In the 21st Century Communication Age, data, information, knowledge
and wisdom are often interpreted as synonymous terms. This is
most evident in how people perceive health issues.
Many of the successes of the 20th Century can be attributed to the
discovery and dissemination of effective preventive measures—notably
immunizations. Immunizations have eradicated smallpox from the planet,
nearly eliminated the polio virus worldwide, and dramatically reduced
the occurrence of other preventable infectious diseases including measles,
pertussis (whooping cough) and rubella (German measles).
Yet, the 21st century patient has begun to question the benefits of
vaccination. This is most evident in a recent April, 2000 U.S. congressional
panel that called on the Department of Health and Human
Services to begin an investigation into claims that childhood vaccines
are dangerous. In particular, this panel has advanced the claim
that the measles, mumps and rubella vaccine given to children is linked
to cases of autism.
As a father and physician, I obviously am concerned about the fear
and pain of individuals and families with autistic children. Yet, I
am frightened by the danger of miscommunication of one of the greatest
success stories in public health in the last century.
Today, the democratization of information has resulted in increased
dissemination, developing an entropic web that lacks source credibility
and validated information. If one looks for information on vaccines
on the world wide web one may find the National Vaccine Information
Center operated by a national, non-profit educational organization called
Dissatisfied Parents Together (DPT). This organization's mission
is not to provide valuable information but to advocate for reformation
of mass vaccination.
Perpetual challenges to conventional wisdom in health continue with
scanty claims. For example. in the autism case, advocates argue
with inferential, historical data. Ten years ago, autism affected 1
in 10,000 children. Today, conservative estimates are that it affects
1 in 500 children. This purported “link” continues to gain momentum
and repetition in investigative journalism. Silicon breast
implants, gulf war syndrome, and now vaccine-linked autism forge the
way for “blame bias.” The 21st Century public and media grasp
for causality.
During the past decade network and cable television programming, including
television and news shows such as Oprah and Nightline, have aired material
questioning the safety of vaccination. In most cases, the
program showcased an emotional story of personal tragedy allegedly associated
with a childhood vaccine. As might be expected the emotional arguments
and visual images are ineffectively countered by the logic and factual
reassurance of the health professional. The message for the audience
often lingers: “Innocent children are being victimized.” The danger
of repetitious communication of such unproven inferences and emotional
arguments is that significant numbers of parents may choose not to vaccinate
their children.
While it may seem that children get a large number of vaccines today—between
18 and 22 doses of vaccine are recommended in the first 18 months of
life—they prevent considerable disease and death.
Without vaccines, we can be sure that a surge in preventable diseases
will take place sooner or later, and some children will suffer severe
complications as a result of the disease. In each of the five
years prior to the measles vaccination introduction in 1963, an average
of 432 measles-associated deaths was reported. With vaccination coverage,
in 1998 there were no deaths due to measles in the U.S.
Hence, I join countless experts who concur that vaccines have safely
and effectively prevented more disease and death than any other medical
intervention or treatment worldwide. Furthermore, there
is no credible scientific evidence that there is any link stronger than
coincidence between vaccinations and autism.
The message about vaccination should be clear—it is quality medicine
that effectively saves lives. But, vaccination is not just about
protecting children. Thousands of adults die in the United States
from vaccine preventable diseases—namely influenza and pneumococcus.
And, countless individuals could benefit from vaccines against Lyme
disease and Hepatitis A & B.
Those interested in health communication can counter the anti-immunization
advocates with some simple activities. First we should accurately
diagnose why there is such questioning of medical progress:
Namely, is it that low immunization rates reflect knowledge gaps (ignorance
of the need or risk of disease), attitudinal barriers (concerns about
the vaccines or perceived risk of the harms), or structural or policy
barriers (lack of access or providers not promoting or delivering vaccines)?
Similarly, we need to assess how many people (both providers and patients)
harbor fallacial beliefs argument that people can contract the flu from
the vaccine designed to protect them.
While accurate diagnostics are important, quality health communication
can help develop an appropriate herd immunity. Quality health
communication can advance key areas for developing a vaccine literacy
to insure immunization coverage. For example efforts should be
aimed to:
1. consistently communicate to the public, policymakers and their
children and families the direct benefits from vaccines;
2. reinforce public and provider perceived negative consequences of
non-vaccination;
3. decrease perception that vaccine-preventable diseases have been eliminated;
and
4. increase providers' capacity to provide relevant and comprehensible
vaccine risk benefit information to their patients.
Finally, quality health communication efforts will need to be developed
to bolster public appreciation of vaccine benefits and allay anxieties
about vaccine safety, without overemphasizing the risk(s). As
these strategies will be designed to deal with highly emotional issues,
communication efforts must incorporate affective appeals, as well as
cognitive ones. Personal stories of disease consequences need
to be developed to counter the stories of vaccine victims. Such
stories must be emotionally compelling to be a powerful influencer and
motivator. To be effective, a simulated experience with these
now-rare diseases should accompany the more traditional, fact-based
appeals that have been used in the past.
The fact that I was born on the cusp of the baby boomer generation
protected me with vaccines. My generation has benefited more than
any other generation from the results of medical and scientific research.
Regardless, we still need a concerted commitment to perpetuate research,
communication and the necessary understanding of primary and secondary
preventive measures with vaccination.
My hope that is during our lifetime, we will have the hopeful discovery
of an effective vaccine against HIV, malaria, certain cancers, addictions
(e.g. nicotine, cocaine addiction) and other non-communicable diseases.
Concomitant with scientific discovery we all should promote an appreciation
of immunization—an element of health literacy—so that every human being
understands the rationale and necessity to advance the quality of life.
