their decisions by thinking that they are taking a small risk and really not hurting anyone else.
http://confutata.wordpress.com Squillo
I also agree that we should focus on the undecided, having been one of those at one time. As a non-scientist, I try to write for people like me, to try to lead them down the same path I traveled–looking at the science from a layman’s perspective, and examining what’s behind the growth of the anti-vax movement.
I’m encouraged by the mainstream media’s beginning to pick up on pseudoscience, and I hope to see more “regular” folks begin to talk about the vaccine issue. It is hard to combat the emotional narratives the anti-vax contingent provides, but I’m afraid that before long, the resurgence of VPDs will provide some emotional stories on the pro-vaccine side.
family practitioner
Why don’t we just back off?
In other words, be on record recommending them but not fighting with people. Let the government do that.
And perhaps we should not be so quick to embrace every new vaccine that comes out. Let’s focus on what is already recommended.
Do we really need gardasil at age 9?
For that matter, do we really need hep b vaccine at birth?
And lets not even mention rotavirus.
How about the financial toll these vaccines are having on our offices?
Is it really worth it?
arf
I’m amazed at how many primary care practices (FP) and even pediatric practices, that stopped giving vaccines because of the damn cost.
My state supplies the vaccines, and used to allow them for all kids. We didn’t charge the vaccines, just allowed an administrative fee. Worked fine.
Naturally now there’s changes to ruin a reasonable system. Now they cover for the Medicaid and uninsured, we have to buy vaccine for privately insured kids. You got that multidose MMR and you give maybe two doses before it expires, you lose your shirt. Then you throw away the whole thing and send all the kids to the health department. Or the pharmacies that can buy the vaccine for pennies on the dollar compared to what I have to pay.
Vaccines. It should be so bonehead simple, and they make it so hard.
isles
“Family practitioner” writes:
“Do we really need gardasil at age 9?”
Would you hate it less if it were offered at 12? 15? How many early-initiating girls should we allow to get HPV in order to avoid offending your sensibilities?
“For that matter, do we really need hep b vaccine at birth?”
Yes. Moms are not always tested. Test results aren’t always read accurately. It is a failsafe against a disease that is *most* deadly when acquired at birth.
“And lets not even mention rotavirus.”
Why not? Don’t like acknowledging that it has been a spectacular, knock-it-out-of-the-park success? Or does it not bother you when your tiniest patients end up in the hospital?
“How about the financial toll these vaccines are having on our offices?”
The fact that you don’t know how to bill properly or manage inventory doesn’t make these vaccines a bad idea.
http://www.squidalicious.com Shannon
The fight is not in any way lost, and minds can be changed (I’m proof).
The last two months has seen a huge wave of posts and articles championing the social contract of vaccination, in non-medical, non-autism, popular and very viral media, e.g.,
http://www.boingboing.net/2009/06/03/roald-dahl-on-vaccin.html
We need to keep asserting our messages: 1) There is no proven link between vaccines and autism, and 2) Vaccines are and a social responsibility. We need to keep doing so in a non-hysterical manner, to contrast with antivax histrionics. A few more prominent, independent voices on the topic wouldn’t hurt.
I now vaccinate my kids (including my autistic child) because of constant exposure to just this measured, forthright approach — combined with the absolute debunking of the thimerosal/autism link, and the upswing in vaccine-preventable diseases.
Keep fighting the good fight. Please. Our kids’ health depends on it.
family practitioner
Isles:
I do not “hate” any of these vaccines.
My point was simple. If I have explained to the best of my abilities why a vacccine is needed, and the parents still say no, for whatever reason, what is the point in arguing with them?
The zeal in your response sort of makes my point. This is similar to a parent/child relationship in that the more we “push”, the more they “resist.” Why don’t we just give them the information, back off, and let the parents decide for themselves. I can’t force my patients to quit smoking, I can only recommend it.
You also need to understand that the “business” of vaccines is quite frustrating for those of us in private practice. We know how to bill and do inventory quite well; that still does not stop 3rd party payors from paying less than the cost of the vaccine.
Anonymous
Perhaps it may be even more important now as a member of the general population or a parent to get the available vaccines, since the growing number of people who refuse vaccines makes it more likely that you will be exposed to some disease that the vaccines would prevent.
Regarding being vaccinated as a “social responsibility” (or positive externality in economic terms), that might not be the best way to convince many people, who, for whatever reason, are more likely to see something as a conspiracy theory and actively go against something promoted as a “social responsibility”. But the self-interest motivation in avoiding polio, measles, tetanus, etc. should be more than sufficient to induce people to get vaccinated. Then again, it may take seeing someone in an iron lung to motivate people in this respect.
Marilyn Mann
Kevin
With all due respect, I think your headline is a little unclear. “Losing the anti-vaccine fight” makes it sound like you are anti-vaccine.
Best, Marilyn
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http://www.mloknitting.com/ MLO
I watch this fight from the purview of the history buff. I look at it in the same way that people who demonize obstetrics go on and on about how home and unassisted birth are the greatest things since sliced bread.
Are there problems with vaccines? Yes.
Do the benefits for most of the vaccines outweigh the problems? Yes.
The simple fact of the matter is that people DIED from these diseases. That’s what parents of today who slept through any history class they had in high school – and I’m including medical professionals.
Is every vaccines 100% necessary? Probably not. But, I will concede most are if we, as a species, wish to prevent pandemics for the things we can.
Maybe if physicians had books with pictures of actual victims of these diseases before vaccines were available littering their waiting rooms in the “adult reading” area people might be a bit less uneducated. But, most folks don’t like reality.
It does not help when everyone has become so entrenched in their view that they can’t even listen to folks with legitimate concerns. Questioning why the schedule is so aggressive is not questioning the legitimacy of the vaccines. Too many physicians act as if that were the same thing. It pushes some who were on the fence onto the anti-vaccines side.
I for one do not want to see a resurgence of the mumps, whooping cough, polio, or any other disease we have effective vaccines for! I’ve read the history and the death tolls. It is true in every endeavor, those who do not learn from history are doomed to repeat it!
http://autisminnb.blogspot.com/ Harold L Doherty
I am one of the “undecided” who does not share your perspective. I am the father of a 13 year old severely autistic boy whose developmental issues were apparent long before he was diagnosed at age 2 and we never attributed his autistic disorder to vaccines.
I also accepted the epidemiological studies as being conclusive on the issue of possible vaccine autism connections. I no long do and I am now undecided. One reason is the public positions tatken by Dr. Bernadine Healy who has said that the epidemiological studies are not specific enough to tell us anything about population subsets that might be vulnerable to vaccine induced injury. Dr. Healy has also pointed out that the 2004 IOM report on vaccines and autism expressly discouraged research, including lab, biological and clinical studies that might have revealed more information about possible vaccine autism connections. Her comments came several years after research Teresa Binstock complained that autism researchers were actively discouraged from exploring ANY possible environmental factors relating to autism including vaccines.
Dr. Healy’s comments have been echoed to some extent by Dr. Julie Gerberding who has said that observational studies of autism rates amongst vaccinated and unvaccinated groups should be done. Dr. Jon Poling, the neurologist, who successfully pursued a vaccine injury claim on behalf of his autistic daughter has also called for more research.
The Interagency Autism Coordinating Committee strategic research plan and the recent NVAC Committee recommendations both recommend autism vaccine research.
If you want people to believe the truth about vaccines and autism let the research be done and then let people assess these issues … whatever the outcome.
Dr_Mnemonic
As a physician (resident) with a son who is autistic, I have been on the front-line of this debate since his diagnosis in 2001 at age 2.
Where are the people talking about how the original, FLAWED study making the link had an n=12 and the author of the study has actually been charged with professional misconduct for the way in which the study not only misinterpreted the autism results, but made claims to have found a new kind of IBD?
http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece
Oh wait… I always forget, facts don’t matter when you are arguing against a pretty blonde and a billionaire who both live in a world where opinion is the ONLY thing of consequence.
I’m sorry. I tell people to their face they are uninformed and misinformed about the vaccine risk if they believe there is a link between the two.
To be fair, there MAY be a pre-disposition that is exacerbated with vaccines, but I doubt it. My son was a 31 weeker with low grade brain bleed at birth that healed. Until we start getting head CT’s on all newborns (I’m kidding) and tracking family history and all symptom cause –> autism – we have NO IDEA what causes it, but I will bet my next board score it’s not vaccines in and of themselves.
Travel MD
Re: Dougherty, This is why patient choice must be protected: we might be wrong. Often, changes come about, not because of our medical establishment, but because of patients who are LIVING the problem. Also, along with FP, I think gardasil is the biggest joke. What were doctors thinking when they hopped on this bandwagon? We may be really smart and really educated, but modesty doesn’t hurt either.
We have TOO many vaccines and separating them into needed or advised could be a way to handle this, too.
Melissa
“And perhaps we should not be so quick to embrace every new vaccine that comes out. Let’s focus on what is already recommended.”
As a mother I heartily agree with this. My daughter (2.5) has had everything recommended by the CDC other than rotavirus. It had just been reintroduced when she should have started it and the pediatrician we saw wasn’t even stocking it. I think the HepB, varicella and rotavirus vaccinations are questionable as far as actual need and danger of these diseases. The simple truth is that if the medical establishment insists that we worry about every little thing the reality will be that we take things like measles, mumps, diphtheria much less seriously.
All that said, I think the tide will turn when these hippy granola communities start seeing lots of kids with measles, mumps and pertussis. I’ve already seen one news story about a playgroup that asked and non-vaccinating mom to withdraw herself and her child.
Evita
I don’t believe that vaccines caused my son to be autistic. There is so much research out there about vaccinations versus not getting them. Not getting them is just plain ignorant. Parents just want an answer to the reason why autism happens and they are grasping at straws. Of course, I would like to know why and I would love a cure but I must face the here and now. So many parents get lost in the why questions. I say that it is not the vaccinations and even if it was, so what. I choose to deal with one day at a time and to focus on making my son smile each day. Smiling is something he can do, severely disabled or not.