Vaccine Safety: Overcoming Media Reports and Public Concerns

[Guest guest]

Date: Thu, 25 Jan 2001 16:47:44 -0500

From: Belkin <Belkin@...>

What a joke. Doctors are so brainwashed about vaccine safety they think

they can brainwash everyone else, with no evidence or skill.

I have a better proposal for them: Have Merck buy every citizen lunch

each day, like they do for pediatricians in medical school -- then

everyone will take their vaccines and pay no attention to media

scaremongering.

MB

+++++++++++++

http://www.medscape.com/CMECircle/Pediatrics/2000/CME02/CME02-04.html

Vaccine Safety: The United Kingdom Experience

Salisbury, MB, FRCP, FRCPH, MFPHM

Overcoming Media Reports and Public Concerns

Slide. Guiding Principle Used by Department of Health

So what are the principles that we use in trying to deal with all of

this? The first is we try to predict, we try to

prepare, we try to be proactive, and we try to achieve positive

responses, and I'll show you these in turn. So what

can you do about prediction?

Slide. Predictions

Well, we do have reasonable ideas, which topics are likely to attract

public interest; thimerosal and mercury

toxicity, not surprising, autism, multiple sclerosis, multiple vaccines

and immune overload. We can anticipate

these are likely to cause trouble. They share common features of an

unknown etiology condition that the public

fears. Often there is a long latency, and that makes the evidence to

negate the claims all the more difficult to get.

It will be almost impossible to set up new studies using immunized and

unimmunized groups. We won't have

unimmunized control groups after vaccines are introduced nationwide. And

the lack of evidence from those

proposing vaccine scares does not appear to hinder them at all. The

public would expect us, the authorities, to

prove the negative, or the theories stand unchallenged.

Slide. Preparation

So what can we do in preparation? Well, ideally the prediction would

have identified the forthcoming problem,

and it's possible that routine information sources will suffice to give

answers, but it is more than probable that

they will not give the answers. So critical is the phase of intelligence

gathering. Does adequate data already

exist that can answer the problem? And it may be that that data is

already there. How feasible is it to collect new

data? And here very important, how much can you find out about the cards

in other players' hands? Most of

these people are so proud of their claims that they'll tell you all

about their experiments if you just ask, but

remember that you're starting from behind in all of these scare stories.

If you need to set up studies to counteract

the scare, it's unlikely that you will have the answers in time, and an

answer that we are awaiting these studies

does not reassure anybody.

Slide. Proactive Steps

So what can you do to be proactive? Well, the first is that uninformed

health professionals will undermine your

efforts. It may be difficult to alert health professionals as promptly

as they would wish because of embargoes on

publications. Many of us often know about material which is about to

appear in a journal, but we cannot tell the

world because there is an embargo on it. You have to appreciate that

doctors hate finding out about vaccine

scares from their patients. It's not difficult for journalists to find

one doctor who will give unhelpful comments, often

based on ignorance, but that is irrelevant. You should provide health

professionals with multilayered information,

both for themselves and for them to use with parents, and wherever

possible, you should involve independent

experts who can endorse your response. You should share the problem if

possible, so you can present a broad

coalition.

Slide. Proactive Steps

So what about proactive? Well, prepare information materials for parents

on many levels, for all audiences. Give

references to parents. If you've quoted a piece of work, give the

parents the reference, they add credibility, and

actually they're very rarely followed up, but it doesn't matter. It at

least shows that you're not just giving opinions.

Test all materials that you use for parents and health professionals

before you print a million leaflets. What

makes sense to you and looks attractive may be useless in getting a

message across. Try to find ways to target

your information to the right health professionals, and more

importantly, to the right parents at the right time, and

I'll show you some of that in a moment. If you brief friendly

journalists, remember that they cherish their

independence, they're always going to show both sides of a story. The

critical issue is where do they draw the

line?

Slide.

