Vaccine Fears: What You Can Do

22 08 2011

What’s not to fear directly about vaccines? There’s a needle that someone pokes into your child. Your child screams. You tense up. What’s in there? you wonder. Viral or bacterial bits that, in ways that are mysterious to a non-immunologist, will keep your child well when intuition seems to say they ought to make your child sick.

Needles, screaming, microbial bits…these naturally would make any parent blanch. The number of vaccines has added to the fear for at least a decade, leading to non–evidence-based calls to “spread out” the schedule or reduce the number of vaccinations.

In fact, the evidence supports the schedule as it’s recommended.

The fear of vaccination is not new. Since Edward Jenner and his cowpox inoculation at the turn of the 19th century, people have latched onto the fear of the known—those needles!—and unknown—what’s in those things?

What might be considered the first anti-vaccine cartoon appeared in response to Jenner’s proposed inoculation of cowpox to combat smallpox.

The vision of cows growing out of arms is comical, but the reality of possible side effects from today’s vaccines can lead some parents to keep their children away from the doctor’s office. Indeed, this anxiety has done so since the days of the 19th century anti-vaccination leagues, aligned against the widespread use of Jenner’s smallpox vaccine.

The vaccine wars in those days were just as bitter and divisive as they are today, including an 1885 march in England in which anti-vaccination forces carried a child’s coffin and an effigy of Jenner himself. Today’s most fanatical crusaders against vaccines may not carry coffins or effigies, but death threats against those who promote vaccines for public health are not unknown.

The fact that the vast majority of parents overcame those fears and had their children vaccinated has led to some of the greatest public health successes of the 20th century. Thanks to the willingness of people to participate in vaccination programs, smallpox disappeared and polio became a thing of the past in much of the world. Indeed, people in those eras knew, often from personal experience, what these diseases could do—maim and kill—and the fear of those very real outcomes outweighed fears of the vaccinations.

But today, we’re different. In the United States, most of us under a certain age have never witnessed a death from diphtheria or tetanus or smallpox or measles. We haven’t seen a child drained of life as a rotavirus rapidly depletes the molecules she needs to live. Many of us have not witnessed the sounds of pertussis, the vomiting, the exploding lungs in an agony of infant death. Why? Because of vaccines.

This very success has, ironically, led to the resurgence of fear and misgiving about vaccines. No longer weighed against anxiety of death or disability from disease, the fear of vaccines now aligns against the bright picture of a nation of children largely free of life-threatening illness.

Without the collective memory of days when children played on the playground one day and died the next of vaccine-preventable disease, the calculus of parental fear pits only the side effects of vaccines against the healthy child. Vaccination requires intentional agency—parental agreement—to impose on that healthy child the very small risk that vaccines carry. Some parents simply are not comfortable either with that intentionality or that risk.

Feeding this reluctance is the explosion of Internet sites that warn against vaccines or disseminate incorrect information about them. The Centers for Disease Control and Prevention (CDC) has provided abundant information about vaccines, including a page devoted to countering erroneous information with facts.

This information will not move the fiercest anti-vaccine groups that lump the CDC in with pharmaceutical companies and others in an alleged conspiracy to harm millions via a money-making vaccine industry. However, it certainly helps concerned parents who simply seek to calm fears, weigh evidence, and make an informed decision about choosing vaccines over the life-threatening illness and compromised public health that result when people don’t vaccinate.

Indeed, these threats to public health have grown considerably with recent large outbreaks of measles and pertussis. The growing threat has led to calls for more stringent requirements for childhood vaccines, including dropping exemptions and requiring that all children be vaccinated over parental objections. This tactic likely would increase vaccination rates among children attending school.

But instead of strong-arming parents into having their children vaccinated, what we really need is a two-fold approach to education. First, we need sober, non-sensationalist reporting from the news media about vaccine-related stories, including stories about side effects, research, and court cases. These articles—and their sensational headlines—are in all likelihood among the prime drivers of the rumor mill against vaccines.

Second, when parents read these stories and turn to a medical professional for input, that input must come as part of a two-way communication between the health professional and the parent, not in lecture format or as patronizing. A little, “I understand your concerns because I’ve had them, too, but here’s what I know that gives me confidence in vaccines,” is considerably better than, “Your child has to be vaccinated, or you can get out of my office.”

As centuries of history attest, no efforts will completely eradicate vaccine fears. Motivations fueling anti-vaccine sentiment that go beyond information gaps range from personal economic benefit to a desire to out-expert the experts to the inertia of fear.

But a careful and persistent information campaign and outreach efforts from medical professionals in the trenches may help keep vaccination rates sufficiently high. To ensure adequate rates requires either these efforts or a resurgence of the deadly diseases that have graphically demonstrated the real balance of the threats at issue here.

Which one would we rather have?

By Emily Willingham

Image courtesy of ajc1



8 responses

22 08 2011
Melody Butler

Thank you for this! Will be sharing this on the Nurses Who Vaccinate facebook page!

22 08 2011

Thanks! We love the nurses – they take care of our kids!

22 08 2011
Susan Gustafson

What needs to be done and is part of a research project by the USDHHS for the National Vaccine Plan for the United States is to survey parents to determine barriers to vaccination. Too often assumptions are made without knowing why parents will or will not vaccinate their child. Once we have a better understanding of why, we can better target educational materials to allay parents concerns.

23 08 2011
Emily Willingham

The below comment is my own and not intended to reflect a stance of PKIDs per se:

The plan referenced is here:

What this plan will not do for the near future is give tools to people currently seeking information about vaccines because of anxiety about vaccines. Having been engaged in the trenches of the vaccination vs anti-vaccination discussions, I write the above based on a historical perspective and what my experiences have been. The post does not address barriers such as economics and access, as the theme of the post is about what drives vaccine fears, not the general reasons children may or may not be vaccinated.

Targeting educational materials is great, but personal relationships with healthcare providers is significant. The USDHHS has had previous National Vaccine Plans, yet…here we are.

24 08 2011
Gordon Darroch

Excellent post. It’s good to underline that bullying reluctant parents into vaccinating their children is maybe not the surest way to quell their fears.

11 09 2011

I really appreciate your blog and your posts. I have read several articles in the past that discussed how the Whooping cough outbreak in California was primarily affecting kids who were already vaccinated. Are you familiar with this info?

25 09 2011

You’re spot on that pediatricians should not be bullying parents. I embrace the miracle of vaccines while also remaining completely dissatisfied with most of my family’s interaction with doctors. I find that pediatricians and obs are almost bullying in their condescension because they have the trump card of “THINK OF THE BABIES”. I can understand the wariness of the medical field that I think stokes a lot of the anti-vax sentiment and like them, I take a lot of my questions about my family’s medical options to the internet instead of doctors because I’ve been made to feel stupid too often by asking questions of the almighty MD. I just look to different sources for my information and am not a conspiracy theorist at heart, but I can see why misguided parents wary of or uneducated in science become anti-vaxers.

23 10 2011
Huffington Post: Irresponsible mouthpiece for the World of Woo | Life of a Lab Rat

[…] the energy to expound on the the importance of vaccines. You can read about their importance here, here, here (from CDC), here, and […]

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