Dr Julie Leask, a senior lecturer in the Sydney Medical School at the University of Sydney, writes:

The decision of the NSW Office of Liquor, Gaming and Racing today to revoke the Australian Vaccination Network’s charitable status will no doubt have a substantial impact on the group.

It was the right decision as this group should never have held a charitable license.

However, it is unlikely to change the numbers of people rejecting vaccination, which has always been fairly small in Australia.

Below I set out some of the myths that have been perpetuated in our genuine concern about the impact of the anti-vaccination lobby on Australian parents.

I also try to explain what drives vaccine refusal or delay and make a few suggestions on what needs to be done about this problem.

Myth 1 “More and more parents are rejecting vaccines nowadays.”

Child vaccination rates have remained stable in Australia over the last decade. More than 92% of two year olds are fully vaccinated by the age of two. Attitudinal trends show very small shifts in public support for vaccination. Vaccine refusers tend to live in clusters, giving diseases more of a foothold in these communities. But refusal rates in these areas, while concerning, are largely unchanged.

Myth 2 “The anti-vaccine lobby is more active than ever.”

Anti-vaccinators have been just as active in the past as they are today. For example, in the late 1990s media articles reflected a similar sort of outrage seen recently about people who don’t immunise. http://www.ncbi.nlm.nih.gov/pubmed/11824920 In Australia today about 3 in every 100 parents actively reject vaccination. This number has not changed over the last decade, despite the continued activity of the anti-vaccination lobby.

Myth 3 “Vaccine scare stories in the media will put parents off vaccinating.”

The vast majority of parents support vaccination. They see it as a way of protecting their children. It’s actually quite hard to put them off. (I sort of tried in this experiment) http://www.ncbi.nlm.nih.gov/pubmed/17052810 I learnt from this and other research that the public has a profound fear of many of our vaccine-preventable diseases and a profound desire to protect children from them. Therefore, it usually takes more than just one frightening media program or website to put a parent off vaccinating their baby.

For a vaccine scare to have an effect, it must get sustained media coverage then begin to enter everyday conversations – mothers groups, family and online environments and so on. The refusal of that vaccine then seems the “fashionable” thing to do. But one only really sees the impact on vaccination rates once doctors and nurses start to doubt the vaccine. This is because they have the greatest influence on parents’ decisions to vaccinate. This occurred with the MMR-autism scare in the UK. http://www.ncbi.nlm.nih.gov/pubmed/12109394

Myth 4 “The media only report the scare stories on vaccination.”

The vast majority of mainstream news media stories about vaccination are positive, such as urges to have an annual flu vaccine; stories of measles outbreaks etc. But they tend to be less memorable than the vaccine scare stories. The latter trigger emotional reactions such as fear or anger, so we remember them. http://www.path.org/files/Leask.pdf

Myth 5 “Parents just need the facts and they will vaccinate.”

This naively assumes that parents make decisions based on entirely rational assessments of the risks and benefits of vaccination. Human behaviour is complex and informed by all sorts of factors –education, family and friends, past experiences and so on. Trying to convince somebody with strong convictions to change their mind can make them more set in their beliefs. http://www.ncbi.nlm.nih.gov/pubmed/8656233 Alternative approaches are needed that work with people and develop a winnable plan. Sometimes it’s better for doctors and nurses to save their precious time for the fence-sitters.

Myth 6 “It’s only the wealthy ‘yummy mummies’ who don’t vaccinate.”

It’s more about education than wealth. Two very different groups of parents don’t get their kids vaccinated: the active rejectors  and the ‘practical barriers’ group. Active rejectors are more likely to have university education. A few of them become vocal anti-vaccine lobbyists. The practical barriers group face lack of access to services and competing priorities. They are more likely to be single parents and have three or more children. They tend to be late for immunisation, rather than not getting them at all. http://www.bmj.com/content/332/7553/1312.long This ‘practical barriers’ group get much less public attention than the active rejectors. Yet they are the ones more amenable to change.

Myth 7 “The anti-vaccination lobby is having a large impact on parents’ decisions to not vaccinate.”

Aside from the fact that only about 3% of parents actively decline vaccines, the anti-vaccination lobby have a limited direct impact on parents’ decisions to forego vaccination.

Parents who reject vaccination do this for complex reasons: because of a bad experience with vaccines or an existing world view which rejects orthodox medicine. Their rejection of vaccines is part of a set of beliefs about health and prevention. Anti-vaccination messages may help them rationale their own views.

Myth 8 “People who question the safety of vaccines threaten public confidence in vaccines.”

Vaccines are one of the most significant public health interventions in the last two hundred years. They have helped us elminate smallpox and almost eliminate polio and diphtheria. However, vaccines, like any other drugs, have side effects. Sometimes these can be rare but serious. Also, vaccines are not always completely effective and immunity can wane.

While vaccination should be promoted and supported, overstating the safety or efficacy of vaccines can erode public trust. Shutting down disquiet about vaccine safety is harmful to public health and simplifies a complex issue, polarising it into a ‘baddies’ versus ‘goodies’ story. The anti-vaccination lobby in Australia are a radical group but they are only one. Unfortunately they are often so vocal they drown out other legitimate criticisms of vaccine programs. We must remain retain the scientific openness that is central to good science. Australia should have good systems in place to investigate potential problems with vaccines.

• If you haven’t already found Julie Leask on Twitter, Croakey recommends following her if you’ve an interest in vaccines and broader public health issues

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Peter Fray
Peter Fray
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