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Restoring Trust in Vaccines: A Complex Task

The FSG Global Health Impact Area regularly organizes training sessions, in which guest speakers are invited to share their perspectives on some of the most pressing health issues. Last week, we were fortunate enough to have Dr. Heidi Larson, Senior Lecturer at the London School of Hygiene and Tropical Medicine and Advisor to FSG’s Global Health Impact Area, speak to us about her work on vaccines. Specifically, she talked about her most recent Lancet article on the topic titled addressing the vaccine confidence gap.

Vaccines have never been entirely uncontroversial. Concerns date back to the anticompulsory vaccination league against mandated smallpox vaccination in the mid-19th century, and have never disappeared since. Most recently, the CIA’s tactic of using a fake vaccination campaign to try to confirm Osama Bin Laden’s presence in Abbottabad as well as Michelle Bachmann’s claims that the HPV vaccine may lead to mental disabilities, have brought the confidence issue back into the spotlight. As Dr. Larson pointed out during our discussion, the reasons for skepticism go beyond safety concerns and vary by region. In Kano, a northern, Muslim region of Nigeria for example, loss of confidence occurred after rumors spread that it was part of a plot by the US to make Islamic children infertile. In the US, a lot of the resistance stems from the right’s uneasiness with the idea of government telling them what to do. Mandatory vaccines are therefore contested for the same reason as mandatory health care.

So why not just let skeptics be skeptics? Well, for one thing, there is an ethical component. Because the science is often so overwhelming, it would be wrong to “give up” on those that choose not to believe in it, similarly as it would be wrong to let someone get in a car drunk, or practice unsafe sex. But there’s a second, broader reason to care. As Henry Miller and Gilbert Ross point out in their blog post, putting a single child at risk also puts the community at risk because the lower the rate of vaccination, the more likely it is for an epidemic to spread. It is thus critical for populations to achieve “herd immunity”, a level of collective vaccination that acts as a barrier to dissemination.

Given the above mentioned reasons, it is important to keep distrust in vaccines from spreading and to nip emerging erosions of trust in the bud. The fact that Michelle Bachmann is not backing down from her comments is worrying. In fact, it may well be that she will continue to stress the issue in the hopes of pushing her political opponent Rick Perry against the ropes. The platform of the primaries enables her to reach a national audience – and possibly instill doubts in the minds of parents currently not skeptical of vaccines.

But how can trust be restored? Dr. Larson pointed out that there will always be a core of doubters – the task is to keep current vaccine users from stopping. My colleague David Zapol blogged about the challenge of changing perceptions of vaccines back in February, and rightly pointed out the difficulty in responding to individual’s fears and doubts about vaccines. Scientific evidence, such as the recent Lancet report which demonstrates that nationwide vaccination programmes for young women against HPV are likely to reduce the number of those infected, are immensely important. But they will not suffice. Religious beliefs, personal convictions, and ongoing rumors about persisting health dangers will continue to breed mistrust. Dr. Larson therefore calls for more research on the determinants of public trust, and on the mix of factors that are likely to sustain it. She’s currently working on a vaccine trust barometer, which will identify a growing confidence crisis at an early stage, and consider various factors to determine the best response. While an early warning system will be of immense value, it will take time to develop and its recommendations will still need to be implemented. According to Dr. Larson, opinions are very much (in)formed by peers, so listening to the fears and doubts of vaccine skeptics, and taking the time to communicate the benefits of vaccines is perhaps the most important way to take influence. So if you know someone who has doubts, take the time to listen to her or his reasons, but also make sure they understand what’s at stake. Thanks to vaccines, devastating diseases such as diphtheria, measles and polio have become rare and contained. Wouldn’t it be great if we could say the same thing for new diseases such as HPV?

Simon Meier

Former Associate Director, FSG