Combatting Anti-Vaccine Misinformation
1) How do I figure out what is true, and what is false, about vaccines?Open or CloseIt is a sad but undeniable fact that there is a lot of misinformation, and in some cases downright lies, circulating about vaccines. This is especially true for the MMR vaccine, but the pernicious effects of the “anti-vaxxers” movement have expanded to the HPV vaccine as well. A recent outbreak of measles in the US has affected more than 100 individuals in 21 states and the District of Columbia. This follows on the heels of outbreaks in 2017, 2016, 2015, etc., including a record number of 667 cases in 2014. How bad is this anti-vaccine mania? Wealthy neighborhoods in Santa Monica and Beverly Hills now have vaccination rates that are similar to those seen in Chad and South Sudan. At some schools more than 60 percent of the kids have filed “personal belief exemptions” that allow them to avoid vaccination.
In my answers to the questions below I’ve listed a number of books and websites that I would recommend so you can learn the facts about how vaccines work, and why the anti-vaccine movement ignores the science.
In the case of HPV, the CDC has assembled a full page of educational and other resources. You can look at similar pages for other vaccines, including measles, shingles, polio, tetanus, and many others.
Note: Some of the information on the internet, either in support of or against vaccines, is actually posted by Russian Trolls are spreading misinformation about vaccines on the internet. Their goal is simply to foment discord. Think critically about any vaccine information that you come across, either positive or negative.
You can also look at the website Media Bias/Fact Check, which maintains a list of conspiracy/pseudoscience websites that you do NOT want to be getting your information from, along with a list of science based websites that are factually based.
A good place to start is the History of Vaccine Safety page on the website of the Centers for Disease Control (CDC). You can also learn about the National Childhood Vaccine Injury Act of 1986 in this same place, and why it was necessary to develop this legislation.
A FREE newly published review paper in Feb. 2019 is an excellent source for getting a handle for what is, and what is not true, in vaccine safety.
DeStefano et al Principal Controversies in Vaccine Safety in the United States. Clinical Infectious Diseases, ciz135, https://doi.org/10.1093/cid/ciz135
Vaxopedia has a compilation of 100 myths about vaccines. Yes, there really are at least that many circulating.
You can also take a look at Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee
2) Are there any good books to read about why people who oppose vaccinations are seriously misinformed?Open or CloseIndeed there are. Take a look at:
The Panic Virus: The True Story Behind the Vaccine-Autism Controversy by Seth Mnookin (2011). A detailed expose about the Andrew Wakefield/vaccines cause autism scandal in Great Britain. This book won the National Association of Science Writers Science in Society Book Award, and was named one of The Wall Street Journal's Top 5 Health and Medicine books of the year.
On a more personal level, I’d also recommend Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad (inspired by his daughter) by Dr. Peter Hotez. As the title indicates Dr. Hotez is a pediatrician, a highly respected vaccine researcher, and the parent of a daughter with severe autism who suffers from intellectual difficulties. He explains the science regarding why vaccines don’t cause autism, what is thought to cause autism, and how he works to combat the voices of anti-vaccination groups.
Do Vaccines Cause That?! A Guide for Evaluating Vaccine Safety Concerns by Martin G. Myers, MD, and Diego Pineda (2008). Does exactly what the title says it does.
There are also four other books I can recommend to learn more about the anti-vaccine movement. Both were written or co-authored by Dr. Paul Offit, a very well known vaccine expert who led a successful effort to develop a vaccine against rotavirus (which can cause fatal diarrhea). This vaccine is saving the lives of hundreds of children across the world every day.
Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (2012) - I highly recommend this one. It covers similar territory to the Panic Virus, but Mnookin’s book is written by a journalist, Offit’s book is written by a physician-researcher who has lived and breathed this subject for years. He is largely responsible for the development of the rotavirus vaccine, which saves the lives of hundreds of children somewhere in the world every day.
Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information (2018) or to put it another way, why the internet isn’t the best place to get your health care information. In this book Dr. Offit explains why you shouldn’t be getting your healthcare advice from Gwyneth Paltrow and her ilk. He also explains why he seldom gets in front of the public to argue with anti-vaxxers. The book is a fast read and basically covers two ideas. About half of the book explains why much of the information available from people with no training in medicine or science is at best mostly worthless and at worst sometimes dangerous. He also gives some very good advice for scientists who are planning on engaging with the press to challenge this bad information. Much of this advice is based on his (few) professional career missteps and is meant to guide you to best handle (and hopefully avoid) lawsuits, death threats, biased debate moderators, and ineffective arguments from those you engage with.
Vaccines and Your Child: Separating Fact from Fiction by Paul Offit and Charlotte A. Moser (2011). This book is focused on allaying parent’s fears about vaccines.
Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure by Paul Moffit (2008). This book is an expose of all that went wrong when autism in children was unfairly linked to the MMR vaccine by a British doctor who’s research has been debunked.
