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Vaccine Hesitancy: When Fear Is More Powerful Than Facts

vaccine.jpgIf every parent relied only on the latest medical information and studies to make decisions about vaccinating their child, we wouldn't have vaccine hesitancy.

After all, vaccines have made a huge difference. They really do prevent disease. Two studies just released in the journal Pediatrics (the official journal of the American Academy of Pediatrics) show just that.

In 1995, the varicella (chicken pox) vaccine was licensed. Between then and 2009, the overall incidence of varicella went down more than 90 percent--as did hospitalizations for the illness. The rotavirus vaccine has had the same effect: hospitalizations for rotavirus diarrhea (which is a kind of diarrhea that very commonly lands babies in the hospital) have gone down more than 90 percent too. That's pretty amazing. That's an awful lot of children who stayed healthy, an awful lot of parents who didn't have to miss work, and an awful lot of health care dollars saved too.

And yet, there are many parents who don't vaccinate their children--or skip some vaccines, or vaccinate on a different schedule.

Most parents do vaccinate. According to a report from the Centers for Disease Control and Prevention (CDC) from last summer, more than 90 percent of children entering kindergarten are immunized. Of the ones who aren't, less than 2 percent refused vaccines (as opposed to not being able to get them for medical reasons). That's a small number, right? A number we don't have to worry about?

Actually, it is a number we have to worry about. Because it doesn't take much to start an outbreak.

That's the message of a third study published in the same edition of Pediatrics. It details an outbreak of measles in Minnesota that started with a 30-month-old Somali who got infected while visiting Kenya. That child spread the illness to 20 others, most of whom were living in the same homeless shelter.

Of the 16 out of that 20 who weren't immunized against measles, 7 were too young. Most of the remaining 9 didn't vaccinate their children because they were afraid of autism. Why? Because people told them that the MMR vaccine causes autism. Andrew Wakefield, the British former researcher who lost his medical license after research he did claiming to link the MMR vaccine and autism was found to be falsified (the journal that published it retracted it) came and met with families in this community, including during the outbreak.

The families were more scared of autism than of measles. It didn't matter that two-thirds of the children ended up in the hospital--all with dehydration, some with breathing problems too. The parents preferred to take the risk. Which I would understand, if the MMR vaccine caused autism. But it doesn't.

We've studied this one, again and again--and can't find any connection between vaccines and autism. While vaccines can certainly have side effects, serious side effects are really, really rare. But some parents still refuse them--because someone told them that vaccines are dangerous, and they believe that person more than their doctor.

Some of that we doctors need to own. We are often better at talking than listening--and listening is what we need to do if we want to help parents who are afraid of vaccines. We need to take their fears seriously and get them the information and reassurance they need. Personally, I think refusing to see them if they don't want to vaccinate is a bad idea. We need to work with them, not against them.

But some of it has to do with fear itself. Once you are afraid, it's hard to stop being afraid--especially when the fear is about your child, whom you love desperately. And when your friends and family or others you trust (including people online who can seem remarkably expert even when they are not) tell you that vaccines are dangerous, it can be really hard to ignore their advice and follow your doctor's instead.

Here in the US, we've done a great job of fighting diseases with vaccines. But there are lots of outbreaks in other countries, and in our global society, it doesn't take much to bring the illnesses into our communities--and when there are unimmunized people, especially a bunch of them living together, it doesn't take much for those illnesses to spread.

I don't have any easy answers to this. But somehow, we need to find ways to help all parents make their decisions about vaccines based on facts, real facts, not fear. There is just too much at stake.


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