Many years ago I worked in a travel clinic advising people about the immunizations they needed before visiting other countries. Sometimes shots were required for entry into a country, such as the yellow fever vaccine. But we also made sure that MMR (measles-mumps-rubella) and other vaccines were up-to-date. The reason was that while immunizations have been very successful in getting rid of measles (and other childhood illnesses) in the US, many countries still have outbreaks. The booster shots were not necessary in the US because we no longer had cases of measles. Until now.
We are seeing cases of measles (and other childhood illnesses) again because parents are increasingly refusing to get their kids vaccinated. The current outbreak of measles in California is causing a lot of public debate about how to force people to get their kids vaccinated. While we may need to find new ways to enforce vaccination, we also need to restore trust – people increasingly don’t trust doctors, pharmaceutical companies, government agencies or payers.
This lack of trust leads people to believe in conspiracy theories. In an article published in JAMA Internal Medicine entitled “Medical Conspiracy Theories and Health Behaviors in the United States”, researchers found that about 50 percent of those surveyed believed in one or more conspiracy theories about health. Among the ideas tested were: the US government is blocking natural remedies; cell phones cause cancer but the government isn’t telling the public; putting fluoride in the water supply is just a way for companies to dispose of chemicals; and vaccines cause autism (a claim that has been proven to be based on made-up data).
In a piece on NPR, Shankar Vedantam discusses the role of fear in the decreasing vaccination rates. Studies have shown that if parents are afraid, trying to convince them to give vaccines to their children only serves to make them more resistant. Rather, he suggests we should acknowledge their fears as we would with a child afraid of ghosts.
We have tons of research and decades of experience to support the fact that vaccines are safe and effective. Trying to convince people that this is true is not working. Acknowledging their fear might help.
How else can we change behavior?
First, we need to find better ways to communicate the seriousness of childhood diseases like measles. Personal stories in healthcare can be very powerful. We need to hear more from people like the author Roald Dahl who wrote in 1986 about the death of his daughter, Olivia, from measles. Or from doctors like retired Canadian pediatrician Frank Jagdis who remembers the misery of measles before we had the MMR vaccine.
And we need to figure out new approaches to achieve higher childhood vaccination rates that address the fear and lack of trust of parents. Stronger enforcement of vaccination may be the answer, but we should engage parents in the process of designing these new approaches. Solutions designed with the involvement of parents are likely to be more creative and effective.
Having strong evidence is important but it is only useful if it understood and accepted by those who need to use it to make healthcare decisions.