law, politics and the messages we send about vaccines

8/9/2019 Law, Politics and the Messages We Send About Vaccines

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The Measles Outbreak

and the Role of VaccineHesitancy

Daniel Salmon, PhD, MPHAssociate Professor

Departments of nternational Health !Health, "eha#ior and Society

Deputy Director, nstitute for VaccineSafety


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Vaccine HesitancyPersons or families $ho%

•Refuse all or some #accines

•Delay some #accines, but accept others

•Accept all #accines, but remain concerned

&

http://www.who.int/immunization/sage/meetings/2013/april/1_

Model_analyze_driversofvaccineonfidence_22_March.pdf


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'http://www.cdc.gov/vaccines/imz!managers/coverage/nis/child/figures/2013!map.html


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Parental Practices

• (') #accinated $ith recommendedschedule

•**) planned to #accinate $ithrecommended schedule

• +) #accinated $ith some but not all#accines

• &) intended to not #accinate at all

Kennedy, Health Affairs, 2011

'- parents of children *.- years from &/*/HealthStyles Panel Sur#ey


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77% of Parents Reported Vaccine Concerns

• Painful to receive so many shots (38%)

• Too many vaccines at one doctors visit (36%)

• Too many vaccines if first to years of life (3!%)

• "ay cause fevers (3#%)

• "ay cause learnin$ disailities& such asautism (3'%)

• n$redients unsafe (#6%)

• ot tested enou$h for safety (*7%)• "ay cause chronic disease (*6%)

• +nli,ely to $et diseases (**%)

-ennedy& .ealth /ffairs& #'**


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haracteristics of #nvaccinated $%&ero

'ose() vs. #nder!vaccinated hildren

• #nvaccinated children more li*ely to +e:

, -hite

, elong to households with higher

income

, Married mother with a college education

, ive with children

mith 4ediatrics 200


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0orthern 1alifornia 2aiserPreschool 1hildren Vaccination by

Time Period2002-2005

2006-2009

2011-2012

3nder.mmuni4ed5%'%*%&%'%*%5 seriesby &5 months

(6*) 76&) *&65)

Shot.limiters

8ully mmuni4ed at'- months but ne#er9& in:ections on aday

/6) *6/) &6')

9 * Vaccine

RefusalDia nosis

0A 0A '6+)

ieu 4ediatrics 2015


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6ypes of 78emptions to chool

9mmunization e;uirements 2015

(

http://www.ncsl.org/research/health/school!immunization!

e8emption!state!laws.asp8


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?!200

$1.03!2.13)

78emption 7ase

'ifficult eference

Medium 1.35 $0.=?!1.=1)

7asy 1.53 $1.10!2.1)


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Mean $=5A 9) ates of Eonmedical 78emptions

+y 6ype F 7ase of 78emption 200?,2011 #

Bmer et al. E7DM 2012


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**


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ncrease s o seasefor 1hildren $ith


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Pertussis 0pace1time Clusters 24emptions Clusters

/d5usted* R

3! (#8 !*)

Overlap of

ExemptionsClusters with

Pertussis Clusters

mer& /9& #''8


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Pertussis Space.time 1lusters and


15/26

>hy Are Some Parents

Vaccine Hesitant?

*+


16/26


17/26

Post hoc ergo propterhoc

:after this& therefore ecause of

this:& is a lo$ical fallacy ;since thatevent followed this one& that eventmust have een caused y this one

http://dictionary.sensagent.com/post+hoc+ergo+propter+hoc/en-en/


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Risks Percei#ed to be@reater

Less Risk More Risk

Voluntary #s6

n#oluntary

ndi#idual 1ontrol #s6

System 1ontrol

Omission #s6

1ommission

0atural #s6

Manmade

Predictable #s6

3npredictable

0ot Dreaded #s6

Dreaded

8amiliar #s6


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hen 4ediatr


20/26

mallpo8 2=005 0 100A

'iphtheria 21053 1 J==A

Measles 53021C ?2> J==A

Mumps 1?23 1151 ==A4ertussis 200C52 2>??0 >?A

4olio $paralytic) 1?31? 0 100A

u+ella CC5 > J==A

ong. u+ella ynd. 152 0 100A

6etanus 5>0 21 =?A

K.Influenzae type + and 20000 2C J==A

un*nown $ L 5 yrs)

Disease 20th Century Annual Morbidity 201 ! "han#e

$otal 1%0&%'( )0%*& *+!

Comparison of 20th Century Annual and CurrentReported Moridity! "ele#ted $a##ine-

%re&entale 'iseases ( $a##ine Ad&erse )&ents!

*nited "tates! 201+


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mallpo8 2=005 0 100A

'iphtheria 21053 1 J==A

Measles 53021C ?2> J==A

Mumps 1?23 1151 ==A4ertussis 200C52 2>??0 >?A

4olio $paralytic) 1?31? 0 100A

u+ella CC5 > J==A

ong. u+ella ynd. 152 0 100A

6etanus 5>0 21 =?A

K.Influenzae type + and 20000 2C J==A

un*nown $ L 5 yrs)

Disease 20th Century Annual Morbidity 201 ! "han#e

eported to I


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4arentsN 4erceptions +y

hildOs Iaccination tatus

p


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Other 1ontemporary ssues• Trust in corporations and ;o#t lo$

• 8ear of Bpharmaceutical industrial comple=

• @ro$in; interest in natural products . C;reen our#accines

• 1han;in; medical model

, Shared decision makin; 9 paternalism

, More patients in less time

• nternet

• The role of the media


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Media #s6 Science Talkin; aboutVaccines

• Media

, 8ocus on the anecdote

, 8alse "alance

, Sensationalism

• Science

, Dismisses anecdote for data

, 1onsiders and discusses limitations ofstudy

, nterprets $ith caution

&5


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>hat To Do About Vaccine


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>hat To Do About VaccineHesitancy

• 1han;e ho$ the media reports on #accines

• 1han;es to State

law, politics and the messages we send about vaccines

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