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Q&A: Vaccine controversies in the US
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A rise in vaccine exemptions in the United States has led to concerns about a resurgence of vaccine-preventable diseases. Recently, experts published a list of current vaccine safety controversies in Clinical Infectious Diseases, along with summaries of the key evidence surrounding those controversies.
Infectious Disease News spoke with one of the authors, Frank DeStefano, MD, MPH, from the CDC’s Immunization Safety Office, about these controversies. – by Erin Michael
What made you decide to address these concerns about vaccine safety in an infectious disease publication, whose readers might already be aware of the evidence?
Clinical Infectious Diseases is a highly respected journal beyond just the field of infectious diseases, including public health. The article was requested by the journal. I assume that the editors must have thought that this was a topic that would be of interest to their readers.
Although vaccines go through years of development and clinical trials to prove their safety and efficacy before being approved by the FDA, vaccine hesitancy remains an issue and was even listed as one of WHO’s top 10 health threats of 2019 . Do you see a way to eradicate vaccine hesitancy in the U.S. ?
It may be possible to decrease vaccine hesitancy, but I am not sure that it can be completely eradicated. Some people are adamant in their beliefs and may not be able to be persuaded otherwise. Fortunately, many vaccine hesitant individuals, including some parents, are just uncertain about the safety of vaccines. They want to be heard and have their concerns addressed with honest and direct information so that they can make informed decisions. The greatest influence on peoples’ acceptance of vaccination is their health care provider. Most parents and other individuals who may question the safety of vaccines will accept vaccination if it is recommended by a trusted health care provider. Thus, health care providers who administer vaccines must be knowledgeable about and be able to effectively communicate the risks and benefits of vaccines.
Public concern regarding a possible link between autism and vaccines is mentioned multiple times in your list. Why do parents continue to view this myth as a concern despite it being proven false by the medical community?
The scientific evidence is clear that vaccines do not cause autism. Scientific data are essential in the monitoring and evaluation of vaccine safety, but scientific evidence alone often is not sufficient for providing reassurance about vaccine safety. The next critical step is developing effective communication strategies and will require the involvement of experts in risk communication and related areas.
One factor that may be contributing to vaccine hesitancy is lack of awareness of the seriousness of measles infection. Measles infection is not benign. It can cause pneumonia, brain damage and even death. Measles vaccination has been so effective at preventing measles that most parents have never seen anyone with the disease and may not realize the importance of vaccination. Lack of acceptance of vaccination with consequent decreases in vaccination coverage leads to resurgence of vaccine-preventable diseases, as is currently occurring with measles in Europe and in pockets of undervaccinated populations in the U.S. Historically, the resurgence of disease is followed by increased acceptance of vaccination. It would be tragic, however, if widespread resurgence of measles, with its attendant suffering, disability and death, becomes the motivating force for renewed acceptance of measles-mumps-rubella vaccination.
What can infectious disease clinicians do to get this information to their patients?
Parents regard their primary health care provider as their most trusted source for information on immunizations. ID specialists are usually not involved in primary patient care. Thus, ID clinicians can probably be most helpful by informing their primary care colleagues about the evidence on vaccine safety. Useful resources include CDC’s vaccine safety website and the Children’s Hospital of Philadelphia’s Vaccine Education Center.
Reference:
DeStefano F, et al. Clin Infect Dis. 2019;doi:10.1093/cid/ciz135.
Disclosures: DeStefano and the other authors report no relevant financial disclosures.