This section provides information to help understand concerns about immunisation.
Concerns about immunisation should be taken seriously and responded to appropriately, with as much information as possible. Individuals have the right to make informed decisions for themselves and those in their care, and to accept responsibility for their decisions. It is important to respect this right.
In New Zealand, as elsewhere, there are groups of people and individuals who actively campaign against immunisation. Their reasons for doing so may include personal experience, such as an adverse event they have attributed to immunisation, philosophical beliefs, or dissatisfaction with inadequate or superﬁcial responses from health professionals, who can seem at times to be dismissive of people’s concerns. It is important for all health professionals to be able to provide accurate information about the benefits and risks of immunisation and to respond with as much information as possible to parent/guardian concerns, or refer people appropriately.
It is not always possible to change people’s position by way of rational argument or presentation of evidence. Anti-immunisation arguments are almost exclusively based on fallacies of fact or logic, or on historical information that is no longer applicable in the current context. Often these arguments can be challenging for the health professional, particularly if they are unfamiliar with the particular argument.
In any discussion it may help to acknowledge that science does not always have all the answers. It is important to point out that an event that follows immunisation is not necessarily caused by the immunisation. Finally, it is always helpful to inform parents/guardians about additional sources of information (see section 2.2 on informed consent, and section 1.6 on the safety monitoring of vaccines in New Zealand).
It is useful to understand that people tend to take on board what makes sense to them and what supports their belief system and to ignore information that does not. The internet makes it very easy to access information that is appealing. People usually make logical decisions based on their perception of risk. Therefore, if a person has the perception that the risk of disease is real and that vaccines are reasonably safe and work, then they are more likely to vaccinate. People are unlikely to vaccinate if they perceive that there is little risk of disease, and that vaccines are not safe and do not work.1
If a parent is concerned about immunising their child, determining their concerns and addressing them can be helpful. As a health professional, you should challenge poor information.
Until recently, anti-immunisation information was propagated mainly via print media. Now, the internet has online magazines and websites dedicated to disseminating myths about immunisation, and social media such as Facebook and Twitter also contribute. Although the source of information has changed, the general themes have not.
An important paper published in 1998 summarised the core arguments presented by those opposed to vaccination.2 The reporting of anti-immunisation arguments by the press frequently contains words and phrases such as:
These themes have been consistent since the first use of the smallpox vaccine over 200 years ago. Most false beliefs have an origin that can be traced and may even contain some element of truth.
Beliefs based on falsehoods or fallacies about immunisation have existed since Benjamin Jesty and Edward Jenner used cowpox to prevent smallpox in the 18th century. During the past 100 years many new vaccines have been developed, and each generation is associated with misperceptions, which often result in children being inappropriately denied vaccination.
Such beliefs have always tended to flourish where there is a limited understanding of science. Also, the dissemination of contradictory information and conspiracy theory has been facilitated by new technologies such as the internet and text messaging. The media will respond to controversy and tend to give equal weight to both sides of the arguments, ignoring the robust science that supports immunisation programmes. There are many examples in the medical literature of negative press coverage and a subsequent reduction in vaccine uptake, followed by a resurgence of disease.
Over the past two centuries, controversies about immunisation have tended to fall into several categories. Although the details may change, the themes remain the same. Table 3.1 summarises some suggested responses to concerns about immunisation. (For more information, see the relevant sections of this chapter.)
|The disease is not serious||Healthy children can and do still die from these diseases, and many more would do so if it were not for vaccination.|
|The disease is uncommon||The disease is common in unimmunised populations and can easily recur and spread if immunisation rates drop.|
|The vaccine is ineffective||Studies showing the effectiveness of a vaccine are needed before a vaccine is introduced.|
|The vaccine is unsafe||As with effectiveness, the safety of a vaccine is rigorously tested before, and after, its introduction.|
|Other methods of disease prevention such as homeopathy are preferable to immunisation||There is no body of scientiﬁc evidence that supports homeopathy or other methods for preventing the diseases.|
Adapted from: Bedford H, Elliman D. 2000. Concerns about immunisation. British Medical Journal 320: 240–3.