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The Immunization Alliance
Alliance working on a multi-pronged approach to recapture the public’s trust in immunization.
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When it comes to vaccines, physicians are pressed from all sides.
First, the recommended immunization schedule has become increasingly complex. Infants and young children now receive vaccines to protect against 14 different infections, requiring as many as 26 inoculations by 2 years of age and five shots at one time. It is an enormous challenge for physicians to make sure that everyone is immunized correctly and on time.
Second, doctors typically put up their own money for vaccines while waiting for insurance companies to reimburse them, sometimes inadequately. And the enormous effort to vaccinate children isn’t compensated by what insurance companies refer to as “administration fees” — ignoring the high cost of vaccine storage, supplies, staff, as well as the knowledge required of every patient’s medical history relevant to specific vaccine contraindications and precautions.
Third, and most importantly, many vaccine-preventable diseases have been completely or virtually eliminated from the United States. Young parents do not see the diseases they are asked to prevent. In fact, most did not grow up seeing these diseases. So vaccination becomes a matter of faith — faith in health care professionals, faith in public health officials and faith in pharmaceutical companies. This kind of faith is in short supply; we live in a cynical, distrustful time.
Finally, because parents today are much less likely than their parents to fear vaccine-preventable diseases, they are much more likely to fear vaccine side effects, real or imagined.
The media has not helped here. On an almost daily basis, false claims of harm by vaccines are trumpeted on talk shows, on nightly news programs, and in newspaper and magazine articles. Because of this misinformation, parents are now concerned that vaccines might cause autism, allergies, asthma, attention-deficit hyperactivity disorder, developmental delays, or that children might be receiving too many vaccines too soon. One prominent pediatrician recently legitimized these fears by publishing a vaccine schedule that allows parents to delay, withhold, separate or space out vaccines (Sears R. “The Vaccine Book: Making the Right Decision for Your Child,” Little, Brown and Co., 2007). Stories of parental fears have dwarfed successes such as the recent development of a human papillomavirus vaccine that could prevent most cases of cervical cancer and a rotavirus vaccine that has already caused a dramatic decline in the incidence of the disease.
Educating the public
In an effort to educate the public about the importance of vaccines and the science behind their safety, several groups have stepped forward: specifically, the Immunization Action Coalition, the National Network for Immunization Information, Parents of Kids with Infectious Diseases, Every Child By Two, Families Fighting Flu, Voices for Vaccines, Meningitis Angels, the National Meningitis Association, and the Vaccine Education Center at the Children’s Hospital of Philadelphia. The CDC also provides excellent information through its website and educational materials.
Recently, another group has stepped into the breech, a group whose core values include a belief in “the inherent worth of all children [as] our most enduring and vulnerable legacy” and whose membership includes about 60,000 pediatricians — the American Academy of Pediatrics (AAP). Although some parents might not trust vaccines, they generally trust their pediatricians. As a professional society, there is no group better positioned to help those on the front lines of the vaccine controversy than the AAP.
On May 30, 2008, the AAP brought together representatives from many of the above-mentioned groups as well as the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Medical Association, the American Public Health Association, the Association of State and Territorial Health Officials, the National Foundation for Infectious Diseases and the National Vaccine Program Office. Called “The Immunization Alliance,” the purpose of this group was to develop a multi-pronged approach to recapture the public’s trust in immunization. To get advice on how to run such a campaign, the Alliance included representatives from Easter Seals, Rotary International and the March of Dimes Foundation.
Under the guidance of Renée Jenkins, president of the AAP and Margaret Fisher, chair of the department of pediatrics at The Children’s Hospital in Long Branch, New Jersey, members of the Immunization Alliance talked about what was at stake; specifically, about the potential consequences of vaccine fears.
Timely discussion
The discussion was timely. During the previous few months, the United States was in the throes of the largest measles outbreak since 1996. About 130 children in 15 states contracted the virus and about one of every five of those children was hospitalized. Although imported from Western Europe and Israel, the outbreak had gained a foothold in the United States because of the existence of pockets of children whose parents had chosen not to vaccinate them. Although the measles outbreak of 2008 appears to be subsiding, its appearance has sounded a warning bell to those concerned about what can happen when parents are misinformed about vaccine safety.
The goal of the Immunization Alliance — to launch and sustain a campaign to educate the public about the importance of vaccines, the robustness of the vaccine safety infrastructure and the science behind vaccine safety — will not be easily accomplished. Many forces are working against them.
Vaccines, like all preventive measures, aren’t very compelling. When vaccines work, nothing happens. The media is far more drawn to bad news stories about vaccines, even if they are inaccurate, than to good news stories. “A good newspaper is never quite good enough,” said Garrison Keillor, “but a lousy newspaper is a joy forever.”
Parent advocacy groups, grounded in the false belief that vaccines are harming their children, are formidable.
Advocacy groups are passionate, media savvy, politically connected, and well-funded. For example, Generation Rescue — a group led by a wealthy businessman named J.B. Handley and dedicated to the notion that thimerosal in vaccines caused autism - hired a high-profile public relations firm to design full-page advertisements in The New York Times and USA Today claiming the harm of vaccines. Groups like Generation Rescue have convinced prominent journalists, such as Sharyl Attkisson at CBS Evening News, of the rightness of their cause. As a consequence, Attkisson and others have aired a series of stories that have unnecessarily frightened the public about the safety of vaccines.
Parents often take their cues from celebrities, not scientists. Jenny McCarthy, a former Playboy Playmate of the Year, has appeared on Good Morning America, the Oprah Winfrey Show and Larry King Live claiming that children receive too many vaccines too soon and that vaccines contain harmful toxins. Many parents are influenced by these shows. Although it is unfortunate that scientists or clinicians who speak out on vaccines are often trumped by the culture of celebrity, celebrities are an important facet of campaigns to educate the public. But eliciting their help will not be easy — given the abuse that will inevitably follow.
The Immunization Alliance has embarked on a difficult road. But doing the right thing isn’t always the easy thing. And the journey started at the May 2008 meeting at the AAP offices in Elk Grove Village, Illinois, represents an important first step in what will undoubtedly be a long journey.
For more information:
- Paul A. Offit, MD, is the Chief in the Division of Infectious Diseases and Director of the Vaccine Education Center at The Children’s Hospital of Philadelphia.