Although media exposure has been found to be associated with increased levels of juvenile violence, sexual activity, obesity, and other childhood ills, fewer than one-third of pediatric residency programs in the United States teach about the effects of the media.4 Therefore, most pediatricians have limited formal training in dealing with harmful media influences. The true impact that fiction and nonfiction vaccine-related media stories have on the vaccine program is unknown, but the pediatric health care provider needs to be aware of the messages to which parents are exposed. Acquiring knowledge about vaccines and antivaccine issues highlighted in the press and the ability to effectively communicate this knowledge to the child’s caregiver are the basic tools needed to combat negative vaccine media. These issues are the focus of this article.
MEDIA AND VACCINES
The public’s experience with the media hype about true and alleged adverse effects of vaccines and lack of experience with the potential harmful effects of vaccine-preventable diseases foster an unfavorable view of vaccines in American society. Any negative publicity can degrade the positive image of vaccines. Among others, recent vaccine-related media topics with true scientific merit include:
•The withdrawal of the first licensed rotavirus vaccine because of its possible association with intussusception.
•Reports of Guillain-Barré syndrome following vaccination with the meningococcal conjugate vaccine.
•The suboptimal effectiveness of the most recent influenza vaccine of the 2007-2008 season.
In the past decade, the most damaging media headlines concerned the alleged link of vaccines with multiple illnesses—especially neurodevelopmental disorders. The dangers of the measles-mumps-rubella vaccine (MMR) and thimerosal use in other vaccines have received the most attention. A thorough review of vaccine controversies is available elsewhere for interested readers.5,6
As described by Danovaro- Holliday and colleagues,7 the lesson learned from the withdrawal of the first licensed rotavirus vaccine in 1999 is that the media can shift quickly from highly pro-vaccine to highly antivaccine. Before the discovery of the rotavirus vaccine–intussusception association, only 2 of 88 reviewed newspaper articles were negative toward the vaccine. During the vaccine withdrawal phase, 77% of reviewed articles were negative; the vast majority highlighted potential adverse effects. This approach by the media of “early idealization–sudden condemnation”7 of vaccines can hurt the image of the immunization program.
The mismatch of the influenza B virus chosen for the flu vaccine in 2007 and 2008 was well publicized,8 perhaps leading some parents to refuse this vaccine or view it as useless. In the 2003-2004 flu season, Ma and colleagues9 reported that the media actually helped increase influenza vaccine rates. Physician recommendation in conjunction with media coverage was associated with higher vaccination rates in children aged 6 months to 59 months. Most of the media messages then emphasized that the flu season was early, that it was severe, and that it was associated with pediatric deaths. Sixty percent of parents reported that they vaccinated their children after physician recommendation and more than one-quarter did so following media coverage or recommendation of a friend.
The minority of parents who blame vaccines for health problems, whether valid or not, will be more inclined to believe information that supports their anti-vaccine sentiment.10 The major debasement of MMR occurred in 1998 with the publication of an article by Wakefield and colleagues11 that alleged an association of MMR with autism. Although most of the coauthors of that report published a retraction,12 the damage to the vaccine program in the United Kingdom (UK) had already been done. National rates of MMR coverage dropped extensively in the UK—even as low as 50% in some areas of London.
Smith and associates13 reported less of an impact in the United States. The US decrease in the number of MMR vaccinations was not as drastic or long-lasting as in the UK. These authors concluded that American physicians must have tempered the potential negative impact of the media, probably by providing adequate information to their patients’ families. According to Smith and coauthors, the likely source of the negative MMR information was the Internet, since the number of negative newspaper, television, and radio reports was limited in the United States during the years immediately following publication of the Wakefield study.13
The Internet is a popular source for the promotion of anti-vaccination sentiment. Anti-vaccine groups focus on several specific themes as highlighted by Wolfe and associates.2 According to some critics, vaccines are ineffective and harm the immune system; vaccine adverse effects are under-reported; vaccine-preventable diseases are not that serious; vaccine supporters (pharmaceutical companies, scientists, pediatricians, and others) are purely profit-driven despite vaccine dangers; mandatory vaccines are a violation of civil liberties; and vaccines are immoral.2 Web sites contain the disturbing stories and photographs of youngsters allegedly harmed by vaccines, and strategies are available to aid parents in obtaining vaccine exemptions.2,3
The anti-vaccine movement downplays or does not address the dangers of vaccine-preventable diseases or their prevalence abroad. The possibility that a child’s disability may have resulted from an event in utero is rarely, if at all, mentioned on vaccinecritical Web sites.3 Many distortions can occur on vaccine-critical Web sites, as exemplified by the public figure “Miss America” of 1995 who is deaf. An anti-vaccine Web site implies that the deafness was indirectly caused by an adverse reaction to a vaccine.14 The pageant winner’s own Web site states that the deafness followed an infection with Haemophilus influenzae.15 Ironically, a vaccine was alleged as the indirect cause of the deafness on the antivaccine Web site when, in fact, one could speculate that a vaccine could have prevented the deafness. Such distortions are probably not evident to most parents, however.
