The Cure — Column

Popular culture is filled with science-free noise about vaccines. And much of the noise is aimed directly at parents. From Donald Trump’s nasty anti-vax Twitter activity to celebrities raising questions about vaccination schedules to health bloggers suggesting there are “natural” (whatever the hell that means) alternatives.

Even if people don’t believe, trust, or even listen to all the anti-vax voices that pervade popular culture, the conflicting messaging can lead to confusion and uncertainty.  The simple fact that those voices are there — on social media, in the pages of People magazine and in political debates — can influence public attitudes. Indeed, there is evidence that even exposure to conspiracy theories and stories that employ false balance to represent the risks of vaccination may have an impact on the intention to vaccinate. The noise matters.

Given this reality, it is no wonder that so many Canadians continue to question the science and safety of vaccinations.  A recent study found that despite decades of robust studies on the effectiveness and safety of vaccines, 39 percent of Canadians think the science around vaccination is uncertain. (In Manitoba, that number jumps to a heartbreaking 48 percent.) Another study, led by Josh Greenberg at Carleton University, found that one in four Canadians believe that or are not sure if vaccinations cause autism and mental illnesses.

Much of the science-free noise about vaccines comes from the alternative medicine and integrative medicine crowd.  For example, it is easy to find a host of Canadian naturopathic clinics that explicitly question the safety and efficacy of vaccines and that offer “alternatives” to the standard flu shot.  Websites for naturopaths suggest, to cite just a few examples, that “doctors are questioning the flu shot,” and that with “young children, the flu vaccine does not decrease influenza-related hospital visits.” These clinic websites go on to suggest that homeopathic vaccines are a “healthy” alternative — a recommendation that is so infuriatingly devoid of even a shred of scientific legitimacy that it requires no explicit critique.

A new study published in the journal Pediatrics highlights the practical impact of this rhetoric in the US. Children who have used complementary and alternative medicine are “vulnerable to lower annual uptake of influenza vaccination.” While the study could not establish a causal connection (there is likely a birds-of-a-feather phenomenon happening), the authors speculate that it can be explained, at least in part, by exposure to the vaccination-hesitant views that are held by many alternative practitioners. This is consistent with other research that has found that there is an association between complementary and alternative medicine use and low vaccination rates.

Unfortunately, this science-free noise is given a major credibility boost by the uncritical acceptance of pseudoscience by some conventional health care providers and university-based researchers. A study by my colleague Ubaka Ogbogu found that nearly 70 percent of Canadian pharmacists explicitly recommend natural health products to their clients, including homeopathic and other unproven or highly questionable products. In addition, there are university-based studies exploring the efficacy of homeopathy at institutions across Canada (alternative and integrative health clinics explicitly use these studies to legitimize and market homeopathy).  To some in the public, this may appear as an embrace of bunk by science-based health professionals and biomedical researchers. This, in turn, may make it easier for the public to swallow the questionable claims about vaccination circulating in popular culture. Heck, if my pharmacist is selling homeopathic products, maybe they are an effective alternative to vaccination?

What is needed to counter the noise?  Studies have found that often simply providing more information and facts is not enough to change parents’ minds about vaccination. And the reasons parents are concerned about vaccinations vary greatly. Not every parent who decides not to vaccinate is a rabid anti-vaxer.  There are complex values and social forces at play, including issues of trust and access.

Still, there is great value in forcefully and loudly combatting vaccine misinformation. A 2015 study found, for example, that emphasizing the high degree of consensus among medical professionals about vaccines can influence public support. Other research has found that clearly conveying where the bulk of the evidence lies (that is, using a science-informed approach and avoiding an overemphasis on marginal perspectives) is “associated with positive vaccine attitudes” through “reduced information uncertainty” about the risks associated with vaccination.  And explaining the possible consequences of not vaccinating — including the use of parents’ stories and images of sick children — can be an effective education tool.

The science and public health community needs to have a strong presence in the popular press and on social media, and this should include explicitly and quickly challenging inaccurate and misleading representations. Trusted voices can have a real impact on the tone of the public debate, particularly if the information is conveyed in a manner that engages the audience. The science-free noise isn’t going away, but introducing notes of clarity will allow for more informed and confident decisions about vaccination.

 


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