vaccine hesitancy and current issues 091117€¦ · hpv vaccine facts gardasil hpv vaccine is a...

Vaccine Hesitancy-Current Issues and Controversies

including HPV vaccine

Dr Brenda Corcoran National Immunisation Office

What is vaccine hesitancy?

An expression of concern or doubt about the value or safety of vaccination

Indecision and reluctance

Continuum between vaccine acceptance and vaccine refusal

X Pro vaccine/ anti vaccine

Consequences

• Public health impact– delayed or selective

vaccination=> increased periods of risk

exposure

• Outbreaks of vaccine preventable diseases

Polio outbreaks a public health emergency: World Health Organization'Extraordinary' situation requires a co-ordinated international response, UN agency saysBy Amina Zafar, CBC News Posted: May 05, 2014 9:06 AM ET Last Updated: May 05, 2014 8:49 PM ET

Survey 2016

• 65,819 people• 67 countries• Overall vaccine

importance is positive • Global average 12%

(disagree that vaccines are safe)

• Less positive in Europe– 7 out of 10 least

confident countries– 41% in France

www.immunisation.ie

Ireland

www.immunisation.ie

Who are vaccine hesitant?

• US estimates 1 in 4 parents• Widely heterogeneous group

Who are vaccine hesitant?

Factors

Confidence– do not trust vaccine

or provider

Complacency- do not see need for

or value vaccine

Convenience

- lack of access

Trust

August 2016

https://www.youtube.com/watch?v=H1JFGWBAC5c

September 2015

2014

“Visiting anti-vaccination websites for 5–10 minutes can increase perceptions of vaccination risks and decrease intentions to vaccinate”

“My son is my science” Jenny McCarthy

The Narrative Bias

“The more narratives people read, the higher is their perception of risk,

regardless of the information contained in simultaneously presented statistical information on the base rate of vaccine adverse events.”

Intention to get vaccinated

Risk perception

Narratives

Influences

Actions• Omission bias

Make non‐vaccination an actionDefault = VaccinationMake clear to parents that they deviate from the recommendationAction = non‐vaccination

• Use narrativesCawkwell PB, Oshinsky D. Med Humanit 2016;42:31–35.

http://www.immunize.org/reports/http://www.voicesforvaccines.org/

Debunking the Myths

• Understand the specific concern• Not all the same• Listen• Don’t bring up new concerns

• Avoid the familiarity backfire effect• Don’t repeat the myth• Give the facts

• Avoid the overkill backfire effect• Focus on the most important arguments• Use clear, simple language

Actions

• Stay on message– Vaccines are safe and effective

• Recommended by independent experts• Higher safety standards than drugs

– Present risks and benefits accurately– Consequences of not vaccinating – Clear language– Herd immunity not relevant for tetanus

CommunicationParticipatory versus Presumptive

www.immunisation.ie

Today, your child is due to

have 3 injections

√

What do you want to do about your child’s

vaccinations?

X

Are we going to give the vaccines

today?

X

He really needs to have all these vaccines today

√

Who are the Targets?

• Evidence is strongest for fence sitters• Keep trying with hardliners

www.immunisation.ie

HPV vaccine uptake 2010/2011 - 2016/2017

Target 80%

~15,000 girls not vaccinated in 2016/17

Estimated uptake 1st dose only

www.hpv.ie

www.hpv.ie

Domino effect

International Contagion• Japan• Denmark• Ireland• ???

Other vaccine contagionEvidence slight reduced uptake of other school vaccines

Erosion of staff resilience

www.hpv.ie

Concerns

• Vaccine safety  • Vaccine safety  • Vaccine safety  • Vaccine causes serious side effects

• Lack of information – not given patient information leaflet • Consent process too rushed• Distrust in Irish health services – link to Pharma• Anti‐establishment agenda

www.hpv.ie

“Those who cannot remember the past are condemned to repeat it.”

