Prickly public reception toward vaccines prompts physician change

The latest trend plaguing the pediatric realm has parents taking shots at vaccination scheduling and vaccines in general. 

Sensationalized reports linking vaccines to autism and a slew of other disorders have jeopardized the buoyancy of immunity, leaving youngster patients in open water and thus susceptible to preventable infectious diseases like measles and tetanus. Despite retractions debunking a number of these reports, public fear continues to circumnavigate vaccination processes and has driven physicians further into the unchartered territory of troubled paternal psyches. 

“Fear is a very strong emotion,” said Divya Joshi, MD, chief medical officer at Miller Children’s Hospital Long Beach.

Like most of the beasts it spawns, fear itself is a multifaceted creature. In the case of vaccination apprehension, Joshi attributed three key factors perpetuating the monster:

  • Media-touted studies of a particularly charged nature are difficult to forget for most concerned parents. “Once we have a certain emotion or certain impression, even if we give a rational argument against it, we might not able to be swayed or convinced,” Joshi noted. “I think it was within the last year that the very same physician [who published a piece linking autism to vaccines] published a landmark study in the international medical journal The Lancet basically retracting his findings. You’d think that people would believe that, if the actual discoverer or describer of the side effects were to contradict his own statement, but I think people did not — despite the media publishing it — really take much notice.”
  • Displacement can put a parent off. “The parents of today are young enough to not have seen how devastating many of these infectious diseases are if you do not have the vaccines,” Joshi said. Due to the fact that vaccines have been effective up to this point, modern patients and their guardians cannot empathize with the possible alternative to being vaccinated: being infected. “Today people don’t know what it is like, so for them it isn’t real; therefore, they are not as concerned.”
  • A sneaking suspicion: Prevention or profit? “Over the course of the last, it’s difficult to say how many years, there’s been an increasing suspicion in the communities and in society regarding healthcare. I don’t think it’s doctors as much as the 'industry of medicine.' You notice you go online and you read some of those blogs that say, ‘Oh, well, people want to give vaccines because they make money, the doctors get rich, the pharmaceutical companies get rich.’ So there is this suspicion.”

Andrew Bonwit, MD, a specialist in pediatric infectious diseases at Loyola University Health System and professor at the Stritch School of Medicine, reiterated a number of the same fear factors.

“I think one part is that there is a fervent, sincerely held belief on the part of different advocates out in the community and even a few physicians, who think vaccines do more harm than good — even though the very great bulk of science demonstrates that [vaccines] on the basis of a population do a great deal of good and a very minimal amount of harm.”

The likelihood of a patient having an adverse reaction to a vaccine is an extreme rarity Bonwit insisted — these instances are “so uncommon…in fact, uncommon is not a strong enough word” — yet some industry specialists, advocates and patients cling to these dubious happenstances as if they were most prominent.

“I think genuinely that some people, including some physicians, have a worry about things we can’t possibly prove. I think a famous politician once said ‘there’s the known knowns, the unknown knowns and the unknown unknowns.’ I think people are always worried about the unknown unknowns, and that’s fine, to say we don’t know what giving all those vaccines together could cause to happen, but we know from decades of experience what seems not to happen,” Bonwit added.

When prompted about the option of alternative vaccine scheduling, which many parents are vying for, both physicians were quick to admit they saw little benefit.

“The only advantage I can think of is that the child doesn’t get poked three times,” Joshi said. “A poke is a poke, but balancing that with the risk of potentially dying from a disease that is 100 percent preventable, I really don’t see any benefit of treating the schedule if it’s been proven to work.”

The physician metamorphosis
With vaccine anxieties at a pinnacle point, the physician’s role has morphed to accommodate the sharp new mindsets.

“Physicians used to be seen as a paternalistic entity — they have all the knowledge, they have all the power and they effectively make the decision and you as patient used to be, in those days, thankful that somebody who is so knowledgeable and powerful and wise would make those decisions for you. That is how it was and now it has shifted to the point that families and patients feel empowered -- they feel empowered over their own lives and futures and they want to make their own decisions,” Joshi said.

This Internet emergence has shifted the physicians role to that of a “knowledge sounding-board” Joshi said.

“I don’t know that it really alters the physician’s role as much as it creates a little bit more work in one of the traditional roles of the physician, which is to be a teacher,” Bonwit said. “I think it just demands that physicians get some basic understanding of the way that vaccinations and the immune system interact and it makes them dust off their understanding of statistics a little bit more so that they can answer these fears.” 

Suggestions for easing patient worry
Both Bonwit and Joshi suggested that communication was pivotal.

Joshi, who co-authored an article with numerous other doctors at the Miller Children’s Hospital in Long Beach, recommended that other physician groups do the same and post the pieces online.

“This is the way society works nowadays…the parents of children who need vaccines, they are in the Facebook age, they are in the blogosphere age, so this might be the best way to communicate with them,” she said.

The physicians communicated via email in a process that took only a couple of weeks. They wrote about their concerns regarding vaccinations and posted the treatise online as well as in their newsletter. Many patients and colleagues posted responses anonymously online, creating an effective and non-threatening discussion.

Bonwit suggested that physicians educate themselves and keep up with some quality source material.

“I think that the CDC is an important resource and with them, the Advisory Committee on Immunization Practices [ACIP] that works with the public health service and the CDC to continually reevaluate and revise vaccine schedules and recommendations,” he said.

In closing, Bonwit added: “Physicians have to be patient and understanding in dealing with the patient’s family’s fears about vaccines and I think that they need to be supportive and try not to be coercive about it because that’s not the point. The point is trying to help people understand that this is offered and encouraged as something that keeps families and children safe and the public at large safe.”