Expert: ‘Authorities should discuss risks of not vaccinating’

In an interview with Vaccines Today, Dr Heidi Larson, senior lecturer at the Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, said the problems arising from declining vaccination rates have not been adequately explained to the public.

“We have not got the message out about the increase in vaccine-preventable disease outbreaks and the notion of herd immunity,” she said.

Dr Larson said industry, scientists and governments should rethink their approach to communication to become more transparent and responsive. Reluctance to spell out the risks of vaccines will prove counterproductive, she said, especially in the age of new media.

“In general, the message has been ‘take this, it’s good for you – the risk, if any, is small’. And I think the public won’t put up with that any more. Even though we live in a much more risk-averse society, we need to be clear about these things. Information is out there so even if you don’t tell the public about it, they are going to find out. So you need to be very clear about risks without amplifying it. If there is a small risk, the public should know,” according to the London-based academic.

New media demand new thinking

She called for a “revitalised communication with the public about science” and said it is essential to engage with people who question the value of vaccines.

“Some people tell me that that when they began to question vaccines nobody was listening so they became more suspicious. I think there needs to be more engagement. The worst thing would be to ignore the questions,” said Dr Larson.

While the Internet and new media helped mobilise anti-vaccination groups, it should become a tool for pro-vaccine groups to get their message across, she added.

Pandemic influences public attitude to all vaccines

Discussing the fallout from the H1N1 pandemic, Dr Larson said the episode brought existing concerns about vaccines to the surface and will feed into the public reaction to future vaccination issues.

“The pandemic didn’t create new concerns but it amplified what was already there beneath the surface. It’s important to realise that the public has a memory. We can’t look at these things in isolation – whether we’re talking about the pandemic response or routine immunisations or a new vaccine.

“In situations where we know there have been previous concerns we should make an extra effort to build public engagement. And every time we introduce a new vaccine, particularly in a crisis situation, it’s important that we’re always thinking about the implications of what we’re doing. Everything we do now will affect the next big thing.

“We can look at a crisis as a time-isolated event that you need to get through and move on. It’s an opportunity to involve the public because if it goes well it will be valuable for the next event,” she said.

On the lessons to be learned from the pandemic, she added that there was too much focus on potential death rates and not enough attention given to the impact the flu-related absenteeism had on productivity, schools and daily life.

Culture, language and politics drive public attitudes

Dr Larson, who is currently working on a book and a series of articles with the support of the Bill and Melinda Gates Foundation, said public attitudes to vaccination are partly driven by language, culture and politics.

In Nigeria, she said, there were public concerns about the polio vaccine but this did not have a major impact in Europe. However, there have been issues around the hepatitis vaccine in France and MMR in the UK which have not always crossed borders.

“It’s an interesting phenomenon because some things do get communicated trans-nationally and some do not. It can be partly due to the language of media, but it’s also the political situation. With MMR in the UK it came on the heels of problems with BSE which was not communicated very transparently and helped erode public trust. In France there had been the tainted HIV blood scandal. So some of it is local political distrust that fomented the issues,” Dr Larson explained.

When public concerns do spread beyond national and linguistic frontiers, they can often be traced through other “trust networks”.

“The polio situation really travelled through Muslim networks around the world. And in terms of refusals of the tetanus vaccine, that went through Catholic networks from the Philippines to Africa to Latin America. So when these issues travel trans-nationally it tends to be through a certain social network that’s a trusted link between communities. The more I research the issue the more I see the complexity of factors that can fuel or calm the situation.”

Click here to read the full transcript of Vaccines Today’s interview with Dr Larson