Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a...

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Vaccine Hesitancy- Current Issues and Controversies including HPV vaccine Dr Brenda Corcoran National Immunisation Office

Transcript of Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a...

Page 1: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Vaccine Hesitancy-Current Issues and Controversies

including HPV vaccine

Dr Brenda Corcoran National Immunisation Office

Page 2: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

What is vaccine hesitancy?

An expression of concern or doubt about the value or safety of vaccination

Indecision and reluctance

Continuum between vaccine acceptance and vaccine refusal

X Pro vaccine/ anti vaccine

Page 3: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13
Page 4: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13
Page 5: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Consequences

• Public health impact– delayed or selective

vaccination=> increased periods of risk

exposure

• Outbreaks of vaccine preventable diseases

Polio outbreaks a public health emergency: World Health Organization'Extraordinary' situation requires a co-ordinated international response, UN agency saysBy Amina Zafar, CBC News Posted: May 05, 2014 9:06 AM ET Last Updated: May 05, 2014 8:49 PM ET

Page 6: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Survey 2016

• 65,819 people• 67 countries• Overall vaccine

importance is positive • Global average 12%

(disagree that vaccines are safe)

• Less positive in Europe– 7 out of 10 least

confident countries– 41% in France

www.immunisation.ie

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Ireland

www.immunisation.ie

Page 8: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Who are vaccine hesitant?

• US estimates 1 in 4 parents• Widely heterogeneous group

Page 9: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Who are vaccine hesitant?

Page 10: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Factors

Confidence– do not trust vaccine

or provider

Complacency- do not see need for

or value vaccine

Convenience

- lack of access

Page 11: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Trust

August 2016

https://www.youtube.com/watch?v=H1JFGWBAC5c

September 2015

2014

Page 12: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

“Visiting anti-vaccination websites for 5–10 minutes can increase perceptions of vaccination risks and decrease intentions to vaccinate”

“My son is my science” Jenny McCarthy

Page 13: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

The Narrative Bias

“The more narratives people read, the higher is their perception of risk,

regardless of the information contained in simultaneously presented statistical information on the base rate of vaccine adverse events.”

Intention to get vaccinated

Risk perception

Narratives

Page 14: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Influences

Page 15: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Actions• Omission bias

Make non‐vaccination an actionDefault = VaccinationMake clear to parents that they deviate from the recommendationAction = non‐vaccination

• Use narrativesCawkwell PB, Oshinsky D. Med Humanit 2016;42:31–35.

http://www.immunize.org/reports/http://www.voicesforvaccines.org/

Page 16: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Debunking the Myths

• Understand the specific concern• Not all the same• Listen• Don’t bring up new concerns

• Avoid the familiarity backfire effect• Don’t repeat the myth• Give the facts

• Avoid the overkill backfire effect• Focus on the most important arguments• Use clear, simple language

Page 17: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Actions

• Stay on message– Vaccines are safe and effective

• Recommended by independent experts• Higher safety standards than drugs

– Present risks and benefits accurately– Consequences of not vaccinating – Clear language– Herd immunity not relevant for tetanus

Page 18: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

CommunicationParticipatory versus Presumptive

www.immunisation.ie

Today, your child is due to

have 3 injections

What do you want to do about your child’s

vaccinations?

X

Are we going to give the vaccines

today?

X

He really needs to have all these vaccines today

Page 19: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Who are the Targets?

• Evidence is strongest for fence sitters• Keep trying with hardliners

www.immunisation.ie

Page 20: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV vaccine uptake 2010/2011 - 2016/2017

Target 80%

~15,000 girls not vaccinated in 2016/17

Estimated uptake 1st dose only

www.hpv.ie

Page 21: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

www.hpv.ie

Page 22: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Domino effect

International Contagion• Japan• Denmark• Ireland• ???

Other vaccine contagionEvidence slight reduced uptake of other school vaccines

Erosion of staff resilience

www.hpv.ie

Page 23: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Concerns

• Vaccine safety  • Vaccine safety  • Vaccine safety  • Vaccine causes serious side effects

• Lack of information – not given patient information leaflet • Consent process too rushed• Distrust in Irish health services – link to Pharma• Anti‐establishment agenda

www.hpv.ie

Page 24: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

“Those who cannot remember the past are condemned to repeat it.”

