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Vaccine refusal: What are the best ways to overcome it?
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Although their influence has waned, clusters of patients and parents who refuse vaccines due to myth and misconception remain. To avoid outbreaks of old infectious disease threats like the measles, clinicians use a variety of strategies when they encounter vaccine refusal. Infectious Disease News asked two experts — Jessica Ridgeway, MD, MS, an assistant professor of medicine and a global health associate hospital epidemiologist at the University of Chicago Medicine; and Mirella Salvatore, MD, a health care policy and research expert specializing in infectious diseases at Weill Cornell Medicine and New York Presbyterian Hospital — how they approach patients who refuse immunization.
Ridgeway: Vaccines save millions of lives every year and are proven to be safe. Despite these facts, myths regarding vaccines and their supposed side effects abound. They include the beliefs that the MMR vaccine causes autism and that the influenza vaccine causes influenza, among others. These myths have been widely debunked, yet a persistent minority of individuals continues to believe them.
As infectious disease physicians, we often find ourselves trying to convince skeptical patients of the benefits of vaccines. Studies are conflicting regarding the most effective way to combat the myths.
In fact, some have found that refuting the link between vaccines and autism can backfire among the most ardent skeptics. After a physician explains the inaccuracy of the measles-mumps-rubella vaccine (MMR)–autism link claim, parents are less likely to believe the myth but are also less likely to vaccinate their children.
Some have suggested that appealing to patients’ emotions and fears about the diseases prevented by vaccines may be a more effective approach. Horne and colleagues found that using such emotional appeals (eg, showing photographs of children with preventable infectious diseases and having patients read a mother’s story of her child contracting measles) were more effective in encouraging vaccination than other approaches.
However, Nyhan and colleagues found that showing photos of children with diseases increased participants’ belief in the link between vaccines and autism, and that a dramatic story about an infant in danger increased people’s concern of vaccine side effects. Clearly, more studies are needed to determine the best approach to convincing vaccine skeptics.
In the meantime, we should educate our patients regarding vaccines as we do with other health issues. Our job is not to scare our patients into taking a certain course of action. There is one practice that physicians can adopt to increase vaccination rates. That is to have our language reflect the strength of the evidence regarding vaccine benefits when providing them.
Instead of saying, “Would you like a flu shot today?” we can say, “You’re due for your flu shot today.”
We would not say to a patient with bacteremia, “Would you like antibiotics?” If we do not make vaccination a point up for debate, patients may be more likely to follow our lead and accept vaccines for the settled science they are.
- References:
- Horne Z, et al. Proc Natl Acad Sci U S A. 2015;doi:10.1073/pnas.1504019112.
- Nyhan B, et al. Pediatrics. 2014;doi:10.1542/peds.2013-2365.
Salvatore: “I do not do vaccines,” my patient says to the offer of an influenza vaccine, looking at me with indifference.
“Can I ask why?” I reply. I’ve heard this same answer many times, but I want to convince myself that maybe this time there is a real reason.
“Because, doctor, I never got the flu except for the year I got the flu shot,” the patient says. “It was terrible. I got the flu right after the shot and I was so sick from it. I will never do it again.”
“Well, this is not correct,” I say while I start my usual little speech on vaccination and influenza mortality. “Since the flu vaccine contains a dead virus, it is impossible to get the flu from it.”
I make parallels to other diseases that have disappeared because of vaccines, dropping with nonchalance a few minutes of real information to counteract the flood of misconceptions.
“Your chronic disease puts you at risk for severe influenza and maybe hospitalization, and a flu shot may prevent it,” I say.
Vaccines, although not always perfect, have contributed to the control of deadly diseases, and their benefits largely outweigh the risks. Yet vaccination has become one of the most controversial issues in infectious disease. Vaccine refusal is triggering the reemergence of diseases considered to be largely eradicated, resulting in potential harm to individuals and populations.
One of the main drivers of vaccine refusal is irrational fear caused by “alternative information” distributed by media sources, often through uninformed celebrities. The same patients who would accept a vaccine like that for yellow fever, despite the potential serious side effects, would refuse the influenza vaccine because they believe it will give them influenza. They might decline the MMR vaccine for their children because they think it will give them autism.
It is alarming that a national survey in 2014 found that about 30% of adults still believe that vaccines cause autism, even though the study by Andrew Wakefield that suggested a link was retracted many years ago.
Approaches to increasing vaccination rates include mandatory vaccination, but this strategy raises the ethical dilemmas of the conflict between the rights of individuals and public health concerns.
“I will think about it and let you know next visit,” my patient says on the way out.
Maybe this time I did not succeed in replacing misconception with information, or maybe he or she will be back asking for the vaccine. These misconceptions are not easy to eradicate because the patient’s faulty sources leverage primitive fears. Those fears are sparked by daunting personal stories rather than the results of rigorous scientific studies. But vaccine safety is not based on opinion or thoughts. It is a scientific fact, and we need to make sure this difference is clear.
Although access to the internet and media provides a flood of information of any kind, the access to trustworthy information is limited, and discriminating between truth and falsehood is difficult. Information on the importance and safety of vaccines, accessible in providers’ offices, is our most powerful tool to bridge the acceptance gap.
- References:
- National Consumers League. Survey: One third of American parents mistakenly link vaccines to autism. http://www.nclnet.org/survey_one_third_of_american_parents_mistakenly_link_vaccines_to_autism. Accessed May 9, 2017.
- Wakefield AJ, et al. Lancet [RETRACTED ARTICLE]. 1998;doi:351:637-641.
Disclosures:Ridgeway and Salvatore report no relevant financial disclosures.
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