What should we do about vaccine hesitancy?
BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4044 (Published 06 June 2019) Cite this as: BMJ 2019;365:l4044All rapid responses
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For a disease like measles, which is highly contagious and can be quite severe, vaccine hesitancy is a serious problem, but so is our very limited overall knowledge of vaccine safety and effectiveness. Therefore, compulsory vaccination is, in general, unethical, unscientific, and unwise. I have seen coercion and censorship up close in the US, so I welcome Fiona Godlee's editorial. Meanwhile, I am reading Rebecca Chandler's references on "systems immunology." It is not easy going!
Incidentally, I recently did a VAERS search for "acute flaccid myelitis" (AFM). Their database includes just 4 case reports of AFM since August 2014. The number of cases of acute flaccid myelitis confirmed by the CDC during the same period is 567. This is one more example of the vast underreporting of potential adverse effects following vaccination.
ALLAN S. CUNNINGHAM 8 June 2019
Competing interests: No competing interests
Due to the success of immunization with vaccines, some diseases are no longer perceived as a threat. Some other diseases have been eradicated in developed, developing and underdeveloped countries. Although these facts are proven, some people or groups have questioned the utility of vaccination in controlling the diseases.
In recent years, a number of web sites have provided unbalanced, misleading and alarming false statements, and information against vaccine safety has been propagated. This can lead to undue fears, particularly among parents and patients.
So misinformation about vaccine safety, based on a few unscientific reports, which seem to be more common in developed nations, should be avoided.
We Indians are for vaccines.
Competing interests: No competing interests
Recently a press release was issued by the National Institute for Health Research (NIHR) announcing a new NIHR centre for patient and public involvement, engagement and participation and research dissemination. [https://www.nihr.ac.uk/news/a-new-nihr-centre-for-patient-and-public-inv... This centre will merge NIHR INVOLVE and the NIHR Dissemination Centre, and will become operational in April 2020. Established in 1996, NIHR INVOLVE promotes and supports patient and public involvement (PPI) in NIHR-funded research, and is currently hosted by the Wessex Institute, University of Southampton, having previously been hosted by the University of Leeds. The NIHR Dissemination Centre, established in 2015 as a partnership between the Wessex Institute and Bazian, exists to critically appraise the latest NIHR-funded research, to identify and disseminate the most reliable, relevant and significant findings.
The Department for Health and Social Care (DHSC) appears to have formed a view that there is synergy and, no doubt efficiency savings, to be had in merging NIHR INVOLVE and NIHR Dissemination Centre. It decided to go out to tender to establish this new centre before the end of the current NIHR INVOLVE contract with the University of Southampton. The competition was open with the specification in the public domain and multiple bids received.
We have concerns that the contract for this new NIHR centre is not going to a university, but to a global private company, LGC Group. LGC Group, already hosts the NIHR Central Commissioning Facility, and describes itself as “a global leader in the life sciences sector” promoting “science for a safer world.” In the context of increasing privatisation in the NHS, the gradual privatisation of its research support infrastructure should concern academics, patients and clinicians alike, and particularly those concerned with PPI.
The press release announcing the creation of the new NIHR centre led to a flurry of activity on Twitter from concerned academics, patients and service users. NIHR have since made clear that patients and the public were involved in the procurement process including peer review and panel membership, and that further clarification on the roll-out of the new centre will be issued in due course on the DHSC website.
As people who have worked in the PPI field for some time, we have the following questions about this move: Will the loss of NIHR INVOLVE mean the loss of expertise and organisational memory, resources, and the genuine involvement of patients, service users in research innovation, processes and production? How will service user-led research and service user-researchers be supported within the new centre? What will happen to NIHR INVOLVE’s current work-plan, including the promotion of NIHR-wide PPI standards and the principles of co-production, its on-going diversity and inclusion programme, and its work to establish an international PPI network? How will the Centre’s key functions of PPI and dissemination be integrated? What are the wider implications of the government outsourcing a national research infrastructure to a private company instead of a university? Are LGC Group bound by the same public interest values, research ethics frameworks, equality and diversity policies and dissemination standards as universities?
