Communicating
vaccines: lessons from
the pandemic
Thomas Abraham
• The percentage of participants answering they would “probably not/definitely not” accept the vaccine increased from 47.1% in week 35 to 63.1% in week 44
• More than half of the people with chronic illnesses (53.3%) indicated “probably not/definitely not”
Image rights: Mike Licht, NotionsCapital.com
What could be done?
“Clear messages on the safety of the pandemic (H1N1) 2009 vaccine be communicated to the public and the media.”
(WHO SAGE at its meeting in October 2009)
“Parents must be told that the vaccine is safe for their infants and toddlers, and not to have them vaccinated is putting their lives at risk.”
Dr Gilbert Ross, American Council on Science and Health
Changing public attitudes is not the issue
The real issue is for the public and public health practitioners to learn to understand each other
Through this process both public health advice, as well as public attitudes could change
The public health dilemma
A safe pandemic vaccine had been produced
Therefore, groups at risk of serious illness should get vaccinated
“For the majority of the respondents (59.8%), the main reason for intending to decline vaccination was the belief that the vaccine might not be safe.” (Sypsa et al)
What was the problem?
Poor communication- the public did not seem to “get it”?
Sensationalized media reporting?
Influence of anti- vaccine campaigners?
What was the issue?
Partly communication: public health and the public speak different languages
Partly because of differing understandings of the risks and benefits of vaccination: the herd vs the individual
We need to learn to talk the
same language
From the point of view of public health, the pandemic vaccine was safe. It had the same profile as the seasonal vaccine- serious adverse effects were rare and the vaccine was well tolerated
From the public point of view, if a vaccine is described as safe, it implies there are noserious adverse events
“As we move through this, we will have numbers or rates that are higher and lower. But at the end of the day, it is the overall safety of the vaccine which is really clear and we have a great deal of confidence in [it],” said David Butler-Jones, Canada's chief public health officer.
Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said severe allergic reactions "are not showing up more commonly than we would expect."
“For the most part, the chance of getting very ill from flu is far higher than the chance of getting GBS after getting the flu vaccine.”
US CDC
"The observed number of two GBS cases among vaccinated persons so far lies within normal expectation of baseline incidence that would occur in a population of 170,000 (regardless of vaccination history), adjusted for age and seasonal effects," the spokesman said.
This puzzles the public
When public health people say something is safe, what exactly do they mean?
How do public health officials decide something is safe?
How trustworthy are experts?
Public health is a black box as far as the public is concerned
Individual risk and societal
benefit
Immunisation has both an individual as well as a herd benefit
In many cases, the benefit to the individual is small
However, vaccine risk is always borne by individuals
No one wants to be the person to bear that risk
Individuals will take this risk when they see that vaccine risk is more tolerable than the risk of disease
In the case of the pandemic, this was not always the case
Some observations
The risks and benefits of vaccination are not as clear cut as publicly made out
We need a dialogue between the public and public health on the risks and benefits of immunization
For a dialogue, both sides need to talk the same language, which they do not at present
This is the role of risk
communication
A channel of communication between experts and the public in order to arrive at consensus
Risk communication is not advocacy
Risk communication is not about persuading the public to get vaccinated
It is about building consensus based on informed consent