Jaclyn Grodecki, PHN
& Lindsay Pys, PHN
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March/April 2014
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Welcome & introductions
Define vaccine hesitancy
Review historical context of immunizations including
morbidity & mortality rates of diseases
Discuss where the recent vaccine controversies have come
from and how they are unfounded
Learn how to dispel vaccine myths regarding Autism,
additives (thymerosal, formaldehyde etc), 3 vaccine "needle
overload“, and natural immunity
Understand how to discuss vaccines more effectively with
parents
Talk about process for families who will not immunize
“Vaccine hesitancy is a term used to
describe refusal or delay in regular
immunization schedules due to concerns
about immunization“ (PHAC, 2013).
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lack of information about vaccines
lack of appreciation of the severity and incidence of
vaccine-preventable diseases
conflicting information
mistrust of the source of information
perceived risk of serious adverse events and concerns
regarding injections
sociocultural beliefs (e.g. religious beliefs)
(PHAC, 2013)
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The internet has changed the environment around immunization
The public is increasingly questioning recommendations of
experts and public institutions on the basis of their own, often
web-based research.
The majority of such individuals are not against immunization,
but are seeking answers to questions about vaccine safety,
immunization schedules, changing policies, and the relevance of
some vaccines.
In general, events that are unfamiliar, involve a man-made
process, involve loss of control, are mandatory, or involve a
decision to do something rather than avoid something, are
perceived as risky.
Assess the level and type of
information that an individual wants
and adapt the information provided
accordingly; for example, some
people will appreciate scientific
evidence while others will prefer
anecdotal information and stories
from personal experience.
(PHAC, 2013)
Present evidence in an understandable
way; for example, concepts such as
single event probability or relative risk
may not be understandable for most
vaccine recipients or parents; scientific
jargon and acronyms should be
avoided.
(PHAC, 2013)
Frame immunization in terms of
positive gains
o “A vaccine is 99% safe” is more effective
than, “There is a 1% chance of side effects.”
o “If you decide not to get the vaccine, you
increase your chances of getting a disease,”
is more effective than, “If you decide to get
the vaccine, you decrease your chances of
getting or transmitting a disease.”
(PHAC, 2013)
Use and have available varied
information formats (visual, audio,
printed material, websites), tailored to
a range of socio-cultural groups (i.e.,
educational level, language, ethnic and
cultural background).
(PHAC, 2013)
In order to have a productive
conversations with parents- assess which
aspect(s) of the vaccine is the barrier to
immunizing (e.g. needing info is going to
be a much different conversation than
religious beliefs)
“Vaccine hesitancy is a term used to describe
refusal or delay in regular immunization
schedules due to concerns about
immunization“ (PHAC, 2013).
 lack of information about vaccines
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lack of appreciation of the severity and incidence of vaccinepreventable diseases
conflicting information
mistrust of the source of information
perceived risk of serious adverse events and concerns regarding
injections
sociocultural beliefs (e.g. religious beliefs)
(PHAC, 2013)
 How
vaccines work
 How vaccines are tested & approved
 Timing of vaccines
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http://www.simcoemuskokahealth.org/topics/immunizatio
n/ImmunizationInformation/howvaccineswork.aspx
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Prior to use in Canada, vaccines are extensively tested and the
manufacturer must submit scientific and clinical evidence that
demonstrates the safety and efficacy of the vaccine.
Health Canada supervises all aspects of vaccine production by
manufacturers to ensure safety, efficacy and quality. Vaccine
safety continues to be rigorously monitored and evaluated after
the vaccine is on the market.
Even after a vaccine has been authorized for marketing in
Canada, every batch is laboratory tested for safety and quality.
Canada has a comprehensive vaccine safety monitoring system
which helps to alert public health authorities to trends in
reported adverse events or any unusual adverse events not
previously reported so that appropriate action can be taken
should such a concern arise.
“Myth: Giving a child more than one vaccine at a time can increase the
risk of harmful side-effects, which can overload the child’s immune
system.
 Scientific evidence shows that giving several vaccines at the same
time has no adverse effect on a child’s immune system.
 Children are exposed to several hundred foreign substances that
trigger an immune response every day. The simple act of eating food
introduces new antigens into the body, and numerous bacteria live in
the mouth and nose. A child is exposed to far more antigens from a
common cold or sore throat than they are from vaccines.
 Key advantages of having several vaccines at once is fewer clinic
visits, which saves time and money, and children are more likely to
complete the recommended vaccinations on schedule.
 Also, when it is possible to have a combined vaccination, e.g. for
measles, mumps and rubella, that means fewer injections.”
(WHO, 2013)
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“Current data suggest that the theoretical capacity determined by
diversity of antibody variable gene regions would allow for as many as
109 to 1011 different antibody specificities”
“If each vaccine contains approximately 100 antigens…then each infant
would have the theoretical capacity to respond to about 10 000
vaccines at any one time”
“Of course, most vaccines contain far fewer than 100 antigens (for
example, the hepatitis B, diphtheria, and tetanus vaccines each contain
1 antigen), so the estimated number of vaccines to which a child could
respond is conservative.”