In putting together this website, I’ve tried to always include links to authoritative sources for the data I’m quoting. However, I suggest you always consult your doctor or medical provider for the best and most recent information. Science and medicine change constantly as new discoveries are made, and I can’t guarantee that everything on even my website is up to date.
3) I want to learn why people who oppose the HPV vaccine (and others) are wrong.Open or CloseIn addition to reading the books I listed above, there are a number of resources that you can turn to. One that I recommend is the Respectful Insolence website. The author of this website, Dr. David Gorski, invests a lot of time debunking studies that purport to show damage caused by vaccines, including the HPV vaccine. As of August 2018, he’s written 148 different blog posts exposing the problems with these anti-vaccine studies. Among these posts are ones specifically focused on HPV. Here’s just one example you can look at: A dumpster fire of a study about HPV vaccination and female fertility, courtesy of Gayle Delong
I also came across an interesting website that has answers to questions that are frequently asked about HPV and cancer, but with two completely different answers to each question. One set of answers is taken from a conservative website (Conservapedia HPV vaccine FAQ), and the second answer to each question is a set of “reality based” responses based on the science. An interesting look at just how differently this subject is viewed, and how little science based information is available on the Conservapedia site.
You might want to take a look at Answering human papillomavirus vaccine concerns; a matter of science and time by David Hawkes, Candice E Lea, and Matthew J Berryman from Infectious Agents and Cancer 2013, 8:22 (free, open access)
Some of you might enjoy comedians Penn and Teller’s humorous explanation for why all modern vaccines have great value. There’s a humorous video HPV Barbie, which unfortunately gets the facts wrong. It might get people talking about HPV, but it’s a good example of why you need to keep in mind that everything you hear about vaccines online is not true. I don’t think Mattel is going to like it, especially since they cite incorrect facts about the HPV vaccine.
Commentator and comedian John Oliver also had some good insights to share about the value of vaccines in this video from Last Week Tonight.
4) So you’re saying that all vaccines are completely safe?Open or CloseActually, I’m not. Vaccines are truly one of mankind’s greatest inventions, and they have saved hundred of millions of lives over the past few centuries. Vaccines, like many things, are not, and likely will never be, completely safe for every individual that receives them. With billions of doses having been given, it’s not at all surprising that there will be rare serious side effects (see the list here from the CDC). However, you’re more likely to be attacked by a shark or hit by lightning than to suffer one of these. Good scientists acknowledge this fact, and will point out the issues involved. An opinion piece in the NY Times suggested that some scientists have gone overboard in defending vaccines against the anti-vaxxer crowd, hesitating to acknowledge that some vaccines do indeed cause rare problems for some people who get them. Vaccine expert Dr. Paul Offit responded by pointing out that these infrequent vaccine injuries have not been hidden. They’ve been published, often and widely, though the quality of these reports varies greatly. Good scientists know that bad science does get published, but as it tends not to be replicable, most of it eventually falls by the wayside.
5) Since the HPV vaccine prevents numerous cancers, why is it so hard to have people act on that info?Open or CloseIt’s a complicated issue, but I can refer you to the following articles that discuss this:
Read about the many issues in getting people to want to be vaccinated in
Assessing the State of Vaccine Confidence in the United States: Recommendations from the
National Vaccine Advisory Committee. Approved by the National Vaccine Advisory Committee on June 10, 2015
What makes some parents fall for anti-vaccine messaging: Public health officials may not be hitting on the right morals in their quest to get all children vaccinated.
Here's The One Thing Scientists Have Found Will Change Anti-Vaxxers Minds: Logic is futile.
The 'Attitude Roots' Underlying Antivaccination Beliefs
Inadvisable anti-vaccination sentiment: Human Papilloma Virus immunisation falsely under the microscope, Head ed all npj Vaccines volume 2, Article number: 6 (2017)
A Hundred Thousand Wombs by Riko Muranaka, a personal look at how rumors about the safety of HPV vaccine in Japan caused vaccination rates to plunge. The author won an award for exposing these rumors as false. The story is also covered in Why Japan’s HPV vaccine rates dropped from 70% to near zero, and how one doctor is fighting back.
6) Is there a good site on the internet to find out if rumors about vaccines are true or false?Open or CloseYes. The best site I’ve found on the internet for checking out ALL rumors (not just those about vaccines) is SNOPES.com. It’s very reliable, and you can read about the methodology that they use here.
Here’s an example of their debunking of a rumor about the HPV vaccine:
FALSE: Pediatricians’ Association Admits HPV Vaccine-Cancer Link: A misleading article claimed that an association of pediatricians had "admitted" a link between the human papillomavirus vaccine Gardasil and ovarian "failure" or cancer.
7) Are there any good TED talk videos online about vaccines, vaccine safety, and fear of vaccines?Open or CloseThere are quite a few of these. The descriptions below are all taken directly from the online details about the TED talks on You Tube.
