Ruth Armstrong: Battlelines

THE US is currently in the grip of a fierce debate about childhood immunisation, triggered by an outbreak of measles, which appears to have originated in California’s Disneyland theme park early in the New Year.

The debate became increasingly heated with a Centers for Disease Control and Prevention announcement last week that there were more than 100 cases of measles in the US in January 2015, and that most cases were in people who had not been vaccinated.

Under intense media attention, the battlelines were clearly demarcated. Many organisations and individuals pointed out that vaccine refusers and the anti-vaccination movement were to blame for the resurgence of measles in the US.

Much of the coverage focused on the recklessness, stupidity and selfishness of refusing vaccination. Some social media posts were attributed to doctors voicing their frustration and their growing reluctance to treat unvaccinated patients and their families.
    
Political figures also joined the fray — some reprised the age-old political tension between personal choice and public good. Others showed clear leadership: President Obama stated that there was “every reason to get vaccinated” and a tweet from Hilary Clinton equated refusal to vaccinate with belief in a flat earth.

Discussing the outbreak and the problematic patches of vaccine refusal in the US, one paediatrician told The Economist that a big problem for immunisation was that most parents had never seen the diseases they were vaccinating their children against. “In the end”, he concluded “people don’t get vaccinated because they don’t fear these diseases.”

It is this sentiment, along with the knowledge that even the medical profession’s memory of some vaccine-preventable diseases is fading, that prompted retired Australian infectious diseases physician, Professor Clem Boughton to update, digitise and post a public education video from the 1990s, showing children affected by vaccine-preventable diseases.

In a comment for MJA InSight this week he encourages doctors to watch and share it with patients who are doubtful about the benefits of immunisation.

Australia had its own skirmish in the vaccination arena early in the New Year when there was strident opposition to a planned speaking tour by prominent American anti-vaccination campaigner Sherri Tenpenny.

Tenpenny eventually decided not to come citing security fears due to threats from “pro-vaccine extremists”. While a more likely reason was cold feet by individual venues, the episode divided the community, including doctors, along the lines of freedom of speech versus “deliberate dissemination of dangerous misinformation”.

These latest battles in the “vaccine wars” are in some ways encouraging: the voice of scientific reason has received widespread coverage and community backing, while the anti-vaccinationists have been shamed.

But there are also dangers in framing any health endeavour in such combative terms. In her first MJA InSight column for the year, Jane McCredie highlights a study conducted by Australian psychologists in a similarly conflicted field — climate change. The researchers argue that strident opposition can strengthen sceptics’ identification as part of a group, and their resolve to achieve their goals. Similar concerns have been expressed in the US press in the past few days.

At the height of the controversy over Tenpenny’s visit, vaccination experts Julie Leask and Katie Attwell reminded readers of Australian Doctor that entrenched vaccination refusal is the tip of the iceberg, with many parents simply lacking opportunities to vaccinate or experiencing hesitancy that is amenable to support and information. Time and effort, they suggested, is best spent on this group, while building trust and rapport and “keeping the door open” to entrenched decliners.

This is good advice, which I suspect reflects the practice of many doctors. It also eliminates much of the perceived conflict.

De-emphasising the “us” and “them” in the immunisation debate might just mean that one day (at least in everyday practice), the vaccine wars will be over — if we want them to be.

 

Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight