Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Social hurdles for administering vaccines: Why aren't we vaccinating?
Recently, we have seen the discussion around vaccination in the US pit many physicians against the 'anti-vaxxer' movement, a group of parents that cross traditional political-economic divides in opposing vaccination, which they consider unsafe or an overstep of government control.
The conversation often turns vitriolic, with physicians and others lobbing educations of ignorance and stupidity at parents, while those same parents grow increasingly hesitant to comply with instructions from a medical community they believe does not respect them.
How do we, as future physicians, change the conversation to improve education and ensure public immunity? It is not as simple as winning the shouting match, which actually may be impossible. And, in fact, that may not be the main hurdle in improving overall public immunity.
This longitudinal study published in 2015 of a study of 5,000 Australian children (which I could not find replicated among American children), gives some critical insight: Only 16% of the children that were not immunized were because of parental disagreement. Overwhelmingly, the study found, non-compliance in immunization is attributed to four other ‘classes’ of issues: “(1) ‘lone parent, mobile families with good support’, (2) ‘low social contact and service information; psychological distress’, (3) ‘larger families, not using formal childcare’, (4) ‘child health issues/concerns’” [1]. The first three of these are all related to the socioeconomic position of families and, understandably, their understanding about immunizations and ability to access those immunizations. The study goes on to say that “the adjusted risk ratio (RR) for incomplete immunization was 1.51 (95% confidence interval: 1.08–2.10) among those characterized by ‘low social contact and service information; psychological distress’, and 2.47 (1.87–3.25) among ‘larger families, not using formal childcare’” [1] – that is to say that we must maximize our interventions for the highest risk individuals in order to see the greatest increase in public immunization.
Clearly, this is not just about the ultra-wealthy of Marin County, CA embracing ‘natural’ over allopathic medicine. It is a much larger endemic problem closely tied to lack of access to healthcare.
As physicians, it will not be enough for us to simply tell our patients to get their children immunized. A study published by the WHO in 2012 recommends that “Every program should monitor missed and under-vaccinated children and assess and address the causes” [2], which it draws from researching the underlying causes of missed immunizations, which are very heterogeneous and regionally variable. As physicians, we are our patient’s advocates, and must be cognizant of the institutionalized class barriers to childhood immunization. Part of our job will be to make it clear, simple, and low-cost for families to get their children immunized.
Sources:
[1] http://www.sciencedirect.com/science/article/pii/S0264410X15005757
[2] http://www.sciencedirect.com/science/article/pii/S1876341312000496
I'd be very interested to see this replicated in the US. I would think that the issue of vaccination noncompliance due to socioeconomic status/other access-related factors is even more pronounced, as the US does not have socialized healthcare like Australia.
While the anti-vaxxer cohort may account for less than 1/5 of the vaccine-schedule-noncompliant children (at least in Australia....), they're probably the most dangerous population. They (in my experience), enjoy using their platform for fear-mongering and spreading misinformation to the rest of the population. Reasoning with them is generally futile, because once you've pointed out that their sources are invalid/research was done poorly, they turn around and try to discredit the research you've presented. Somewhat like a certain current presidential candidate who shall remain nameless, they don't understand what they're talking about, but pretend they do, spout buzzwords to grab people's attention, and prey on other's inability or unwillingness to do their own research. Long story short, someone who doesn't know the proper vax schedule for their kid isn't going to tell their neighbor, Hey, don't let your kid get that shot! but an anti-vaxxer will. They recruit.
For context: My mother is an anti-vaxxer. It's literally impossible to reason with her. I was not vaccinated from approximately age 5/6-18.
Health care disparities are undoubtably a major issue and particularly problematic for preventive health care. However, I question how relevant the Australian study may be to the US population and am surprised that no comparable US study exists. Based on personal observation (i.e., study abroad - possibly not the most reliable experience to compare), Australians have different attitudes/values when it comes to healthcare. Also, major differences in healthcare systems surely play a role.
I really like that you promote physicians as patient advocates. The role of the physician (or any provider) in assessing complex health determinants can never be overstated!