“But using this estimate, we would predict that if 11 vaccines were
given to infants at one time, then about 0.1% of the immune system
would be “used up.””
http://pediatrics.aappublications.org/content/109/1/124.full
“Vaccine hesitancy is a term used to describe
refusal or delay in regular immunization
schedules due to concerns about immunization“
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lack of information about vaccines
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lack of appreciation of the severity and
incidence of vaccine-preventable diseases
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conflicting information
mistrust of the source of information
perceived risk of serious adverse events and concerns
regarding injections
sociocultural beliefs (e.g. religious beliefs)
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(PHAC, 2013)
 Rates
of diseases (morbidity & mortality)
 Change in rates due to vaccine
 Symptoms of diseases
Incidence table
http://www.phac-aspc.gc.ca/publicat/ciggci/p01-02-eng.php#tab1
Map
http://www.npr.org/blogs/health/2014/01
/25/265750719/how-vaccine-fears-fueledthe-resurgence-of-preventable-diseases
“Vaccine hesitancy is a term used to describe
refusal or delay in regular immunization
schedules due to concerns about immunization“
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lack of information about vaccines
lack of appreciation of the severity and incidence of vaccinepreventable diseases
 conflicting
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information
mistrust of the source of information
perceived risk of serious adverse events and concerns
regarding injections
sociocultural beliefs (e.g. religious beliefs)
(PHAC, 2013)
Some of the below professionals do not
believe in vaccination but it seems to be
person dependent
 Chiropractors http://www.drbarryyoung.com/article/1572.html
 Naturopaths http://www.healthwatcher.net/quackerywatch
/Naturopathy/tstar000709-Lisa-Doran.html
“Vaccine hesitancy is a term used to describe
refusal or delay in regular immunization
schedules due to concerns about immunization“
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lack of information about vaccines
lack of appreciation of the severity and incidence of vaccinepreventable diseases
conflicting information
 perceived
risk of serious adverse events
and concerns regarding injections
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mistrust of the source of information
sociocultural beliefs (e.g. religious beliefs)
(PHAC, 2013)
Represent the risks and benefits of
vaccines fairly and openly.
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anticipation of pain and anxiety associated with the needle
coincidental rather than causal adverse events that are
perceived as vaccine-related (autism)
components of vaccine (formaldehyde, thymerosol etc)
risk of vaccine causing disease like symptoms
actual vaccine side effects (or adverse events)
-Common side effects: low fever, sore red spot, small swelling at the site,
irritability or drowsiness
-Additional side effects vary in severity and dependent on type of
vaccine.
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Pain relief options (acetaminophen, breastfeeding, sugar water,
distraction – bubbles, toys)
Coincidental discussion will depend on parental concerns; for
example discuss incidence of normal childhood illnesses (fever,
fussiness, rash), discuss timing of MMR with speech eruption /
early autism signs
Components of vaccine - see handout
Vaccines can cause disease-like symptoms - although live
attenuated vaccines replicate, they usually do not cause disease
such as may occur with the “wild” form of the organism. When a
live attenuated vaccine does cause “disease,” it is usually much
milder than the natural disease and is referred to as an adverse
reaction.
Be open and honest about possible side effects of vaccines. Use
positive phrasing such as “vaccines are 99% safe” as opposed to
“there is a 1% chance of adverse reactions”. Compare side
effects with symptoms of contracting the disease
“Vaccine hesitancy is a term used to describe
refusal or delay in regular immunization
schedules due to concerns about immunization“




lack of information about vaccines
lack of appreciation of the severity and incidence of vaccinepreventable diseases
conflicting information
perceived risk of serious adverse events and concerns
regarding injections
 mistrust
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of the source of information
sociocultural beliefs (e.g. religious beliefs)
(PHAC, 2013)
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Mistrust of the source of information (e.g., perceptions of
business and financial motives of the vaccine industry)
Personal perceptions and the trust in individuals and
institutions that produce, legislate, and deliver vaccines
There are a number of factors that affect the extent to
which an individual is trusted: perceptions of knowledge
and expertise, openness and honesty, and concern and
caring.
Health care providers are perceived as trusted individuals
and have a vital role in ensuring continued success of
immunization programs and in maintaining confidence in
the effectiveness and safety of vaccines.
PHAC, 2013
“Vaccine hesitancy is a term used to describe refusal or delay
in regular immunization schedules due to concerns about
immunization“
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

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lack of information about vaccines
lack of appreciation of the severity and incidence of vaccinepreventable diseases
conflicting information
perceived risk of serious adverse events and concerns
regarding injections
mistrust of the source of information
 sociocultural
beliefs (e.g. religious beliefs)
(PHAC, 2013)
 There
are certain religious individuals (e.g. within
the Catholic, Amish, Muslim or Christian Scientist
religions) who are morally opposed to vaccinations.
Please be respectful of these religious beliefs.
 For those who are morally opposed to vaccines, or
those parents who refuse immunization (despite
HCP best efforts), it would not be in the best
interest of the child to consider releasing the family
from your care. Parents who choose not to
vaccinate must complete a legal statement. This
form must be notarized. These forms must be
brought to Public Health Services.
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Effective treatments do not exist for many vaccine preventable
diseases
Pre-vaccination screening exists to help prevent adverse
reactions
Those who receive vaccines are monitored post vaccine for signs
and symptoms; doctor offices are trained to manage adverse
reactions (eg: anaphylaxis)
Herd immunity will protect those unable to receive the
vaccination- parents should not rely on this (e.g. tetanus) an
unvaccinated child could infect others
Re-emergence of vaccine preventable diseases reappear quickly
once immunization rates begin to decrease (eg: mumps and
measles)
Do you want your child to have the same health advantages that
you had?
http://www.who.int/features/qa/84/en/
http://www.phac-aspc.gc.ca/publicat/cig-gci/p01-04-eng.php
http://www.cps.ca/documents/position/working-with-vaccine-hesitant-parents
http://www.hamilton.ca/HealthandSocialServices/PublicHealth/Immunization/
HANDOUTS
-Incidence of select vaccine preventable diseases in Canada
-Statement of conscience or religious belief
-Statement of medical exemption
-PHO adverse events 2012
-Vaccines may contain additional substances to ensure effectiveness and safety
-Common side effects of diseases and vaccines
-Vaccine schedule for Ontario
-Minimum dose intervals for vaccines
-FAQ for Health Care providers.