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