by ahopkins1

“Fact-Checking the Anti-Vaccine Movement” Part 3: Public Health Professionals who will be tasked with implementing evidence-based practices

In order for the campaign to be effective, it is essential that the public health workforce knows the facts. Utilizing the data gathered from our website research of popular anti-vaccine websites and chatrooms, targeted fact-pages will be created for distribution amongst healthcare providers. These one-page flyers or fact sheets will be printed on laminated paper so as to last longer, but will contain the popular myths and rumors used in the Anti-vaccine websites and provide effective messages to respectfully counter their arguments. In addition to fact sheets, we will have targeted trainings of 1 hour ‘working-lunch’ sessions in which a bagged lunch will be provided while trainings are conducted.

 

Specific learning objectives of the training sessions include:

  1. Definitions of common vaccine terms: Public Health Professionals (PHPs) should be able to define and explain common terminology such as: immunizations, antigens, attenuated vaccine, booster shots, communicable etc.
  2. Safety of Vaccines
  • Herd Immunity
  1. Altruistic nature of vaccines
  2. PHPs should be familiar with at least one case study of a previous antivaxxer getting themselves or child immunized
  3. PHPs should be able to talk about the effectiveness of vaccines in a calm, polite manner and be able to provide facts about vaccines and be able to point to reputable resources for more knowledge

Social Media plays a critical role in fueling the anti-vaccination movement though social media messages tend to be about predominantly negative experiences.

Benefits of vaccinations are minimized and focus is on negative experience, fueling public mistrust. Anecdotal stories which have little or no scientific or evidence-based information are driving these online communities. The validity of the stories and credibility of the individuals sharing them typically go unchallenged as they tend to confirm the biases of forum participants visiting anti-vaccine websites.  In a 2004 study in which the beliefs and attitudes of school personnel involved in reviewing student’s immunization status were associated with the vaccination status of children [1], the authors found that nurses were more likely to hold beliefs in support of vaccine safety and effectiveness. They found that misconceptions of vaccines were common and many school personnel were ignorant of the seriousness of some vaccine-preventable diseases and that unimmunized children are highly susceptible to diseases. These misperceptions were associated with an increased likelihood of a child having an exemption to getting required vaccines. The study found that personnel without formal health care training who advise parents on vaccines could be passing on misinformation.

The Public Health Workforce is critical to changing the mindset of anti-vaxxers and some of the tools used in public health communities to counteract the anti-vaccine movement include: statistics and research which are often delivered in the form of CDC Vaccine Information Statements. Another effective strategy is to use the same techniques used by the anti-vaccine movement: storytelling [2]. Giving first-person accounts of positive vaccine experiences or ‘milder’ forms of vaccine-preventable diseases made more manageable because of vaccinations.  Another powerful pro-vaccine narrative is the “anti-vax to pro-vax” conversion in which a parent’s decision not to vaccinate results in a vaccine-preventable disease. Evidence suggests that one of the most persuasive and effective means of communicating vaccine information to some parents is the anecdote [3].  A story shared between parents, or between parent and provider, can sometimes have a greater and lasting impact than a Vaccine Information Statement handed to a parent at a doctor’s visit.

With the rarity of vaccine-preventable diseases in developed countries, there is an associated lack of awareness about them. Health education activities brought home from school can also have a positive influence on how parents understand and manage health issues. Children can act as behavior change agents regarding health-related issues which is why another strategy we will use will be to spread the messages to children and adolescents by providing information about vaccine safety in schools, leading to pro-vaccination behaviors in parents similar to anti-smoking campaigns which focused on teaching children about second-hand smoke, which were very effective and also had a positive influence on their parents [4]. We hope to replicate this by focusing on children and adolescents with age-appropriate factual material with the hopes of introducing these children to thinking critically and how to verify authenticity of information they read.

