When Anecdote Trumps Evidence

Brian J Ward Colloque Blue 2013

WHAT !!Another talk

about vaccine hesitancy?

raspeberry.blogspot.com

Changing Perception of Vaccines Angel Dust

Tools of the Devil

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1990 1992 1994 1996 1998 2000 2002 2003 2005 2006 2007 2008 2009 2010 2011 2012

Vaccines are ‘Good’

Vaccines are ‘Bad’

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unforgettablebeattt.blogspot.com

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Yadayadayada VaccineYadayada Yada Yadayada

Sudden Death

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Yadayadayada VACCINEYadayada Yada Yadayada

SUDDEN DEATH

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shrinknextdoor.com

Is There a Debate?

cartoonstock.com

This depends uponhow you define the word ‘debate’ …

The Committed and the Hesitant?

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bitchlifestyle.com

Demonizing the opposing view is rarely productive

colorlines.commarriedwithbusinessblog.comcanadafrancais.com

homosapienssaveyourearth.blogspot.com

studyforwomen.blogspot.com

eliotburdett.com

Perhaps We All Need A

‘Time-Out’?

panchtatva-blog.blogspot.com

What Do They See?

shutterstock.com

shutterstock.com

shutterstock.com

shutterstock.com

fasttrack.nutoonpool.combest-of-web.comstartribune.com

Some Vaccines Are Now Blockbusters

Resources Devoted to Vaccine Programs (USA)

M Davis. Price as a double-edged sword in thegolden era of vaccines. Human Vaccines 2010

fasttrack.nutoonpool.combest-of-web.comstartribune.com

Vaccine community should take the lead

in transparency

Conflict of Interest Statement (Last 5 Years)

Position in Pharma Medical Officer for Medicago Inc. (Oct 2011 - present)

Consulting Pfizer, Merck, Novartis, GSK, Sanofi Pasteur

MSSS, US Dept of Justice (Vaccine Compensation Programs)

Contracts Vaccine trials for virtually all companies

Shared Awards

Shared CIHR Team grant (Laval U, GSK)

CIHR-Industry grant (Medicago)

Shared CQDM grant (Medicago, Laval U, SNC Lavalin)

Occasional Speakers Honoraria

Pfizer, Sanofi Pasteur

Investments (sadly) Nil

colourbox.com

Big Pharma Approach, Including‘Whatever the Market will Bear’

Pricing Strategies have a Cost

shutterstock.com

Are We Sending AClear Message?

Vaccine Organizationin Canada

Local Authorities Tend to beQuite Dogmatic

Sophisticated Parents Often Confronted by Mixed Messages

Aside from program issues, therereally aren’t many cogent arguments against some flexibility … • age at MMR or varicella (any vaccine) • number of doses - menC - HBV - HPV

Sloth, poor parenting and procrastinationmeant our 3 kids got MMR at 15, 16 and 18 months of age …

Why weren’t childservices called?

De Serres G et al. CID 2012)

With vaccines, we are building our boat and sailing it at the same time

David Heymann, World Health Organization

nauticexpo.com

Absence of a National Program Great for Science

but has Consequences

Each Jurisdiction Needs to be More Humble (and

Flexible) about its Programs

senseiwisdom.com

suethomas.ca

What possible excuse can there be for the lack of

a national vaccine registry in 2012?

shutterstock.com

What Does the New Parent Experience?

thehealthyhomeeconomist.com unicef.ca

transcanadacoyote.blogspot.com

Needles are Not a Huge Factor … but they ARE a Factor for Some

Why are we Still Using this Medieval Tool?

• first used in Roman times • mostly for sucking stuff out (Egypt/Iraq) • 1844 - first subcutaneous injection with a hollow needle (Ireland) • 1853 - first ‘hypodermic’ syringe

for medical purposes (UK)

allposters.com

There are many reasons to target development of NEEDLE-FREEvaccines: • taking the needle out of the equation • HCW safety • keeping ‘sharps’ out of environment • probably better immune responses

Mitragotri S. Immunization without needles. Nat Rev Immunol. 2005 Dec;5(12):905-16.

The ‘It’s Good Enough’Attitude is Probably NOT Good Enough

For Vaccines

shutterstock.com

Are we all too ‘invested’ in vaccine programs to respond appropriately

to problems?

alaska-in-pictures.com

Our Defensive Reflexes are Well-Developed

Answer the following questions.YES or NO answers only:

YES NO

Measles vaccine uses a live (weakened) virus

This virus can persist for years

This vaccine can kill some children

This vaccine is probably as dangerous as OPV that we no longer use because of its risks

Major vaccine makers working on a safer measles vaccine?

gettyimages.com

OK - I can see see a few hands raised to speak… but we’re not done yet

More questions - same rules:YES NO

Adverse events can happen years post-vaccine

Vaccines licensed only after years of surveillance

Immunity after natural infection often for life

Immunity after vaccination is also lifelong

Some vaccines contaminated with animal viruses

Vaccine makers have monopolies on some products that are worth many millions of dollars

Governments & academics can independently confirm company claims for all vaccines

These questions are obviously unfair and biased …

However - each ‘yes’ or ‘no’ has some truth in it.

Each is a building block of the anti-vaccine argument

We’ve made safer vaccines for: • rabies • pertussis • polio • even smallpox

upmc-biosecurity.org

• Can’t neglect old vaccines chasing new targets • As we approach eradication of measles … will the current vaccine be safe enough?

• Insist that products in Canada can be studied independently

• Work harder to understand how vaccines work and how adverse events occur

• Support programs to compensate those who are truly harmed

humboldtsentinel.com

The Committed and the Hesitant?

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If We Don’t Like the ‘House’ that Vaccine Opponents have Built …

Perhaps We Should Work to Remove Some of the Bricks

that We’ve Given Them

pediatrics.about.com

A First Step in Dealing with VaccineHesitancy Might be a Look in the Mirror

Questions &

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