NEW THIS TUESDAY: INOCULATING COMMUNITIES AGAINST VACCINE SCARE STORIES

Monday, 17th of June 2013

INOCULATING COMMUNITIES AGAINST VACCINE SCARE STORIES

The Lancet Infectious Diseases, Early Online Publication, 13 May 2013

Natasha Sarah Crowcroft a b, Kwame Julius McKenzie c d

The biggest threat facing the success of immunisation might be public lack of confidence in vaccines, repeatedly undermined by safety concerns promulgated in social and news media.1 In The Lancet Infectious Diseases, Heidi Larson and colleagues study examines how a typology of concerns can be applied within an established global surveillance system, HealthMap, to track and characterise vaccine news stories.2, 3 The usefulness of systematically tracking online media stories was first established for disease surveillance through a Canadian project, the Global Public Health Information Network,4 followed by several other systems including HealthMap. These systems offer the potential for efficient and early signal detection.

Surveillance of different types of vaccine safety concerns will be an important way to listen to communities, and will also serve as a platform for research. Such surveillance gives concerns a greater profile, and emphasises gaps in the public health systems responses to and preparedness for vaccine safety events. Bad news stories damage vaccination programmes as much as biological hazards, and these stories evolve over minutes or hours, needing immediate action. By the time a detailed scientific analysis of a vaccine safety issue is completed, the story is no longer newsworthy. Despite growing knowledge about how to respond to vaccine safety events and the availability of good guidance, confidence in vaccines is falling.5, 6 Much can be learnt from antivaccine campaigners who make good use of engaging narrative and social media to voice their ideas.7

Vaccine concerns do not inevitably or predictably spread from one country to another. Because some people are more resistant to scare stories than are others, protecting against such events at the community level might be useful. With respect to the loss of confidence in the measles, mumps, and rubella (MMR) vaccine, UK public health bodies applied lessons learnt from the whooping cough vaccine scare of the 1970s to good effect: MMR vaccine coverage only dropped to a low of 80% compared with the pertussis vaccine coverage low of 30%.8, 9 Although MMR vaccine coverage recovered as media interest declined,10 the recovery was not sufficient to avert the end of measles elimination in the UK, and the scare heralded a wider re-emergence of measles in Europe.11

Because immunisation is so important for health, public health systems need to move beyond passive responses to vaccine safety events towards active preparedness. Researchers need to discover how to make communities resilient to bad science and interest-driven scare stories to change public ideas and norms and to promote belief in vaccines.12 However, beliefs are hard to change, and correct information might paradoxically entrench existing negative attitudes and undermine positive ones.13 Pre-emptive action in childhood to promote immunisation might prime the minds of future parents, health-care providers, journalists, and politicians with a positive attitude towards immunisation. The benefits and risks of immunisation could be discussed in schools as part of history, politics, science, health, and ethics courses. This approach might lead to a stronger sense of the value of immunisation for both the individual and the public.

Immunisation is a part of history and protects against future disease outbreaks. Benefits of smallpox eradication continue to accrue—although they are invisible to most people—but many challenges will need to be overcome to reach polio and measles elimination goals.14 Speed might be essential to achieve disease eradication, but moving quickly enough will only be possible by first building strong public belief and confidence in immunisation.

We declare that we have no conflicts of interest.

References

1 Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger JA. Vaccine hesitancy: an overview. Hum Vaccin Immunother 2013. published online April 12. http://www.landesbioscience.com/journals/vaccines/article/24657/.

2 Larson HJ, Smith DMD, Paterson P, et al. Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines. Lancet Infect Dis 2013. published online May 13. http://dx.doi.org/10.1016/S1473-3099(13)70108-7.

3 Brownstein JS, Freifeld CC, Reis BY, Mandl KD. Surveillance Sans Frontières: internet-based emerging infectious disease intelligence and the HealthMap project. PLoS Med 2008; 5: e151. CrossRef | PubMed

4 Mykhalovskiy E, Weir L. The Global Public Health Intelligence Network and early warning outbreak detection: a Canadian contribution to global public health. Can J Public Health 2006; 97: 42-44. PubMed

5 WHO Regional Office for Europe. Vaccine safety events: managing the communications response. A guide for Ministry of Health EPI Managers and Health Promotion Units. http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/vaccines-and-immunization/publications/2013/vaccine-safety-events-managing-the-communications-response. (accessed April 26, 2013).

6 Stefanoff P, Mamelund SE, Robinson M, et alfor the VACSATC working group on standardization of attitudinal studies in Europe. Tracking parental attitudes on vaccination across European countries: the Vaccine Safety, Attitudes, Training and Communication Project (VACSATC). Vaccine 2010; 28: 5731-5737. CrossRef | PubMed

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9 UK Department of Health. NHS immunisation statistics 2003—04. http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalhealthcare/DH_4099576 (accessed April 25, 2013).

10 Smith A, Yarwood J, Salisbury DM. Tracking mothers attitudes to MMR immunisation 1996—2006. Vaccine 2007; 25: 3996-4002. CrossRef | PubMed

11 European Centre for Disease Prevention and Control. Measles atlas: progress towards elimination. http://emmageocase.ecdc.europa.eu/atlas/measles/?t=4&m=7&x=8.08&y=49.68&l=3. (accessed April 25, 2013).

12 Casiday RE, Cox AR. Restoring confidence in vaccines by explaining vaccine safety monitoring: is a targeted approach needed?. Drug Saf 2006; 29: 1105-1109. CrossRef | PubMed

13 Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol 1996; 49: 697-703. CrossRef | PubMed

14 Omer SB, Orenstein WA, Koplan JP. Go big and go fast—vaccine refusal and disease eradication. N Engl J Med 2013; 368: 1374-1376. CrossRef | PubMed

a Public Health Ontario, Toronto, ON, M5G 1V2, Canada

b Laboratory Medicine and Pathobiology and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

c Department of Psychiatry, University of Toronto, Toronto, ON, Canada

d Centre for Addictions and Mental Health, Toronto, ON, Canada

Linked Articles

Articles Measuring vaccine confidence: analysis of data obtained by a media surveillance system used to analyse public concerns about vaccines Heidi J Larson,David MD Smith,Pauline Paterson,Melissa Cumming,Elisabeth Eckersberger,Clark C Freifeld,Isaac Ghinai,Caitlin Jarrett,Louisa Paushter,John S Brownstein,Lawrence C Madoff. The Lancet Infectious Diseases 13 May 2013