Training will involve six 1-hour working lunch sessions comprised of the following:

  1. Knowledge Assessment: this will be in the form of a ‘Jeopardy-type’ questions-answer game. Questions will determine knowledge level of participants on vaccine safety, efficacy and popular vaccine misconceptions.
  2. Evidence-Based Facts: the second hour will be presenting essential vaccine and immunization facts including information on eradicated diseases such as smallpox.
  3. Similar to the second hour, this will reaffirm the efficacy of vaccines and include common misconceptions found in the anti-vaccine movement
  4. Narrative Development: the fourth hour will be on sharing or re-telling an anecdotal pro-vaccine story
  5. Knowledge Assessment: A second ‘Jeopardy-type’ questions-answer game to assess effectiveness of training
  6. Distribution of Fact-sheets and Vaccine Information Statements featuring vaccine terminology and vaccination schedules

 

At the end of the sessions:

  • Public Health Professionals should be able to facilitate a discussion or support group composed of individuals reluctant to get themselves or their children immunized.
  • PHPs should be familiar with at least one case study of a previous antivaxxer getting themselves or child immunized
  • PHPs should be able to talk about the effectiveness of vaccines in a calm, polite manner and be able to provide facts about vaccines and be able to point to reputable resources for more knowledge

Fact-Checking the Anti-vaccine movement Phase III

References

  1. Salmon DA, M.L., Omer SB, Chace LM, Klassen A, Talebian P, Halsey NA., Knowledge, attitudes, and beliefs of school nurses and personnel and associations with nonmedical immunization exemptions. Pediatrics, 2004. 113(6): p. 552-559.
  2. Ashley Shelby, K.E., Story and Science: How Providers and Parents can Utilize storytelling to combat ant-vaccine misinformation. Human Vaccines and Immunotherapeutics, 2013. 9(8): p. 1795-1801.
  3. Betsch C, U.C., Renkewitz F, Betsch T., The influence of narrative v. statistical information on perceiving vaccination risks. Medical Decision Making, 2011. 31(5): p. 742-753.
  4. Arede M, B.-A.M., Bouchard É, Singh Gill G, Plajer V, Shehraj A, Adam Shuaib Y., Combating Vaccine Hesitancy: Teaching the Next Generation to Navigate Through the Post Truth Era. Frontiers in Public Health, 2019. 14(6).
by ahopkins1

Fact-Checking the Anti-Vaccine Movement: Policymakers

 

Policymakers are responsible for setting, reviewing and revising rules and laws of any institution, organization or government. They generally set the legislative agenda, oversight and accountability; and, ultimately funding of policy implementation. Public health professionals (PHP) must advocate for the general public and is an essential competency requirement for health educators; they should be able to craft and create public health policy by using social and national health-related issues to improve individual and community health (1). Policymakers must work with health educators as they are able to support an issue by providing data, assessing needs and are capable of program planning, implementation and evaluation.

In addressing policymakers for the “Fact-Checking the Anti-Vaccine Movement” our approach will be through a one-page “policy sheet” which provides:

  • Key data on vaccine efficacy
  • Cost of relatively recent outbreaks due to vaccine-preventable diseases
  • Current policies which allow for State-required vaccine exemptions
  • Current outbreak data
  • Specific attainable objectives that legislators are able to vote on

The simple, plain and easily-read ‘fact sheet’ will be presented/ provided at State legislative lobbying sessions, colloquially known as ‘working the velvet ropes’ (2) to lawmakers. Lawmakers wanting further information can scan the visible QR code on this visually-pleasing and accessible one-pager where they can provide their contact information for a response from Subject Matter Expertise (SMEs) on our “Fact-Checking the Anti-Vaccine Movement” policy initiative.

Upon initial contact with the legislator’s office, the SME will briefly conduct an information-gathering session through phone interview in order to determine knowledge-gaps and expertise on the anti-vaccine movement by policymakers. Legislator’s (or their representatives) will be invited to attend one of our hourly ‘implementer training modules’ where they can see first-hand the level of concern and engagement with providers and caregivers.

Further discussions with policymakers will entail educating with the intent of increasing (3):

  • Knowledge of current vaccine exemption policy consequences
  • Vaccine efficacy: the value of vaccines and consequences of poor vaccine rates
  • Cost/ Benefit awareness of outbreaks of vaccine-preventable diseases

At the end of these discussions with SMEs, policymakers should be able to:

  • facilitate meetings with their constituents
  • form and delegate committees to gather public knowledge and perception
  • inform and advocate for their constituent’s individual and public health

Our ultimate project goal for this final phase of our campaign is to shape policy, with tangible objectives or ‘asks’ including:

  • Public declaration of the efficacy and your support of vaccines
  • Policy changes requiring counselling and demonstrated support of personal vaccine beliefs
  • Constituent acknowledgment that in the event of a vaccine-preventable disease outbreak, constituents may be forcibly vaccinated to control spread of the epidemic

 

 

References

  1. Robert J. Bensley JB-F. Community Health Education Methods, A practical guide 3rd ed 2009.
  2. Mark Niesse MTP. Follow this year’s Georgia Legislature. AJC. 2018 01/04/2018.
  3. ASTHO. Communicating Effectively About Vaccines: New Communication Resources for Health Officials. 2010.