So what have we done to be proactive or be responsive? So here is an

example of how we sent a letter from the

Chief Medical Officer to every single doctor in the United Kingdom,

measles-mumps-rubella vaccine, Crohn's

disease and autism, and the point here is that this letter, which is

about six sides long, demolishes a whole lot of

the arguments about an association. I would have been mortified if my

work had been so criticized.

Slide. Leaflet

Now here's an information leaflet we can use for parents where we go

through the arguments about MMR,

autism, and bowel disease and so on. This was pre-tested before we ever

issued it, and then tested afterwards.

This is sent through the computerized register system, so that whenever

a child is being called for their MMR

immunization, this leaflet can be inserted in the call-up letter, goes

by post, direct to the parent, before they bring

their child for immunization, so the parent already has read the

information by the time they come to the primary

care physician.

Slide. Positive Responses

So what about positive responses? Tell the truth, give clear messages.

While parents want to feel that they're

making a choice, very few will be sufficiently informed to actually be

making a fully informed choice. Unless they

have degrees in epidemiology, statistics, immunology, virology and

bacteriology, and vaccine design,

manufacturing, quality assurance and quality control, it's unlikely that

they will actually make an informed choice,

but they like to feel that they're doing that. Risk assessment by

parents and many health professionals implies a

degree of rationality which is usually absent. If you say to someone the

risk is one in a million, do they interpret

that differently to a risk of 1 in 100,000? As soon as you put a number

on a risk, you validate the risk; you give a

veracity that there is a risk. We know that's not what the statistics

mean, but it's not interpreted that way. I believe

we should not offer a choice of risks. If you say to people the risk

after the vaccine is this, the risk after the

disease is that, and it's far better to have the vaccine than the

disease, that doesn't mean anything to parents

who have never seen measles, have no perception, and for whom it

actually is not a real fear because most

parents' children will never get measles now. So this business about

saying here's the risk, here's the benefit is

very difficult to put into realistic terms within peoples' lives. Do not

patronize. To say we're the experts so you can

believe us, goes down like a lead balloon. The expertise of anybody

called doctor by a journalist is considered

as credible as anybody else called doctor, and you can always find a

doctor who'll say something different. A

professor can be a bit tricky. People know that professors are

important, but they're always thought to be a bit

too brainy, so don't use too many professors.

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Vaccine Safety: The United Kingdom Experience

Salisbury, MB, FRCP, FRCPH, MFPHM

Overcoming Media Reports and Public Concerns

Slide

Slide. Guiding Principle Used by Department of Health

So what are the principles that we use in trying to deal with all of this?

The first is we try to predict, we try to prepare, we try to be proactive,

and we try to achieve positive responses, and I'll show you these in turn.

So what can you do about prediction?

Slide

Slide. Predictions

Well, we do have reasonable ideas, which topics are likely to attract

public interest; thimerosal and mercury toxicity, not surprising, autism,

multiple sclerosis, multiple vaccines and immune overload. We can

anticipate these are likely to cause trouble. They share common features of

an unknown etiology condition that the public fears. Often there is a long

latency, and that makes the evidence to negate the claims all the more

difficult to get. It will be almost impossible to set up new studies using

immunized and unimmunized groups. We won't have unimmunized control groups

after vaccines are introduced nationwide. And the lack of evidence from

those proposing vaccine scares does not appear to hinder them at all. The

public would expect us, the authorities, to prove the negative, or the

theories stand unchallenged.

Slide

Slide. Preparation

So what can we do in preparation? Well, ideally the prediction would have

identified the forthcoming problem, and it's possible that routine

information sources will suffice to give answers, but it is more than

probable that they will not give the answers. So critical is the phase of

intelligence gathering. Does adequate data already exist that can answer

the problem? And it may be that that data is already there. How feasible is

it to collect new data? And here very important, how much can you find out

about the cards in other players' hands? Most of these people are so proud

of their claims that they'll tell you all about their experiments if you

just ask, but remember that you're starting from behind in all of these

scare stories. If you need to set up studies to counteract the scare, it's

unlikely that you will have the answers in time, and an answer that we are

awaiting these studies does not reassure anybody.