Seth Berkley: The troubling reason why vaccines are made too late, if they’re made at all. 7:17 in length (from 2015).
“It seems like we wait for a disastrous disease outbreak before we get serious about making a vaccine for it. Seth Berkley lays out the market realities and unbalanced risks behind why we aren't making vaccines for the world's biggest diseases.”
Tara Haelle: Why Parents Fear Vaccines. 12:15 in length (from 2016)
“Tara Haelle will focus on vaccine hesitancy and vaccine refusal. This is a global health threat that lurks unnoticed until it erupts into unpredictable disease outbreaks that are difficult to contain. She explains what underlies the fear and hesitancy that many people have toward vaccines, why it's not as irrational as some believe, and what's necessary to address it.”
Danielle Stringer: Why I Changed My Mind On Vaccinations. 16:28 in length (from 2017)
“”Vaccines are BAD! Wait! Vaccines are GOOD!" - Pediatric Nurse Practitioner, Danielle Stringer, shares her experience and ideas that caused her to leave her vaccine-hesitancy behind and advocate for immunizations.”
Dr. Lindsay Levkoff Diamond: Vaccination: A Story of Risk & Community. 13:09 in length (from 2015)
“Herd immunity works for vaccinations as it does Facebook share fact checking. Dr. Lindsay Diamond discusses the risk about the vaccination choice that parents face. What is risk and what does community do to our choices?”
Catharine Young: Tracking the journey of vaccines. 4:22 in length (from 2017)
“Why are so many vaccines manufactured never getting to the public to save lives? Neuroscientist and TED Fellow Catherine Young uncovers the answer through her mobile app that tracks the journey of vaccines by monitoring drivers. The data she gathers will help uncover weak points in the supply chain, and allow for specific solutions.”
8) What general talking points to you recommend when trying to convince people to vaccinate their kids?Open or CloseLet me point you to two really excellent resources:
The WHO has published Best Practice Guidance: How to Respond to Vocal Vaccine Deniers in Public. This is freely available online. Here’s what’s covered:
Chapter 1: Introduction
1.1. What situation does this document address?
1.2. The term vaccine denier
1.3. Who are vocal vaccine deniers?
Chapter 2: The target audience
2.1. Understanding the target audience
Chapter 3: The speaker
3.1. Who should be the spokesperson?
3.1.1. Being a good speaker
3.1.2. Being a good listener
3.2. Do’s and don’ts of communication
Chapter 4: The argument
4.1. Response to vocal vaccine denier
Chapter 5: Unfavorable interview conditions
Chapter 6: Embracing the opponent
Chapter 7: Religious beliefs
7.1. How to respond to religious concerns?
Chapter 8: How to behave in a passionate discussion
Chapter 9: Participating – or not
Chapter 10: Fake experts
Chapter 11: What now?
Annex 1: HURIER model of listening instruction
Here are a number of talking points, borrowed from vaccine expert Dr. Peter Hotez, from his book Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad (inspired by his daughter):
1) Childhood vaccines save lives
2) Childhood vaccines do NOT cause autism, plain and simple
3) Autism is caused by something other than vaccines
4) There is an abundance of deliberately misleading information about vaccines on the Internet
Dr. Hotez has also highlighted a number of myths that circulate widely
1) Mandatory vaccination is part of some type of conspiracy
2) These infectious diseases are gone, and therefore we don’t need vaccines
3) More children die in the US from vaccines compared to the diseases they prevent
4) Our body’s own “natural immunity” provides adequate protection from these infectious diseases
5) There’s a need to be concerned about vaccine ingredients
9) Got any resources for doctors and other medical professionals regarding how to get patients to accept the HPV vaccine?Open or CloseI think there are actually a large number of these. I’ll add to this list over time. Let’s start with:
The CDC has this helpful one page guide for talking to parents about the HPV vaccine. They also have this general guide for talking to parents about all vaccines.
Here’s advice about talking to vaccine-hesitant parents from the American Academy of Pediatrics.
The World Health Organization also has a resource for talking to parents about vaccines.
Here’s advice from the Canadian Pediatric Society in dealing with vaccine hesitant parents.
And a guide from vaccineresources.org, a handbook for healthcare workers and parents from PATH
ACIP (Advisory Committee on Immunization Practices) guidelines can be found on this page of the CDC website.
Vaccination resources from the WA state Dept. of Health can be found here.
HPV IQ - Immunization improvement, assessment, and feedback tools, along with communication training tools.
The CDC’s AFIX program - AFIX is a quality improvement program conducted by CDC’s immunization program awardees to support Vaccines for Children (VFC) providers in their jurisdiction. The goal of the AFIX program is to increase vaccination of children and adolescents with all Advisory Committee on Immunization Practices (ACIP)-recommended vaccines by reducing missed opportunities to vaccinate and improving immunization delivery practices at the provider level. The AFIX program consists of four components: Assessment, Feedback, Incentives, and eXchange.