 

 

by ahopkins1

Fact-Checking the Anti-Vaccine Movement: The General Public Health Workforce

In any epidemic, it is essential that there is high vaccination rates so as to limit transmission, protect high-risk groups and reduce the number of severe outcomes in order to not overwhelm the healthcare system [1]. Many individuals use the internet to obtain health information including vaccines. This readily available information is disseminated not only by public health communicators and pharmaceutical companies but by anti-vaccination groups as well. Vaccine information on social media focuses predominantly on the negative experiences [2] instead of the benefits of vaccination (ie. absence of disease). This results in increasing disbelief in the efficacy of vaccines and mistrust in public health officials and pharmaceutical companies. They fear that a new vaccine has been rushed to production with insufficient trials or that they haven’t been tested adequately, and more long-term studies are needed.  This reached a pinnacle in 1999 when The Lancet published (and retracted 12 years later) an article by Dr. Andrew Wakefield, which claimed a correlation of the measles vaccine with autism. Since then, the anti-vaccine movement (commonly referred to as anti-vaxxers) have gained considerable momentum in their messages, playing on emotional outrage rather than fact. There have been unsubstantiated claims of an association between hepatitis B vaccination and multiple sclerosis in France; human papilloma virus immunizations and convulsions/ sudden death. Members of these anti-vaccine groups tend to be very active and vocal on social media websites such as Twitter and Facebook [3]. Social media has the reach of traditional mass media (such as print or television) as well as the interactivity and dynamism of interpersonal communications, making it a very effective communication tool, with the potential of major amplification on effects, perceptions, attitudes and behavior through ‘word-of-mouth’ 

In order to address the growing ‘anti-vaxxer movement’, a sustained campaign is needed to calm the fears of the public, and provide accurate information. Efforts should be made to address any legitimate safety concerns.

Pharmaceutical and Public Health officials should be transparent about the vaccine development process in efforts to re-gain the trust of the public [1].  Anti-vaccine campaigns have been followed by falling immunization rates and outbreaks of vaccine-preventable diseases [4] . Other than the purely public health goal that vaccines prevent disease, it has been well-documented that outbreaks of vaccine-preventable diseases contributes significantly to disease burden and has a significant economic cost. Outbreaks require a vigorous public health response.  As exemplified by the 2011 measles outbreak, these economic costs are substantial. Efforts to contain an outbreak of 16 measles cases in 2011 required 42,635-83,133 personnel hours and $2.7 to $5.3 million US dollars [5]. Associated costs include:

  1. Investigation
  2. Contact tracking
  • Screening
  1. Laboratory
  2. Emergency Response
  3. Surveillance

The responses to this particular outbreak had a tremendous impact on local and state public health departments not only in cost, but also in diverting needed personnel and public health resources from other priority investigations. The costs of these outbreaks is compounded by subpopulations of unvaccinated individuals.

The public health campaign to fact-check the anti-vaccine movement and ultimately increase the rates of vaccine will involve a multi-pronged approach:

  1. Anti-vaccination Website Research: in order to gather and categorize the popular message themes amongst anti-vaxxers, we will use machine learning to examine the content of the 100 most popular anti-vaccination websites [4].
  2. Algorithms will be created to extract explicit claims about vaccines so as to create targeted ‘factoids’ to dispel these rumors. These algorithms will target specific claims and tactics used in the anti-vaxxer movement: skewing science, shifting hypothesis, censoring opposition and claiming vaccines are ‘toxic’ or unnatural [6].
  3. Educating the Public Health Workforce: In order for the campaign to be effective, it is essential that the public health workforce knows the facts. Utilizing the data gathered from the website research, targeted fact-pages will be created for distribution amongst healthcare providers. These one-page flyers will be printed on laminated paper so as to last longer, but will contain the popular myths and rumors used in the Anti-vaccine websites and provide effective messages to respectfully counter their arguments. In addition to fact sheets, we will have targeted trainings of 1 hour ‘working-lunch’ sessions in which a bagged lunch will be provided while trainings are conducted. Specific learning objectives of the training sessions include:
  4. Definitions of common vaccine terms
  5. Safety of Vaccines
  • Herd Immunity

https://imgur.com/a/8M7q8

  1. Altruistic nature of vaccines

 

