Vaccine advocacy 101

I recently finished a 2-year stint as an American Society for Microbiology Distinguished Lecturer. It’s an excellent program–ASM pays all travel expenses for lecturers, who speak at ASM Branch meetings throughout the country. I was able to attend Branch meetings from California and Washington in the West, to Massachusetts in the east, and south as far as El Paso, Texas, with many in-between. Each Lecturer selects several topics to speak on, and the Branch chooses from those which they want to hear. Mine included basic research (zoonotic disease, antibiotic resistance) as well as science outreach and advocacy topics (zombies, vaccines).

My talk on vaccines covered vaccine hesitancy and denial, the concerns some parents have regarding vaccination, and the way social media and celebrities contributed to the spread of vaccine misinformation. Inevitably, someone would ask in the Q&A or speak to me afterward inquiring, “But what can I do? I don’t feel I know enough about why people reject vaccines, and feel helpless to combat the fears and misinformation that is out there.” These were audiences of microbiologists and other types of infectious disease specialists–people who are very likely to be educated about vaccines and vaccine-preventable diseases, but who may not have followed the saga of disgraced former physician Andrew Wakefield, or aren’t familiar with the claims of the current anti-vaccine documentary, Vaxxed, or other common anti-vaccine talking points.

To help fill this gap, I recently published a paper in Open Forum Infectious Diseases,” Vaccine Rejection and Hesitancy: a Review and Call to Action.” As the title suggests, in it I give a brief overview of some of the figures in the anti-vax movement and the arguments they commonly use. I don’t go into rebuttals directly within the paper, but the supplemental information includes a subset of both anti-vax literature as well as several published rebuttals to them that interested individuals can look up.

I also briefly review the literature on vaccine hesitancy. Who fears or rejects vaccines, why do they do so, and how might we reach them to change their minds? This is really an area where many individuals, even if they’re educated about vaccines and infectious disease, lack a lot of background. As I note in the paper, many science-minded people still think that it’s enough to just educate people about vaccines properly, and that will be enough. While accurate information is indeed important, for many individuals on the vaccine-hesitant spectrum, it’s not only about misinformation, but also about group identity, previous experience with the health care field, and much more.

Still, vaccine advocates can get involved in a number of way. One of the easiest is simply to discuss your own vaccine history in order to normalize it. I regularly post pictures of my own vaccinations on social media (including my public Facebook and Twitter accounts), and those of my kids*. In over 17 years of parenthood, their vaccinations have all been…boring. These “uneventful vaccination” stories are the ones which rarely get told, as the media focuses on “vaccine injury” stories, in which the injuries may or may not actually be caused by vaccines. Those interested in promoting vaccines can write letters to the editor, get involved with local physicians to speak with hesitant families, break out and be political about vaccine exemptions; there are a number of ways that we can work to encourage vaccination and keep our children and our communities healthy (again, explored in more detail in the manuscript).

Figure 1: Examples of photos posted to the author’s social media accounts. Panel A: The author (middle) and her older children after receipt of seasonal influenza vaccines. Panel B: The author’s youngest child at Walt Disney World, wearing a shirt saying “Fully Vaccinated. You’re Welcome.” Both techniques can serve as conversation-starters around vaccination.


I hope this paper will serve as a starting point for those who want to be a vaccine advocate, but just aren’t sure they know enough background, or know where or how to jump in. Whether you’re an expert in the area or not, everyone can do small things to encourage vaccines and demonstrate your trust in them. Those of us working in the area thank you in advance for your help.


Smith TCVaccine Rejection and Hesitancy: a Review and Call to Action. Open Forum Infectious Diseases, 2017, in press.


*AKA, how to get your kids’ pictures into a scientific paper.

Is history repeating itself?

This is the fifteenth of 16 student posts, guest-authored by Cassie Klostermann. 

One of the major accomplishments that public health professionals pride themselves in is the reduction of people getting sick or dying from preventable infectious diseases. Unfortunately, these debilitating, historic diseases that health professionals had once thought they had under control are starting to rear their ugly heads once again in the United States (U.S.). One of these diseases that I am referring to is measles. Measles is a highly contagious virus (from the genus Morbillivirus) spread through the air when an infected person coughs or sneezes making measles extremely easy to get by being around someone who is sick with this disease. According to the Centers for Disease Control and Prevention (CDC), if someone has the measles virus they could potentially infect 9 out of 10 people they come in contact with who are not immune (i.e. not vaccinated) to the disease.

