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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