We look forward to receiving further clarification on these important issues from DHSC and LGC Group.
Jonathan Boote is a freelance researcher and consultant, with particular expertise in patient and public involvement in research. He has been a member of the NIHR INVOLVE Advisory Group, and is currently an associate member of NIHR INVOLVE.
Twitter: @jonathanboote
Competing interests: JB was a member of the NIHR INVOLVE advisory group and is currently an associate member of NIHR INVOLVE
Sarah Carr is Senior Fellow in Mental Health Policy, University of Birmingham and was a member of the Main Group and Empowerment Sub-Group of NIHR INVOLVE from 2002-2010. She has particular expertise in PPI and service user research.
Twitter: @SchrebersSister
Competing interests: SC was a member of the main group and empowerment sub-group, NIHR INVOLVE, from February 2002 until June 2010
Competing interests: SC was a member of the main group and empowerment sub-group, NIHR INVOLVE, from February 2002 until June 2010. JB was a member of the NIHR INVOLVE advisory group and is currently an associate member of NIHR INVOLVE.
Bravo! Dr. Godlee once more provides us with a sense of proportionality amidst contention. Science, education, and debate are more likely to persuade than the heavy hand of government coercion to influence behavior. Government can better proceed by spending to improve reporting of adverse events associated with vaccines and all drugs. Understatement and denial of safety issues are pervasive in commercialized medicine.
Competing interests: No competing interests
It was not that long ago when vaccination was, quite literally, the talk of the town. Infectious disease was an ever-present fear in the minds of parents, reinforced by morbid reports of sick and disabled children. Vaccines were embraced by the world and brought with them a new age of medicine. Presently, the fear that once gripped parents is no more. The threat of infectious disease is out of sight and out of mind, replaced by tabloid reports on side effects and additives; leaving many wondering if all these visits to the doctor are essential.
Medical school teaches upcoming doctors many things, but there is one lesson you will not find in your trusty cheese & onion; people do not share the same values. It is easy to fall into the trap that medical values such as getting plenty of exercise, not smoking, and eating a balanced diet, are as evident to everyone as they are to us. They are not.
As the number of people hesitant to engage with vaccination services grow, the world seems to be taking a stance of fighting fire with fire; debates of banning unvaccinated children from school and making vaccination compulsory. These people are not ignorant or uneducated; they have legitimate questions but do not have easy access to the information they need. What they do have is unlimited and easy access to Facebook groups, YouTube videos, and tabloid articles spreading misinformation and distrust towards medical professionals. Is it not apparent that pushing these people away is just going to make it easier for these outlets to pull them closer?
Outside of the healthcare setting, I do not think I have ever seen something promoting the benefits of vaccination. A poster in the GP waiting room or at the counter of the local pharmacy is all well and good, but are they not just preaching to the choir? Health promotion needs a booster shot; the message needs to be in the same place the opposition speaks, and it needs to be loud. As of writing, the official NHS Facebook page [1] has between 15-150 ‘shares’ per post. This might sound impressive, but considering that half of all parents with small children have been exposed to misinformation regarding vaccines on social media [2], we could be doing better. If you want to fight fire with fire, first get on the same battlefield.
References
1. NHS. official nhs.uk facebook page. facebook.com. https://www.facebook.com/NHSwebsite/. Accessed June 7, 2019.
2. Royal Society for Public Health. Moving the Needle: Promoting Vaccination Uptake across the Life Course.; 2019. https://www.rsph.org.uk/uploads/assets/uploaded/3b82db00-a7ef-494c-85451....
Competing interests: No competing interests
Re: What should we do about vaccine hesitancy?
Vaccination is the cornerstone of public health and is one of the most cost-effective health-care interventions. Vaccination status of a population is as important as Infant Mortality Rate is to a Country's development.
Vaccine hesitancy is a very complex issue. It is influenced by numerous parental and vaccine-specific factors. These factors need to be understood better to be addressed better. Since addressing any public health concern begins at the population and community level, a good starting point could be identifying the target population and listening to the true nature of their particular vaccine or vaccination concerns and perceptions.
Competing interests: No competing interests