G Santayana

Source: HPSC

95% Target

Wakefield article

www.hpv.ie

Health Professional Vaccine Deniers

www.hpv.ie

HPV vaccine effectiveness and safety 2006- 2017

HPV vaccine and cervical cancer facts

Cervical Cancer in Ireland

Every year • 6,500 women need hospital treatment pre-cancerous lesions• > 280 (many young) women need treatment for invasive cancer• 90 women die

Best way to prevent cervical cancer = HPV vaccination + cervical screening

Vaccine prevents precancerous growths and cancer  Screening detects pre cancer or cancer of the cervix

www.hpv.ie

HPV vaccine factsGardasil HPV vaccine • in use in over 25 European countries, the US, Canada, Australia & NZ• >100 million people vaccinated worldwide • >230,000 girls in Ireland• long lasting protection

• 10 years + protection without any loss of immunity • expected to provide life time protection

HPV vaccine has not been withdrawn in any country

www.hpv.ie

HPV Vaccine Facts

Gardasil HPV vaccine is a safe vaccine with no long term side effects• The safety profile studied for >13 years in >1 million people during 

clinical trials and since the vaccine was licensed in 2006.

• No increase in the rates of any serious long term condition including autoimmune diseases and chronic fatigue syndrome in vaccinated girls.

• Since the programme started in 2010 to 31 March 2017 HPRA has received 1082 suspected adverse reactions/events • most of these reports are expected side effects • 14  ‐ chronic fatigue syndrome• 10  ‐ post viral fatigue• 3  ‐ an auto immune condition

Much less than expected

HPV Vaccine FactsThere is no document that states there are more than 20 known side effects of Gardasil HPV vaccine

Side effects seen after use => Scientific evidence of causation• pain, redness or swelling in the arm• headache • nausea• a mild fever• Itchy rash/ hives• fainting• serious allergic reactions very rare 

Side effects reported during general use => No scientific evidence of causation

There is no evidence of any long term side effectswww.hpv.ie

Chronic fatigue syndrome (CFS)

• known for over 200 years • “commonest cause of prolonged school absence”

Professor Alf Nicholson Clinical Lead Paediatrics• 3-4 times more common in females and younger

adolescents • 10,000 cases in Ireland• estimated prevalence rate in Ireland 0.2-0.4% • 220,000 girls vaccinated (660,000 doses)

=> at least 440-880 cases expected

Reported numbers much lower than expectedwww.hpv.ie

CDC

http://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccine-is-safe.pdf

www.hpv.ie

Does HPV vaccine work?

ActionsLiaison• The Irish Cancer Society• National Cancer Screening Service • Professional bodies • Department of Education/ Schools • National Parents Councils• Politicians• Global

www.hpv.ie

Actions

Health professional training• Prioritise immunisation in healthcare education

–minimal immunisation teaching at undergraduate and postgraduate level–opportunistic education sessions > 2500 in 2016

• Fact sheets/ articles in journals• ICGP elearning modules• Pharmacies

www.hpv.ie

ActionsInformation for parents • Focus groups• Offer vaccine again• Information for 6th class parents• Short information videos • Revised parents leaflet (with quotes)• More time to consent

www.hpv.ie

Actions• Increase awareness of vaccine• National and local radio advertising • Social media listening• Social media campaign

• vaccinated girls• international experts

• Alliance of health care and other supportive bodies

• women’s rights• childrens’ rights• cancer charities• youth groups• influencers

www.hpv.ie

Political support

www.hpv.ie

Media

Impact

www.hpv.ie

• Uptake stabilising

• No decline in HPV2

• ~4% increase in HPV1

?

“I have met with a number of the people who believe that the Gardasil vaccine harmed them and I recognise their symptoms as real but there is no evidence linking them to the immunisation.

It is a natural human reaction to anchor unexplained things to moments that you remember in your past but that does not mean that one thing triggered the other.

I have never found one connection between the Gardasil vaccine and the symptoms reported by these girls”.

Professor Karina ButlerProfessor of PaediatricsChair, NIAC

More information

• www.hpv.ie

• www.immunisation.ie