May16 describes media as portraying vaccines in a way that promotes irrational fears. Health issues become more reportable if there is drama and personalization. Emotionally charged parental accounts of the evils of vaccines prove to be very effective in promoting fear about immunizations. The use of celebrities to promote the anti-vaccine agenda is a growing trend. Celebrities with minimal, if any, medical background appear on popular television talk shows, write books, and tout the evils of vaccinations based on experiences with their own children and heart-wrenching stories from other parents of alleged vaccine-injured children. Physicians with vast knowledge of scientifically sound information about vaccine safety are sometimes featured alongside these celebrities, which gives the audience the impression that the medical expert and the celebrity carry equal scientific credibility. The media successfully creates the perception that the alleged vaccine controversies have extensive scientific merit.10 The majority of respondents to a survey believed there was equal evidence on both sides of the MMR-autism debate, and less than one-quarter knew that scientific evidence does not support a link between MMR and autism.17
It is quite easy to appreciate why parents experience confusion when the pediatrician promotes vaccine safety while the media highlights the devastation suffered by children allegedly injured by vaccines. The public is further confused with the recent awarding of financial compensation to a family of an autistic child with an underlying mitochondrial disorder; the US courts concluded that vaccinations aggravated the child’s neurodevelopmental abnormality. For further information on this topic, the CDC has made available a media briefing transcript about autism and mitochondrial diseases.18
COMBAT STRATEGY
Every pediatric health care provider must continually stay abreast of the latest issues concerning vaccines. Even if an issue does not seem to be of great significance, the pediatrician should be aware of it so that the parents’ questions can be answered accurately. For example, in early 2008, the Advisory Committee on Immunization Practices updated its recommendation for vaccination against measles, mumps, rubella and varicella; because of the possible minimal increase in febrile seizures after the first dose of MMRV (combination measles-mumps-rubella-varicella vaccine), MMRV is not preferred over separate vaccine components.19
Controversies should be discussed early and often so that misconceptions are not established in the parents’ minds. The importance of vaccinating one’s child should be emphasized and pro-vaccine posters and literature should be displayed in the clinic setting. Zimicki and colleagues20 describe the establishment of a “vaccine day” each month to further emphasize the strong commitment to vaccinating all eligible children.
The American Academy of Pediatrics (AAP) provides information to help pediatricians prepare for media interviews and answer parents’ questions about vaccine-related issues.21 The CDC and the AAP have posted statements to counteract a fictional plot of a recent television show about vaccine damages.22,23 May16 recommends the use of “packaging” information for parents, providing details from both pro- and anti-vaccine viewpoints to allow for a complete discussion. Pediatricians are encouraged to view multiple anti-vaccine Web sites, to watch and/or listen to radio and television shows, and to read articles in parent magazines where vaccines are the topic. By being aware of the alleged ills of vaccinations, one can more readily defend the pro-vaccine sentiment. A major criticism by antivaccine groups is that pediatricians are ignorant about vaccine composition, drug company–government connections, and parental reasons for choosing not to vaccinate.
Parents are more likely to retain information when they are touched personally, (for example, when they listen to another parent describe the difficulties of parenting a child allegedly injured by vaccines). Pediatricians who preach about theoretical dangers of non-vaccination probably leave less of a lasting impression. If the clinician has no experience with caring for children who have suffered from a vaccine- preventable disease, sharing details from published case reports may be helpful. Burgess and colleagues23 emphasize that science alone is not advancing the positive image of the vaccine program. Adding sensitivity and personal experience to the promotion of vaccines may improve the provaccine campaign. Consider proclaiming your personal choice to vaccinate your own children or supporting the vaccination of your grandchildren. The numerous scientifically sound studies that refute much of the negative vaccine publicity can ease many parents’ fears, but sharing your personal choice to vaccinate your own children will probably have an even more powerful impact.
Parents need to understand that the risks associated with non-vaccination become even greater as a larger pool of unvaccinated individuals grows in society. Exposure to the preventable disease becomes more likely when more persons are not immune. The concept of herd immunity should be explained and that choosing not to vaccinate is not without risk. Mention that encounters with some infections may only be a plane ride away. The suggestions listed in a review by Nield and Kamat24 about dealing with parental refusal of vaccines can be employed. The other suggestions in the Table will also help you counteract the anti-vaccine bias.
On the public level, a mass media vaccine campaign can significantly improve vaccination coverage.20 Zimicki and colleagues20 suggest that access to mass media is a key factor in promoting the vaccine program. Culturally sensitive and ethnically specific media messages about immunizations have been shown to be effective tools for positively influencing minority parents.25,26 The messages appeared as advertisements on radio, television, billboards, and printed materials. The prompt use of experts in the media when a vaccine controversy arises will help correct distorted facts from the beginning.
May16 warns that as information gets further and further away from a primary scientific source, the facts have the potential to become more distorted. As recommended by Lewis and Speers,17 the individual health professional should not rely on the government alone to improve the image of the MMR vaccine. These authors contend that some citizens do not trust scientists, fearing conflict of interest from potential financial gain. Promotion by the child’s own primary care provider is likely to be more effective than from an unknown higher authority.
Be aware that alternative medical interventions are also commonly promoted by anti-vaccine supporters.2,3 Pharmaceutical companies that manufacture vaccines are readily chastised for their profit-making motives, but profit-making by the sale of alternative medical supplies and the potential conflict of interest on anti-vaccine Internet sites is not considered.3 Parents need to be reminded that alternative medicine interventions, in general, are also not without risk and have not been rigorously studied in controlled trials as vaccinations have been.
Recent strategies employed by the AAP to combat negative vaccine media include recruitment of parents of autistic children who support vaccines to serve as spokespersons.27 Parents of children who have suffered vaccine-preventable diseases are also being sought to make the dangers of these diseases more tangible to other families. Open discussions about the true risks versus benefits, expressions of concern and understanding of parental fears, and outward support of current vaccines and promotion of even safer vaccines are important to provide for all families.