It was flu season.
I was meeting the usual frustrations of trying to convince my patients to get the flu shot. The flu vaccine has such potential to save lives, yet its reputation is marred by misinformation, leading people to decline this simple, inexpensive, and effective way to limit disease and death. Day in and day out, I felt like I was beating my head against a wall.
This particular day, I was visiting with a patient for her annual wellness visit. Let’s call her Mary. Mary voiced a common response to my flu shot offer — “No thanks.” It would have been easy enough to let this slide. We had lots of other things to talk about. But I wanted to know why. So I asked, “What worries you about the flu shot?”. “I’ve heard all the stuff in vaccines can cause cancer, and so many of my family members have died from cancer,” she said. “Why would I do something that would increase my risk of dying?”
An “a-ha” moment
I learned three valuable lessons from this interaction.
1. If we don’t ask why patients are declining vaccination, we’ll miss an important opportunity for education.
2. There is a ton of misinformation out there. Patients are just trying to make the best decisions they can with what they know.
3. Fear is the primary driver of resistance to vaccines.
These “a-ha” moments allowed me to empathize. It’s a confusing world out there. With Facebook, Twitter, Google, and more, there is such easy access to information. And some of it is good and true, but much of it is not. There are statistics that are skewed to show certain outcomes. There are heart-yanking videos that scare the bejeezus out of us. There are “fake news” articles that are made to look like the real thing. How is your average non-medical person to know fact from fiction?
A constantly shifting goal post
I was able to speak to Mary’s fears, but there were so many other vaccine claims coming my way that I just didn’t feel equipped to handle. I knew what patients were claiming about vaccines was false, but I didn’t have the data to support my assertions. In medical school, we study infectious disease, pathophysiology, immunology, public health, and more. But what we don’t have is a sort of “putting it all together, putting it into practice” curriculum that helps us address the vaccine-hesitant patient sitting in front of us.
Knowing that my inability to confidently answer my patients’ concerns was negatively impacting their care didn’t sit well with me. I set out to educate myself. I took every anti-vaccine claim I had ever heard and begun researching any evidence I could find that would support or refute those claims. And what I found was overwhelmingly, without a doubt, contrary to what patients were asserting.
It’s not just about the data
I also learned that convincing people of the safety and efficacy of vaccines was actually more about the approach to the discussion. Building trust is of utmost importance. A presumptive approach, bundling recommendations, and motivational interviewing techniques can help patients gain confidence in the decision to vaccinate. I studied the psychology of the anti-vaccine movement and how people can continue to believe a claim when all evidence points against it. My research became not only a study of hard science and statistics but also a study of social science. Why do people do what they do and believe what they believe? Fascinating stuff!
How best to educate the masses?
One of my passions in medicine is efficiency of care. And inefficiency drives me nuts! Imagine the frustration of knowing what I know and only being able to share it with one or two people at a time. All the while, competing against a social media machine that has access to our patients 24/7. I felt like I was fighting an impossible battle.
I was also beginning to recognize how much my fellow medical partners were struggling with the same issues. Some continued fighting, but others had given up completely, letting the subject drop when patients declined vaccines. This left patients unvaccinated and unprotected and left a bad taste in the mouths of those providers. It fostered resentment toward patients who chose not to vaccinate. I wanted to help. I wanted to take what I had learned and share it.
But who has the time?
During the course of my research, I found innumerable studies countering anti-vaccine claims. There are a multitude of organizations working to support vaccination and better the health of our communities. There are amazing websites, blogs, and videos with reliable vaccine information. But none of it was in one, easily accessible place.
Primary care providers are busy. We hardly have time to spend with friends and family or to pursue self-care, let alone spend the hundreds of hours necessary to find all this useful information. This is where I come in. I had already done the research. I had compiled the data. I had the time and the passion for putting it all together.
The birth of a book
I wrote my book for you … for the clinician who seeks to keep patients from falling victim to vaccine misinformation; for the educators, who want to arm our next generation of medical professionals with the tools they need to advocate for preventive care and public health; for anyone who desires to work together with those on the fence about vaccines, as opposed to facing off in an unrewarding adversarial relationship. My aim is to educate, facilitate discussion, increase vaccination successes, and to decrease the daily frustrations of our hard-working primary care colleagues.
The WHO named vaccine hesitancy one of the top 10 threats to global health in 2019. I don’t believe this to be an overstatement. Around the world, we have seen the highest numbers of measles cases in decades. Influenza killed 80,000 people in the U.S. in 2017-18. Mumps and pertussis cases are on the rise. Polio is making a comeback in the Philippines.
We need vaccine advocacy now more than ever. Get educated. Speak up. Let’s make the voices of science and reason the voices our patients hear when they seek out vaccine information on the internet.
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