Some of the most common symptoms associated with measles are fever, runny nose, and cough which are also very similar to the symptoms of many other diseases. Measles also commonly causes a rash that can cover the entire body. Those who have measles can spread the virus to another person about 4 days before and after the rash shows up. There are also a few more rare but more serious complications that can develop from having the measles virus such as pneumonia and encephalitis and it can also lead to the death of those infected.

The word measles comes from the Middle Dutch word masel meaning “blemish.” The history of measles cases goes relatively far back into history with references of the virus appearing in records as early as 700 AD. In the U.S., before the vaccine was introduced in 1963, there were about 3-4 million cases (essentially every child had had the disease by the time they were 15 years old), about 1,000 people suffered deafness or permanent brain damage (from encephalitis, for example) and around 450 people died from measles each year. By 2000, naturally occurring cases of measles in the U.S. (meaning cases that originated in the U.S. rather than another country) had been eliminated, although there are normally about 50 measles cases per year in the U.S. that come from other countries where measles is endemic (or constantly present in their population) and with increased worldwide travel people need to be more aware of their risk for contracting measles. Throughout the world, there are an estimated 20 million cases leading to about 164,000 deaths from measles each year, which is a great improvement from the 2.6 million deaths that occurred before the measles vaccine was globally used. The number of measles cases, long-term diseases, and deaths caused by measles are going down year by year and much of this progress can be attributed to efforts that provide the measles vaccine worldwide.

While the overall number of measles cases throughout the world are decreasing (mostly from decreasing cases in developing countries) the U.S. and other developed countries are seeing the opposite trend. According to the Notifiable Diseases and Mortality Tables from the Morbidity and Mortality Weekly Report, there were 223 reported cases of measles for 2011 occurring over 17 outbreaks in the U.S. (the average number of outbreaks is 4). This is an increase from previous numbers (63 cases in 2010 and 71 cases in 2009, to name a couple) and the majority of people infected, about 65%, had not been vaccinated against measles even though most of them were eligible to get the vaccine. Out of the measles cases seen in 2011, 90% were traced back to measles viruses seen in endemic countries and brought back to the U.S. where it was spread person to person in the States. Even though historically measles cases have been high in developing countries (especially Africa and Asia) extensive immunization programs have greatly decreased the amount of cases per year. Now European countries are seeing a large increase in their numbers of measles cases since 2009 because the number of vaccinated people has decreased.

The only proven way to effectively protect someone against contracting measles is to get the MMR (measles, mumps, and rubella) vaccine. If you have not been vaccinated then you are leaving yourself vulnerable to getting the diseases included in the MMR vaccine. This issue doesn’t just stop with the individual person, it spreads to everyone that individual comes into contact with. As mentioned above, measles is highly contagious and is spread through the air when an infected person coughs or sneezes so it can easily infect anyone breathing the same air you breath that is also vulnerable to the disease. When people who are vulnerable to getting the disease breathe in the contaminated air, they have a fairly high chance of getting measles and it is important to keep in mind that there are people who cannot get the MMR vaccine because they are either too young (under 12 months old), too sick (i.e. cancer patients), or the elderly who may have lost some of their immunity. For these people, they do not have a choice as to whether or not they get the vaccine, but they still deserve to have some protection from diseases prevented by vaccines. This protection comes from a concept referred to as herd immunity where there are enough people in a community or country vaccinated against a disease so that is unable to be “kept alive” because there not enough vulnerable people for it to pass through. If we are able to keep herd immunity up high enough by having enough people vaccinated against the measles, then the number of measles cases per year could drop back down to the normal 50 per year instead of 220 per year.

Travelers especially need to keep in mind that although a disease, like measles, is usually a rare occurrence in the U.S., this is not the case in many other countries in Europe, Asia, and Africa as examples. People traveling to countries where measles is endemic really should consider being vaccinated because their risk of being infected is much greater due to the higher number of people in the country infected with the disease.

As with anything in medicine, vaccines can cause reactions in rare situations and I urge people to ask their healthcare provider any questions they have regarding the MMR vaccine. I also urge people to receive all of the recommended vaccines they can (unless they have had past allergic reactions to a specific vaccine) because the risk of contracting measles and dying from it is more common than having a more moderate reaction to the MMR vaccine. If you or your kids are eligible to receive the MMR vaccine, please, please get vaccinated and talk to your doctor if you have concerns about an allergic reaction. By getting vaccinated you are not only protecting yourself and your children but also those who are unable to get the vaccine to protect them from the measles. If vaccination rates do not improve, we may very well see case numbers approach historical highs present before the vaccine was used.



