Measles: Overcoming Vaccination Hesitancy

Following their analysis of vaccination aversion, experts expand on how health care professionals can educate patients and ensure vaccination.

Christina Tan, MD, MPH: The issues are related to how a lot of times, it is misconceptions about the vaccines and being able to turn to reliable sources for information. And that segues into a question for you, Glenn, related to what you’re seeing in your practice and trying to get correct information out there to your patient population.

Glenn Fennelly, MD, MPH: Yes, yes. So most immediately in our practice in Newark at New Jersey Medical School, of the patients who we serve, a very high proportion agree to immunization. They trust our recommendation. And when there’s an explanation necessary about potential adverse effects, really the facts are that upward of maybe 5% will get local swelling, pains, and redness. A much smaller proportion may get a mild fever, a sense of malaise. But beyond that, really the adverse effects overlap with those if you were just to give an injection of saline or salt water, and I think that’s a very important thing to note. I think the challenges are coming now in other parts of the country. So the outbreak of 1989 to 1991 in the United States was mostly in urban areas, which were underimmunized. Some of it had to do with access, and some of it had to do with just single-dose immunization. It may have had to do with waning immunity. So most of the outbreaks were in urban areas. Now it’s the reverse. It’s in suburban areas where there is a lot of vaccine hesitancy. So that’s the area I think that has to be targeted in better ways through social media, through helping to give the providers the tools to translate the science or the facts to their patients. That’s becoming increasingly important.

Christina Tan, MD, MPH: Well, public health wants to help providers as well because we know from a lot of research on examining attitudes toward vaccines that parents will always say having that recommendation from the providers is the No 1 source of trusted information, and that’s what influences parents to vaccinate. And so the CDC [US Centers for Disease Control and Prevention], the state health departments like New Jersey’s, all have various tool kits that help clinicians, because we know that it’s a multifaceted approach to try to get correct information out there for trusted sources.

Glenn Fennelly, MD, MPH: Yes.

Christina Tan, MD, MPH: So for example, the CDC has a variety of resources that are available to help physicians have conversations with patients and has developed evidence-based strategies related to how to approach parents. Because the first thing is recognizing that a lot of times, we assume the parents are going to accept the vaccine in a vast majority of situations. But then also make that strong recommendation and be available to offer any sort of answers to questions that they may have, because it’s understandable why parents want to ask these questions, because this is their child whom they’re trusting to you.

Glenn Fennelly, MD, MPH: Of course. And I think for parents, the CDC website is a fantastic resource. There’s the AAP [American Academy of Pediatrics] website for providers in New Jersey locally. And interestingly in the state of New Jersey there’s been various legislation, if you will, or the laws around enforcing compulsory vaccination at the state level. There’s been pending legislation to insist or require all parents to go through some sort of counseling before they opt out. And I think that that’s been very popular in that the pediatrician or other provider could use some of those tools to engage the parents and persuade those who are sitting on the fence, which as you point out are the highest proportion and can be persuaded in the overwhelming majority of cases. More recently I think in part in the wake of certain outbreaks that have been seen globally in the United States and locally, there’s pending legislation to limit exemptions to only medical.

Christina Tan, MD, MPH: Right. I think that unfortunately, we’re always the victims of our own success. As a practicing physician and as a public health practitioner, we are really proud of the impact that vaccination has made in terms of curbing vaccine-preventable diseases. And not seeing some of the diseases rampant as they were prior to the prevaccination era, as we call it—where you were seeing hundreds of thousands of cases of measles or other vaccine-preventable diseases—sometimes gives people a false sense of security.

Glenn Fennelly, MD, MPH: Yes, yes. And I’m reminded of the children’s book writer Roald Dahl, who lost his daughter to measles when she was 7 years old in 1962, just before the vaccine was available. She died from measles and encephalitis. So he actually dedicated subsequent books to her, and he spoke very forcefully in 1984 about this when he said, “If you are a school-age child who has not been vaccinated, you should insist that your parents vaccinate you.”

So I would bet that would be another message to parents next time. Because they read to their children, they can remember the experience of Roald Dahl. So yes, it was highly prevalent. We do become complacent. I think this is what’s happening in parts of Europe as well. People just do not realize the risk, but it’s real; it’s out there. And again, keep in mind those statistics: 1 in 1000 severe encephalitis or 1 to 2 in 1000 deaths.

Christina Tan, MD, MPH: And we can’t predict who will have those severe complications.

Glenn Fennelly, MD, MPH: Absolutely.

Christina Tan, MD, MPH: And that’s why it’s not only to protect the individual, because you can’t predict who’s going to get the severe complications, but also to create that herd immunity, as you said.

Glenn Fennelly, MD, MPH: Yes.