  1. Critical Thinking for Children and Adolescents: Because most of the anti-vaxxers tend to be rigid in their views, they will not be the main focus of this campaign. With the rarity of vaccine-preventable diseases in developed countries, there is an associated lack of awareness about them. We hope to spread the messages to children and adolescents [2] Studies teaching children about second-hand smoke were very effective and also had a positive influence on their parents. We hope to replicate this by focusing on children and adolescents with age-appropriate factual material with the hopes of introducing these children to thinking critically and how to verify authenticity.
  2. Mass Media and Social Media Postings: Billboards and YouTube videos will be created with interviews of recent anti-vaxxers that decided to get vaccinated.

Fact-Checking the Anti-vaccine movement – Part II

 

 

References

  1. Neil Seeman, A.I. and R. Carlos, Assessing and Responding in Real Time to Online Anti-vaccine Sentiment during a Flu Pandemic. Healthcare Quarterly, 2010. 13(Sp): p. 8-15.
  2. Arede, M., et al., Combating Vaccine Hesitancy: Teaching the Next Generation to Navigate Through the Post Truth Era. 2019. 6(381).
  3. Betsch, C., et al., Opportunities and challenges of Web 2.0 for vaccination decisions. Vaccine, 2012. 30(25): p. 3727-3733.
  4. Davies, P., S. Chapman, and J. Leask, Antivaccination activists on the world wide web. 2002. 87(1): p. 22-25.
  5. Ortega-Sanchez, I.R., et al., The economic burden of sixteen measles outbreaks on United States public health departments in 2011. Vaccine, 2014. 32(11): p. 1311-1317.
  6. Azhar Hussain, S.A., Madiha Ahmed, Sheharyar Hussain, The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus, 2018. 10(7).
by ahopkins1

Fact-Checking the Anti-Vaccine Movement: The General Public

Vaccines are one of the most important preventative measures in protecting against disease and infections. Vaccine campaigns have contributed to decreasing rates of common childhood diseases such as measles and mumps.

Some diseases have also been eradicated some such as smallpox (saving up to 5 million lives) [1] and close to eradicating others such as polio.

Within the last decade, there have been increasing anti-vaccination movement in the public resulting in several outbreaks. In 2013-2015, a large measles outbreak swept through Disneyland in California. In this outbreak, children were left intentionally unvaccinated by their parents resulting in over 1000 cases of measles with one death reported in 2015.

Organized anti-vaccination groups contribute to a decline in vaccine compliance and through the use of social media spread anxiety and falsehoods about vaccines. Celebrity figures through their popularity also exacerbate this problem. Historically, vaccines were first banned in 1763 due to the failure of a physician to properly quarantine people inoculated [2]. In England in 1853, the Vaccination Act ordered mandatory vaccination from infants up to 3 months old. The anti-vaccine movement spread to the United States in 1879 after William Tebb visited the United States from Britain. In 1902, after a smallpox outbreak, the board of health of Cambridge, Massachusetts required all residents to be vaccinated. A series of unfortunate events in carrying out vaccine campaigns lead to public mistrust: The 1955 Cutter Incident produced 120,000 doses of Salk polio vaccine that contained the live polio virus resulting in 40,000 cases of polio, 53 cases of paralysis and 5 deaths.

In 1998 a British doctor published a research paper (later retracted) that claimed an association with the MMR (measles, mumps and rubella) vaccine and autism.     

False and misleading claims about science and public health are having a significant impact on politics and policy and engender fear [3] and therefore require critical attention from public health officials, academics, the medical community and the media. In order to address this anti-vaccine movement, we are proposing a ‘fact-checking’ campaign to educate the public on vaccine safety.

We hope to target popular anti-vaccine websites such as “A Voice for Choice” and dispel myths found on the websites.

We will use billboards and posters to debunk falsehoods and provide historical facts on the effectiveness of vaccines.

 

Fact-Checking the Anti-vaccine movement

 

References

 

  1. UNICEF, Vaccines bring 7 diseases under control. 1996.
  2. Kirkpatrick, M., Anti-Vaccine Movement, in Measles Rubella Initiative. 2018.
  3. Caplan, A.E.a.A., The overlooked dangers of anti-vaccination groups’ social media presence. Human Vaccines and Immunotherapeutics, 2017. 13(6): p. 1475-1476.