Low vaccination rates worry Michigan health officials, physician transparency can help with the solution

One afternoon when Rebecca Chottiner picked up her son from daycare, she noticed the infant had developed what appeared to be a bad cold, with allergies, watery eyes and a rash. Instead, the doctor diagnosed him with an illness Chottiner never expected: the measles. Still too young to be immunized against the disease at the time, he had easily contracted it from a non-vaccinated teacher at the daycare. Though this occurred in 1998, Chottiner and her family continue to feel its impact years later. Chottiner’s son suffered numerous complications from the measles that required constant medical care long after he recovered from the initial illness. One, a sensory sensitivity, required years of occupational therapy. Another, known as measles pneumonia, left him chronically ill throughout his early childhood, as he was prone to any minor cold or infection becoming a serious health risk. In addition to these health concerns, Chottiner left her job to care for her son during this period, and feels her career never fully recovered from the time off.

Today, there is a significant risk for others to suffer similarly from vaccine preventable disease, especially in Michigan where only 55% of toddlers are up to date on all immunizations, according to the Michigan Care Improvement Registry. This number falls well below the scientifically agreed upon 90-95% coverage needed to maintain herd immunity, the threshold at which enough the population is vaccinated to prevent the spread of disease. Data from the Michigan Department of Health and Human Services (MDHHS) show the state’s school vaccination waiver rate increased from 2015 to 2016 and, at 3.2%, it ranks the 11^th highest in the nation. These coverage gaps are both striking and concerning to public health officials, who worry they have left Michigan susceptible to the spread of a variety of diseases, including the current outbreak of Hepatitis A severely affecting southeastern areas of the state.

“It’s hard to link (these outbreaks) to something exactly,” said Bob Swanson, director of the Division of Immunization at MDHHS. “But I will say there’s been a lot more vaccine hesitancy in Michigan in recent years and I’m concerned that may be part of the cause.”

Joel Dorfman, a board member for Michigan for Vaccine Choice, explained that some parents’ hesitancy stems from a reluctance to trust doctors’ recommendations due to a perceived bias and lack of transparency on the part of medical and health professionals. “The health department does not encourage informed consent,” he said. “There are risks associated with immunizations, and the evidence of those risks is irrefutable. (Health officials) would be much better off to be honest about and acknowledge that there are potentially benefits, and there are certainly potentially risks as well.”

In response, Michigan has implemented a variety of education initiatives to teach physicians how to effectively address patient concerns about vaccine safety. These programs, such as Immunization Nurse Educators and the Physician Peer Education Project on Immunization, provide physicians and nurses with the most current vaccine education information so they can give patients objective, evidence-based recommendations. According to Terri Adams, section manager of the Division of Immunization at MDHHS, teaching physicians to engage in “open, honest, transparent discussion,” about the risks and benefits of immunizations and to ultimately give a strong recommendation in their favor has proven to be an effective strategy toward increasing patient confidence in vaccine safety and toward improving vaccination rates.

Another obstacle public health officials and physicians are working to overcome is the ease with which misleading or inaccurate information spreads online. “My biggest concern is that we have a society that is seeking health information on the internet without stopping to think about the accuracy of that information,” said Mark Sawyer, a pediatrician and member of the American Academy of Pediatrics’ Committee on Infectious Diseases

Anne Hernandez, a clinical psychologist who conducted Ph.D. research on immunizations at the University of Rhode Island, noted that, especially in today’s fake news era, it can be difficult for individuals to determine what sources to trust. “Not everyone even knows exactly what the (Centers for Disease Control and Prevention) is,” she said. “There are other links (online) that also appear very legitimate… It’s not as easy to parse what’s credible and what’s not as it may seem to someone who is working in the health field.” Because of this general confusion surrounding the reliability or bias of information outlets, Hernandez explained that “what a trusted relative or friend tells (someone) may have more salience than what (they) see on the news.”

Sawyer said the key to addressing this type of hesitancy is to listen to the patient’s concerns, then try to understand where the relative or friend originally found the information and offer more credible sources. “Often these kinds of communications are anecdotes of a single negative experience,” he said, explaining that it is important to point out how these singular stories are easily “promulgated” on the internet despite the fact that they are not representative of the majority of cases. “The trouble with such single experiences is that you are not discussing the huge number of children who received the same vaccine without any reaction,” he said.

Sawyer also noted that to increase overall herd immunity, health officials need to focus on adults as well as children, because some of the vaccines currently recommended for children, such as Hepatitis A, were not routinely issued until relatively recently. “There are more and more adult vaccinations available and adults are generally less well immunized than children,” he said. “We need to turn to the adult population and get them up-to-date with their vaccines as well.”

Experts are confident improving the distribution of complete, transparent data to patients and parents can help address vaccine hesitancy and increase immunization rates to prevent others from suffering the effects of vaccine preventable disease as Chottiner’s son did. “The way people need to look at the question is the risk of the disease versus the risk of the vaccine,” said Sawyer. “When you do that equation, for all the vaccines we currently recommend, you come out in favor of the vaccine.”