Great editorial response to the Jumbotron ad

The Times Square Jumbotron ad keeps trucking, and with it frustration from the medical and public health community. The American Academy of Pediatrics sent a letter to CBS Outdoors, asking them to pull the ad, to no avail. Rahul Parikh thinks it’s time to do more:

We in medicine need more than letters and passive education for parents on a website. What we really need are some Mad Men of our own. If you want guidance, look at what the folks at the the American Legacy Foundation have done with their anti-smoking campaign, The Truth. Who can forget the TV commercial where a truck pulls up to the headquarters of a tobacco company and teenagers jump out, carrying body bags? We need powerful and unforgettable messages that remind us what’s at stake here.

Have you heard the horrifying whoop of pertussis? Seen how meningitis kills and maims kids, or the painful, paralyzing rigor of every muscle in the body of a child with tetanus? Dear AAP, collect those sights, sounds and the true stories of kids injured by vaccine-preventable diseases and the parents who cried for them when they got sick. Then have the audacity to buy space on a jumbotron, right next to NVIC’s, or in a newspaper the day after Generation Rescue takes out another of its bogus ads. Tell the stories of those parents and children — if they’re still alive today — and make it clear that choosing vaccines means choosing health for kids, families and communities.

I agree with what Parikh is saying, but it’s still sometimes tough to get over my gut reaction to that kind of emotional advertising. He’s right that it can be effective where the simple scientific facts don’t work, but like Chris Mooney notes, it also has to be “presented in a context that doesn’t trigger a defensive, emotional reaction.” For those currently eschewing vaccines for their children, that could be tricky to do, but I wonder how many are true “fence-sitters” and not emotionally committed to an anti-vaccine stance? Those are the ones we really need to work with.

[Edited to add: Steven Novella has a great post up today that reminds us why this is such an important fight: Consequences].

Science and the media: three new books

There has been a surge of interest recently in science denial, particularly revolving around the issue of vaccines. Last year saw the release of Michael Specter’s Denialism; in the last few months, three others have been released: Seth Mnookin’s Panic Virus, Robert Goldberg’s Tabloid Medicine, and Paul Offit’s “Deadly Choices.” More about each of them after the jump.
Continue reading “Science and the media: three new books”

Skepchicks are made of awesome–and they could use your help

The Skepchicks are sponsoring a pertussis vaccination clinic at Dragon*Con over Labor Day weekend. They’re teaming up with the Georgia Dept. of Health, who is providing free assistance and vaccines, but they need some assistance raising funds to cover space rental, posters, and other miscellaneous charges. If you’re able to assist, you can donate to their “Hug me! I’m vaccinated!” campaign at the links included in the post.

And while I’m nagging about donations, I’ll also note that donations to help the flooded in Pakistan have been slow, especially compared to the Haiti earthquake. If you can spare a few dollars, Doctors Without Borders is one of my favorite charities (though I’ve not seen a dedicated Pakistan donation page there), and here is one list of other charities working there. With either of these causes, remember that every little bit helps.

The consequences of refusal

I’ve written previously about “chicken pox parties”. These types of events are coming back into vogue (they were common in the days before the vaccine, when the only way to provide immunity was to be infected), as parents mistakenly believe that “natural exposures” to these pathogens are somehow superior–and safer–than vaccinations. Though the latest rage are “H1N1 parties”, chicken pox parties are still around, and potentially being held at your local McDonald’s by families connecting on the internet:

I am trying to put together a chicken pox party and am looking for someone to donate their chickenpox to the event.
I was thinking of having it at McDonald or some place with toys to play on.
if you know anyone who would like to contribute or would like more information on a time and place let me know.

This is, again, one of my biggest problems with those who refuse vaccines. They frame the issue as solely “my child, my choice.” Which is fine, until you put that child in with the rest of society via school, or daycare, or even trips to McDonald’s. These interactions include infants who are too young to get vaccinated; people with chronic conditions or who are receiving chemotherapy, and are therefore more susceptible to disease; or those in whom the vaccine just didn’t “take” (my own measles titers were not high enough to be protective, I learned last year when I was preparing to go to Mongolia–despite having 2 doses of the vaccine), and on and on. Yes, you have the right to make decisions for your child–but parents should realize that this particular choice can put a lot of others in danger.