Stories We Don’t Tell—And Should

Which stories within health care are told, are shared widely, and which are not? Who holds the talking stick power to tell their stories and have them listened to? The ethics of storytelling about health, illness, and healthcare experience is an important and overlooked aspect of medical and public health ethics.

One current event case in point: The NYT editorial board published a compelling piece this past week, “How to Inoculate Against Anti-Vaxxers.” They highlight the fact that the World Health Organization has added vaccine hesitancy (or outright refusal) as one of the top ten global health threats for 2019. And they point to the outsized power of the singular (and scientifically inaccurate) stories of anti-vaxxers who use emotionally-charged personal anecdotes of the “horrors of vaccination” to persuade people not to vaccinate themselves or their children.

Not included in this opinion piece is the fact that this is a significant health equity issue since the overwhelming majority of anti-vaxxers are affluent white people (a story that needs to be told). Hence, the current event here in the Pacific Northwest of Portland, Oregon (the whitest city in the US) being the epicenter of a large measles outbreak—because Portland is a hot spot of anti-vaxxers. Washington State Governor Jay Inslee has declared a public health state of emergency over the measles outbreak that has spread from Portland into southwestern Washington State and now up to Seattle.

Something else that is not talked about—a story not told—is the fact that so many naturopaths and other alternative/complementary medicine practitioners are actively anti-vaxxers themselves and pass this on to their patients.

Nurses play an outsized and important role in educating people—especially parents—about the benefits of vaccinations. As the NYT article points out, the vast majority of parents who are vaccine hesitant are open to conversations with healthcare providers about the risks and benefits of specific vaccines. Taking the time to listen to their concerns and answer their questions—using motivational interviewing techniques—can help lead to a healthier future for everyone. Nurses and other healthcare providers can tell true stories of all the uneventful vaccinations that led to healthy children.

Shame on Anti-vaccinators

IMG_3414A 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 RulesNYT, 2-4-15).