March 18, 2020 10:01 am Michael Devitt -- Understandably, news headlines around the country -- and, indeed, around the globe -- are currently being dominated by the coronavirus disease 2019 pandemic, and the AAFP has been leading the charge to keep family physicians up to date with the latest COVID-19 developments.
It's critical to remember, though, that outbreaks of infectious diseases such as influenza and measles continue -- and that although a vaccine for coronavirus is still a year or more away, vaccines for other known preventable diseases already exist and are readily available.
Unfortunately, as the results of a recent Gallup survey indicate, public support for vaccines continues to trend in the wrong direction. The survey found that fewer people today say it's important for parents to get their children vaccinated than in 2001, while more people now think that vaccines cause autism in children and are more dangerous than the diseases they are designed to prevent.
The survey involved 1,025 American adults who answered a series of questions about childhood vaccinations. Responses were compared with those of similar surveys administered in 2001 and 2015. Specifically, participants were asked about the following vaccine-related topics:
The importance of vaccines. In the 2019 survey, 84% of adults said it was extremely important or very important that parents get their children vaccinated, down from 94% in 2001. At the same time, 4% of adults said it was not at all important that parents get their children vaccinated, up from 1% in 2001.
Advantages and disadvantages of vaccination. Of those surveyed in 2019, 89% said they had personally heard a great deal or a fair amount about the advantages of childhood vaccinations, up from 73% in 2001. On the other hand, 79% of those surveyed also said they had heard a great deal or fair amount about the possible disadvantages of those vaccinations -- more than twice the percentage of those surveyed in 2001 (39%).
Potential harms. In 2019, 11% of those surveyed said they think vaccines are more dangerous than the diseases they are designed to prevent, compared with 6% of those surveyed in 2001.
Vaccines and autism. Of the adults surveyed in 2019, 10% said they think certain vaccines can cause autism in children, an increase from 6% in 2015. (This question was not asked in the 2001 survey.) Of note, a slightly higher percentage of those surveyed in 2019 said they think vaccines are not a cause of autism (45% vs. 41%).
AAFP News asked Madalyn Schaefgen, M.D., of Allentown, Pa., a 2019-2020 AAFP Vaccine Science Fellow, and John Epling Jr., M.D. M.S.Ed., professor and medical director of research in the Department of Family and Community Medicine at Virginia Tech Carilion School of Medicine in Roanoke, member of the CDC's Advisory Committee on Immunization Practices, and a 2011-2012 AAFP Vaccine Science Fellow, to comment on the survey's findings. They share their reactions and provide useful information on educating patients about vaccinations in the following Q&A.
AAFP News: What was your first impression after reading the survey results?
John Epling: The important thing to keep in mind is that most Americans (84%) agree that vaccination is very important. However, some of our neighbors and friends are not as sure about vaccines as they used to be, so I think we can all do more to discuss this important issue and try to find and spread the correct information about vaccines.
Madalyn Schaefgen: I was surprised that 46% of Americans are still unsure as to whether vaccines can cause autism despite multiple studies with thousands of participants proving that this is not the case.
AAFP News: The percentage of people who said they had heard about the possible disadvantages of vaccinations for children more than doubled between 2001 and 2019. Where do you think this information is coming from?
MS: There is a lot of misinformation, disinformation and some anecdotal stories out there about bad things that happen after vaccinations. Bad things happen other times, too, but when they occur in close proximity to vaccines, people are quick to blame the vaccines. With the rise of the internet and the ability of stories to go viral, one emotionally moving story can spread like wildfire and change people's minds.
JE: My patients talk about getting their information from family members, friends, online sources and social media.
AAFP News: Eleven percent of people think vaccines are more dangerous than the diseases they're designed to prevent, and 10 percent think vaccines cause autism. How do you talk with patients who have these beliefs and help ease their concerns?
JE: I try to find out their specific concerns about specific vaccines and discuss them. I discuss the safety monitoring that all vaccines are subject to. With regard to autism, I tell them that study after study has debunked the myth of an association between (measles, mumps and rubella) vaccine and autism. Finally, I occasionally relay the tremendous success that vaccines have had even just during my career: As a resident, I admitted many cases of Haemophilus influenzae type b infections, and now we rarely see it. The irony of our success in vaccination policy is that our society has forgotten many of the devastating diseases that are now largely prevented by vaccination, and some of our patients are deciding to not vaccinate based on incomplete information.
MS: I like to show graphs. I compare the number of people who got the disease, who had complications and died from the disease before we started immunizing and then show the significant drop in the number of people affected by illness after we started immunizing for that disease. Also, I show the number of children in the U.K. who were diagnosed with autism, which continued to rise in the early 2000s even while there was a significant decline in giving MMR vaccine after the flawed and erroneous paper came out about autism, yet the number of measles cases in the country surged and children died needlessly.
AAFP News: The survey indicated that the only group that has maintained its support for childhood vaccinations over the years is those with postgraduate degrees -- a relatively small group. What challenges could this present for FPs?
MS: We need persuasive arguments that don't rely on people understanding rigorous scientific studies and statistics but use emotional and persuasive stories that represent the truth of the statistics.
JE: The advantage and particular skill of family physicians is their ability to address the health concerns of a wide variety of patients across their lifespan. It's important to figure out what information our patients need at that time and supply it in a patient-centered manner rather than just delivering a standard message. Family physicians do that well across a whole range of health and wellness issues because of our relationships with our patients and our appreciation of their family, social and community context.
AAFP News: What role can FPs play in educating parents about the importance of childhood vaccinations?
JE: Emphasizing that both the doctor and the parent share a concern over the health of the child is the best way to begin. It should be a conversation with mutual respect and patience for the process of health behavior change.
MS: Develop strong relationships with parents and patients that show our emotional caring for the health and well-being of our patients and their children.
AAFP News: What have you found to be the most effective strategies for communicating with patients about getting their children vaccinated?
MS: Presenting the facts simply, positively and in a manner that lets the parents know that I believe in the vaccines and that I have given them to my children because I know that they are the best way that I can protect them from serious harm.
JE: In addition to the above ideas, another that works well is presenting a "default choice" -- i.e., avoiding accidentally tentative recommendations like "Do you want to give your child this vaccine?" and instead saying, "It's time for your child's vaccines. Do you have any questions or concerns about them?" Ensuring that you and your practice are giving strong, consistent positive messages about vaccines is also important.
AAFP News: What AAFP resources on this topic would you recommend for other family physicians? What about non-AAFP resources?
JE: The AAFP's immunizations page is an important resource -- scheduling information, coding recommendations and reports from previous AAFP Immunization Office Champion projects are all great sources of information about vaccination. In addition, the CDC’s Vaccines & Immunizations page and the Immunization Action Coalition website are fantastic resources.
MS: I use mostly the AAFP, CDC and IAC resources about vaccines and the benefits and the risks of not vaccinating.
AAFP News: Anything else you'd like to add?
JE: The article about the Gallup poll can seem a little discouraging if we let it. Instead, I think we should focus on the fact that the vast majority of Americans recognize the importance of vaccines. Family physicians should continue to talk about the importance of routine, complete vaccination with all our patients. FPs and their practice staffs should give strong, consistent positive messages about the benefits of vaccines to help our patients make the best health decisions.