G Santayana

Source: HPSC

95% Target

Wakefield article

www.hpv.ie

Page 25: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Health Professional Vaccine Deniers

www.hpv.ie

Page 26: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV vaccine effectiveness and safety 2006- 2017

Page 27: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV vaccine and cervical cancer facts

Cervical Cancer in Ireland

Every year • 6,500 women need hospital treatment pre-cancerous lesions• > 280 (many young) women need treatment for invasive cancer• 90 women die

Best way to prevent cervical cancer = HPV vaccination + cervical screening

Vaccine prevents precancerous growths and cancer  Screening detects pre cancer or cancer of the cervix

www.hpv.ie

Page 28: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV vaccine factsGardasil HPV vaccine • in use in over 25 European countries, the US, Canada, Australia & NZ• >100 million people vaccinated worldwide • >230,000 girls in Ireland• long lasting protection

• 10 years + protection without any loss of immunity • expected to provide life time protection

HPV vaccine has not been withdrawn in any country

www.hpv.ie

Page 29: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV Vaccine Facts

Gardasil HPV vaccine is a safe vaccine with no long term side effects• The safety profile studied for >13 years in >1 million people during 

clinical trials and since the vaccine was licensed in 2006.

• No increase in the rates of any serious long term condition including autoimmune diseases and chronic fatigue syndrome in vaccinated girls.

• Since the programme started in 2010 to 31 March 2017 HPRA has received 1082 suspected adverse reactions/events • most of these reports are expected side effects • 14  ‐ chronic fatigue syndrome• 10  ‐ post viral fatigue• 3  ‐ an auto immune condition

Much less than expected

Page 30: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

HPV Vaccine FactsThere is no document that states there are more than 20 known side effects of Gardasil HPV vaccine

Side effects seen after use => Scientific evidence of causation• pain, redness or swelling in the arm• headache • nausea• a mild fever• Itchy rash/ hives• fainting• serious allergic reactions very rare 

Side effects reported during general use => No scientific evidence of causation

There is no evidence of any long term side effectswww.hpv.ie

Page 31: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Chronic fatigue syndrome (CFS)

• known for over 200 years • “commonest cause of prolonged school absence”

Professor Alf Nicholson Clinical Lead Paediatrics• 3-4 times more common in females and younger

adolescents • 10,000 cases in Ireland• estimated prevalence rate in Ireland 0.2-0.4% • 220,000 girls vaccinated (660,000 doses)

=> at least 440-880 cases expected

Reported numbers much lower than expectedwww.hpv.ie

Page 32: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

CDC

http://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccine-is-safe.pdf

www.hpv.ie

Page 33: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Does HPV vaccine work?

Page 34: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

ActionsLiaison• The Irish Cancer Society• National Cancer Screening Service • Professional bodies • Department of Education/ Schools • National Parents Councils• Politicians• Global

www.hpv.ie

Page 35: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Actions

Health professional training• Prioritise immunisation in healthcare education

–minimal immunisation teaching at undergraduate and postgraduate level–opportunistic education sessions > 2500 in 2016

• Fact sheets/ articles in journals• ICGP elearning modules• Pharmacies

www.hpv.ie

Page 36: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

ActionsInformation for parents • Focus groups• Offer vaccine again• Information for 6th class parents• Short information videos • Revised parents leaflet (with quotes)• More time to consent

www.hpv.ie

Page 37: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Actions• Increase awareness of vaccine• National and local radio advertising • Social media listening• Social media campaign

• vaccinated girls• international experts

• Alliance of health care and other supportive bodies

• women’s rights• childrens’ rights• cancer charities• youth groups• influencers

www.hpv.ie

Page 38: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Political support

www.hpv.ie

Page 39: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Media

Page 40: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

Impact

www.hpv.ie

• Uptake stabilising

• No decline in HPV2

• ~4% increase in HPV1

?

Page 41: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

“I have met with a number of the people who believe that the Gardasil vaccine harmed them and I recognise their symptoms as real but there is no evidence linking them to the immunisation.

It is a natural human reaction to anchor unexplained things to moments that you remember in your past but that does not mean that one thing triggered the other.

I have never found one connection between the Gardasil vaccine and the symptoms reported by these girls”.

Professor Karina ButlerProfessor of PaediatricsChair, NIAC

Page 42: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13
Page 43: Vaccine hesitancy and current issues 091117€¦ · HPV Vaccine Facts Gardasil HPV vaccine is a safe vaccine with no long term side effects • The safety profile studied for >13

More information

• www.hpv.ie

• www.immunisation.ie