A few years ago I wrote a blog post “Nurses and Anti-Vaccination” (6-4-12). The post stirred up some interesting and impassioned reader comments. I said then that as a health care provider I consider it my professional duty to stay current on recommended vaccinations, including the annual flu vaccine. I still believe that. In fact, I’ll extend it to state that I believe it is a basic ethical and civic duty for everyone within a community to stay current on recommended vaccinations–unless they have valid medical reasons for an exemption. And, it is a basic duty of our public health/ health care systems to ensure equal access to safe and affordable vaccines.
With the current mutli-state serious measles outbreaks caused by anti-vaccinator parents opting out of vaccinating their children (and then taking them to Disneyland), there seems to be growing public sentiment in favor of stricter vaccine regulations. An important aspect of this ‘hot topic’ which is left out of most news reports, is the fact that it is mainly affluent, educated, white parents who are the anti-vaccinators. They typically believe in everything ‘natural,’ including how natural it is for small children to get really sick (and die) from ‘natural’ childhood communicable diseases. For the truly paranoid/OCD, this would be yet another good reason to never shop at Whole Foods, since I am convinced their shoppers have some of the highest rates of anti-vaccination anywhere in a community.
But on a less strident note, I do understand that anti-vaccinators (parents or otherwise) are not evil or stupid–and that it does no good from a practical and public health perspective to try and shame them into changing their minds. As I teach my nursing students, in approaching this topic with friends, family members, and patients, it is helpful to step back and use positive communication techniques from motivational interviewing–of establishing basic respect first, then exploring the motivations, fears, and beliefs behind the action. Only then can possible positive changes occur.
This past year, Eula Biss’ book On Immunity:An Innoculation (Graywolf Press 2014) addressed the issues related to anti-vaccination. I had high hopes when I first purchased her book and began to read it. While the book is well-written and mostly a pleasure to read, it was almost too easy to read. It felt more like I was eavesdropping on informal chatty banter from a neurotic new mother, albeit from an intelligent (and likeable) neurotic new mother. And while I understand her choice to not include real citations/footnotes for sources, that made me not trust many of the things she claimed to be ‘facts.’ I got really annoyed with how many times she inserted random quotes from her oncologist father. Other quotes/comments she included from various ‘experts’ seemed to be straight out of Frontline’s ‘video ‘The Vaccine War’ from 2010. Frontline’s website is an excellent and more updated resource for discussion and education on this topic. Michelle Dean posted the interesting piece ‘A Q&A With Eula Biss’ with further insights into why she wrote the book (Gawker Review of Books, 9-30-14).
The national debate on vaccination continues. Epidemiologist Saad B. Omer from Emery University wrote an important NYT op-ed piece “How to Handle Vaccine Skeptics” (2-6-15) advocating for policy-level changes to address high ‘opt-out’ rates. And poor Mississippi even made the news recently in conjunction with this topic: they have among the strictest state vaccine ‘opt-out’ laws and “the country’s highest immunization rate among kindergartners.” (Alan Blinder, “Mississippi: A Vaccination Leader, Stands By Its Strict Rules” NYT, 2-4-15).