Childhood immunisation campaigns should better target doctors and nurses to head off the next vaccine scare, says one expert.
Social scientist Dr Julie Leask of the National Centre for Immunisation research and Surveillance in Sydney lays out her argument this week in Nature.
Leask says that globally immunisation rates are by and large high, and there is no major trend downwards.
"95 per cent of children have received all three primary doses of DTP vaccine in OECD countries," says Leask, who studies attitudes to immunisation.
But, she says there is concern that public controversies, for examples over MMR vaccines, may erode public confidence in vaccination and threaten herd immunity.
"Increasingly doctors are saying they are getting more and more questions about immunisation and that those discussions are taking up more and more of their time," says Leask.
Concerned parents
Leask says up to one third of parents in the US, Britain and Australia report concerns about the number of vaccines babies are now receiving and are more distrustful of newer vaccines.
And she says a survey in Europe found one fifth of parents reported having doubts about having their child vaccinated.
Leask says a small proportion of people - about 3 per cent of Australians - are "rusted on" opponents of vaccination and are unlikely to change their mind in response to campaigns.
But she says immunisation campaigns should target the 20 per cent of parents who would normally get their kids vaccinated but delay or decline a vaccine that has become "stigmatised".
And she says family doctors and nurses are key to influencing these parents.
'Target the health professionals'
Leask says her research has shown parents will usually ask the advice of doctors and nurses about any negative media reports on vaccination.
"It's my theory that it's health professionals that are actually the tipping point in vaccine scares catching fire," says Leask.
She says governments and medical bodies should brief doctors and nurses as soon as possible about concerns that are raised in the media so the health professionals can advise parents with confidence, says Leask.
Leask says this helps a doctor or nurse to save face if they haven't heard about the controversy. It is especially important if they themselves have unwarranted concerns about vaccination brought on by media reports.
"It's really clear that health professionals who are committed and confident help get children immunised on time appropriately," says Leask.
Beyond the facts
Leask says a major problem is that communication strategies often assume that lack of factual knowledge is the main reason why people don't vaccinate.
But Leask says refusers are more likely to have a university education than those who accept vaccination. Scientific arguments in favour of immunisation, in isolation, will not convince them and may even increase their resolve not to immunise.
Leask says most people who vaccinate do so for cultural reasons.
"It's like grandma and apple pie. It's a social norm, it's what's reinforced by their peer networks, it's what's reinforced by media messages," she says.
Leask says for those who don't vaccinate, there's usually a wider belief system that underscores that decision.
She says they tend to prefer alternative approaches to disease prevention including a healthy diet and lifestyle, and are wary of the excessive intervention of medicine into everyday life.
Refusers are also less trustworthy of health authorities than the average parent, and are concerned about the influence of the pharmaceutical industry on healthcare, says Leask.
She says such "cultural rationality" includes legitimately grounded concerns that need to be taken into account when addressing the concerns of questioning parents.
Leask says it's important not to "shut down" public concerns about vaccines.
"An atmosphere that censors any public concerns can hinder efforts to hear and respond to real problems and can alienate hesitant parents, the most important audience to keep on side," says Leask.
Leask also believes there are strong ethical reasons for a compensation system to make sure that the very small number of children who have serious effects from vaccination are properly compensated.
"The public health and the vaccination community are calling for a compensation system," says Leask.
"It's definitely something that should be on the agenda in the Australian setting. It should be right there."
Doctors 'key to preventing vaccine scares'.
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