POST 01334E: PROTECTING PUBLIC TRUST IN IMMUNIZATION

POST 01334E: PROTECTING PUBLIC TRUST IN IMMUNIZATION 11 OCTOBER 2008 ******************************************* Claude shares with us this interesting article on how important pubic trust is to the success of immunization programmes and the threats to this trust and how trust could be built and sustained. Many thanks. Our current news updates on the TechNet21 website on the resurgence of measles in the UK and US make interesting reading in this context. -------- "Protecting Public Trust in Immunization" (Louis Z. Cooper et al. Pediatrics, 2008;122;149–153) Background Vaccination against childhood diseases is one of the greatest medical success stories of the last half-century. Worldwide, tens of millions of lives have been saved thanks to vaccinations. Over past years, clinicians and public health leaders have taken for granted the magnitude of that act of trust. Public trust in the safety and efficacy of vaccines is one key to the remarkable success of immunization programs within the United States and globally. This success has come from considerable and focused investment (financial and scientific) in the development of vaccines, the biological effectiveness of vaccines, sound public policy and implementation in delivering vaccines to target audiences, and a history of high levels of public trust in vaccine safety and efficacy. This trust is an expression of a special social contract that is one key to the success of immunization programs. Allegations of harm from vaccination have raised parental, political, and clinical anxiety to a level that now threatens the ability of children to receive timely, full immunization. This article offers reflections on factors that have contributed to this situation and some suggestions that may help to strengthen public trust and decrease the polarity that is sapping precious health resources. New dynamics and drivers that have lead to a more questioning public around the safety and efficacy of vaccines. Multiple factors have contributed to current concerns, including: 1. incomplete science; 2. faulty or dishonest "science"; 3. political motivation; 4. financial motivation; and 5. philosophic and religious objections to immunization or some constituent used in vaccine preparation. Given the long history of vaccines, there has also been: A dramatic increase in the number of vaccines available and recommended for routine use. [/list] Consumerism has risen, with people wanting to understand health issues and assume responsibility for their own health decisions (the end of medical paternalism) and physicians wanting patients to become partners in their care. [/list] Information technology has increased access to information and misinformation about immunization. Unfortunately, misinformation has equal access to the Internet, and the volume of this non­sccience-based material exceeds that from reliable sources. Rumor, disinformation, and misinformation can be spread globally in minutes. [/list] What can be done to strengthen public trust in immunization? Investment in two key areas is critical to strengthening public trust. 1. Increased investment in immunization-safety science. Immunization safety science requires leadership, infrastructure, facilities and human resources, and appropriate long-range planning and funding different from, but appropriately comparable with, the programs that have contributed to the great success of immunization programs. Biological, social, and communication sciences play important roles in immunization safety. Some of these sciences are more central and obvious than others, such as allergy/immunology, epidemiology, and infectious diseases. But anthropology, ethics and political science also have important roles given the multiplicity of questions. Research on the short- and longer-term risks and benefits of combinations and timing of multiple vaccines requires a different profile of disciplines and social and communication science may outline different aspects than biological science alone. 2. Increased financial investment and significant rethinking by the "vaccine community" in its communication strategy. The following suggestions for strengthening public trust are worthy of consideration by national and local public health, industry, medical, consumer, and political leaders: Invest more in public awareness and genuine public engagement around immunization issues. Recognize the number and heterogeneity of publics to be served and the diversity and legitimacy of their questions and concerns. Improve the communication skills of public and private health leaders to present information in perspective, including benefits, risks, and gaps in knowledge. Avoid obfuscation, admit gaps in knowledge, and be available and candid in answering the questions asked, building comfort even when the circumstances are uncomfortable. Take the time to explain changes in recommendations/policy. Such explanations are essential for reducing charges of waffling, indecision, and hidden agendas. Invest in research on what is truly driving parents' questions and concerns and what may be needed to earn/keep their trust in vaccines. Conclusion Investments in immunization-safety science and in communication strategy are absolutely interdependent, because effective communication must rely on clear information that is based on adequate immunization-safety science. Prompt attention by public health leadership to spreading concern about the safety of immunization is essential for protecting deserved public trust in immunization. To read the full article, Protecting Public Trust in Immunization, click on http://pediatrics.aappublications.org/cgi/content/full/122/1/149 NOTE: Access to this full article is on a pay per view or subscription basis. Post generated using Mail2Forum (http://www.mail2forum.com)