Slide

Slide. Proactive Steps

So what can you do to be proactive? Well, the first is that uninformed

health professionals will undermine your efforts. It may be difficult to

alert health professionals as promptly as they would wish because of

embargoes on publications. Many of us often know about material which is

about to appear in a journal, but we cannot tell the world because there is

an embargo on it. You have to appreciate that doctors hate finding out

about vaccine scares from their patients. It's not difficult for

journalists to find one doctor who will give unhelpful comments, often

based on ignorance, but that is irrelevant. You should provide health

professionals with multilayered information, both for themselves and for

them to use with parents, and wherever possible, you should involve

independent experts who can endorse your response. You should share the

problem if possible, so you can present a broad coalition.

Slide

Slide. Proactive Steps

So what about proactive? Well, prepare information materials for parents on

many levels, for all audiences. Give references to parents. If you've

quoted a piece of work, give the parents the reference, they add

credibility, and actually they're very rarely followed up, but it doesn't

matter. It at least shows that you're not just giving opinions. Test all

materials that you use for parents and health professionals before you

print a million leaflets. What makes sense to you and looks attractive may

be useless in getting a message across. Try to find ways to target your

information to the right health professionals, and more importantly, to the

right parents at the right time, and I'll show you some of that in a

moment. If you brief friendly journalists, remember that they cherish their

independence, they're always going to show both sides of a story. The

critical issue is where do they draw the line?

Slide

Slide.

So what have we done to be proactive or be responsive? So here is an

example of how we sent a letter from the Chief Medical Officer to every

single doctor in the United Kingdom, measles-mumps-rubella vaccine, Crohn's

disease and autism, and the point here is that this letter, which is about

six sides long, demolishes a whole lot of the arguments about an

association. I would have been mortified if my work had been so criticized.

Slide

Slide. Leaflet

Now here's an information leaflet we can use for parents where we go

through the arguments about MMR, autism, and bowel disease and so on. This

was pre-tested before we ever issued it, and then tested afterwards. This

is sent through the computerized register system, so that whenever a child

is being called for their MMR immunization, this leaflet can be inserted in

the call-up letter, goes by post, direct to the parent, before they bring

their child for immunization, so the parent already has read the

information by the time they come to the primary care physician.

Slide

Slide. Positive Responses

So what about positive responses? Tell the truth, give clear messages.

While parents want to feel that they're making a choice, very few will be

sufficiently informed to actually be making a fully informed choice. Unless

they have degrees in epidemiology, statistics, immunology, virology and

bacteriology, and vaccine design, manufacturing, quality assurance and

quality control, it's unlikely that they will actually make an informed

choice, but they like to feel that they're doing that. Risk assessment by

parents and many health professionals implies a degree of rationality which

is usually absent. If you say to someone the risk is one in a million, do

they interpret that differently to a risk of 1 in 100,000? As soon as you

put a number on a risk, you validate the risk; you give a veracity that

there is a risk. We know that's not what the statistics mean, but it's not

interpreted that way. I believe we should not offer a choice of risks. If

you say to people the risk after the vaccine is this, the risk after the

disease is that, and it's far better to have the vaccine than the disease,

that doesn't mean anything to parents who have never seen measles, have no

perception, and for whom it actually is not a real fear because most

parents' children will never get measles now. So this business about saying

here's the risk, here's the benefit is very difficult to put into realistic

terms within peoples' lives. Do not patronize. To say we're the experts so

you can believe us, goes down like a lead balloon. The expertise of anybody

called doctor by a journalist is considered as credible as anybody else

called doctor, and you can always find a doctor who'll say something

different. A professor can be a bit tricky. People know that professors are

important, but they're always thought to be a bit too brainy, so don't use

too many professors.

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