Vaccination Q & A with Dr. Gregory Taylor
With several measles outbreaks in Canada so far this year, we're looking at why concerns about vaccination persist and whether Canada should be taking steps to counter claims by anti-vaccine groups.
Leading up to Jian's conversation with risk communication expert David Ropeik, Q producer Julie Crysler spoke to Dr. Gregory Taylor, Deputy Chief Public Health Officer at the Public Health Agency of Canada.
Here, in a Q & A edited for length and clarity, is their conversation:
Q: There have been a number of efforts to curb anti-vaccine messages in other countries, such as Australia. I'm wondering the extent to which you see anti-vaccine groups as an issue, and what impact that might be having on vaccination relate rates?
Dr Gregory Taylor: It's certainly an issue in Canada and that's been illustrated most clearly by the measles outbreak we've been seeing the last few months in Canada. Those have been isolated outbreaks but I think as you're aware in B.C. there were about 400 different clinically confirmed cases of measles, which is quite worrisome. [It is] worrisome from the perspective of that, of kids that get the measles about one in 1,000 get encephalitis, that's an infection of the brain which can have lifelong neurological complications. Of kids who get the measles about one of every 2,000 to 3,000 die. What's sad about that is it's totally preventable with vaccine. So the anti-vaccine movement or vaccine-hesitancy -- that's the word that we use -- is causing some concerns. Although what's been positive in the last few years in Canada, our vaccination rates are stable. We have about 95% coverage for most of the childhood vaccines and that hasn't fluctuated much in the last few years. So we don't think it's having an impact or the impact had been there for quite some time. And these are relatively small numbers compare to the majority of population. But these kids and these adults are not that are not been vaccinated are at risk of disease.
Q: So it sounds like there's a slight mixed message there. Vaccination rates are stable but at the same time there's concern about these anti-vaccine messages. Are you more worried about what could happen if these anti-vaccine groups were to gain more traction?
Dr Gregory Taylor: Well it's both. The target would be to have 100% percent of population vaccinated. There are a few people who just can't be vaccinated for health reasons. That's a very small number. So we'd love to see the target much higher than that so we don't have this outbreak of measles in Canada or outbreaks of other communicable diseases. Obviously the concern is if the anti-vaccine movement does convince more people not to have their vaccine that would be worrisome. But so far -- and our data is relatively rough, it's done with surveys, we don't have vaccine registries to have precision -- but it's been relatively stable. So that's the good news. We're always worried of course that that may change. That's why we consistently monitor on an ongoing basis the vaccine uptake."
Q: Of the people who are not getting vaccinated, do we know that's a result of concerns around most famously the now debunked link between the Measles Mumps Rubella vaccine and autism?
Dr Gregory Taylor: I don't think we know precisely. There are a variety of reason why people wouldn't get vaccinated. I think one has to remember that you give your child antibiotics and drugs when they're sick and a vaccine you give it to them when they're well. And I've had a couple of children and sometimes it's tough to bring your healthy, bouncing child in and have a needle stuck in the arm. You have to remember that the risks of that are so, so tiny compare to the real, real risks of getting the disease itself. So I think there's part of that. There are folks who have religious objections to vaccine and other concerns about that. Part of it lately with social media and with our rapid communications, is there's lots of misinformation is going out. We really don't know if that is making a difference or not or if it's just being picked up with the folks who are already convinced they shouldn't have vaccines. We don't know that and we haven't done any research on that. What's been really interesting in the last few months some of the pro-vaccine messages are going out in the media, on Twitter, on Facebook, etc. Certainly, from a public health perspective we're delighted to see that. It really reinforces the positive message, how positive vaccines are.
Q: Let me pick up on that though. There was a study from Dartmouth found that pro-vaccine messages were actually making people less likely to vaccinate. Is that disheartening?
Dr Gregory Taylor: It's interesting. When you start talking about pro-vaccine messages and you give some of the side effects it does raise anxiety in some people. And I think one of the strategies that physicians will use in their office is say "This is the next step, giving the vaccine and let's move on" rather than saying: "Would you like your child to be vaccinated?" That sounds a little paternalistic and it is to a certain extent. You've got anxious parents who have young children and as I mentioned they're healthy and when you sit down and try and have a risk communication discussion and balance that risk out it gets very intellectual and it get sometimes difficult because it's emotional decision. So, we'd be a little paternalistic because we have a product that saves lives and saves side effects so we push hard as physicians and as public health.
Q: In the UK, there have been efforts to remove magazines that carry anti-vaccine content from newsstands. In Australia, authorities have forced the Australian Vaccination Network to change its name to the "Australian Vaccination Skeptics Network". Are at the point where we should consider these types of measures in Canada?
Dr. Gregory Taylor: Not from my perspective. Not from the Public Health Agency's perspective. As I said our coverage rates are fairly consistent. We prefer to give very positive messages. Vaccines are not mandatory. We encourage people. It's for the health of their children, health of themselves. And that's the approach we've been using and so it's been effective, relatively effective. We still have a few groups of folks who don't get vaccinated for a whole variety of reasons but that's not the direction that we're coming from.
Q: You were talking about paternalism before and one of the things some people will argue for is that we need to nudge people. This is not making vaccines mandatory, but just making a little harder to refuse. What do you think of that?
Dr Gregory Taylor: Well that is how it works in some jurisdictions in Canada. I mean I can speak to this personally because my kids were brought up in Ontario where you have to a proof of vaccination for your child to be in school or you have to sign something that say you have an objection to that. But I think the paternalism part is we try and give the numbers of these things. So the risk that I mentioned for the measles one in 1,000 get encephalitis and one in 2,000 or 3,000 die. The severe side effects of a vaccine are less than one in a million. And those are mostly allergic reactions which can be taken care of. That's why when you have your children vaccinated it's done in a doctor's office, so if something happens, an allergic reaction, they can be taken care of with Epinephrine or a shot.
Q: Given all that we know about the safety of vaccines and their efficacy, why do you think that these beliefs and concerns persist?
Dr Gregory Taylor: Good question. That's hard to say. I mean, behaviour of humans is based on typically three different things. Knowledge is just part of it. The attitudes and the beliefs are part of what actually motivates people. So we do our best with the knowledge, give them the best available knowledge. And sometimes it's difficult to get at attitudes and beliefs, beliefs can be religious beliefs, they can be beliefs from fear. There are a whole variety of things there. I think the analogy of smoking is a really nice one. As people continue to smoke, I believe we have 25% or so of population still smoking when we know that's detrimental and kills people. But people still choose to do that. Vaccination for children are a little bit different in that it's a good of society and it's children who aren't making the decisions, the parents are making on their behalf. It's a little bit of a different circumstance where we push harder with that one.
Q: If the vaccination rate is stable, at around 95%, but the desire is for it to be higher, what do you think it would take to achieve that?
Dr Gregory Taylor: Well we're promoting positive uptakes, and we're working with provinces and territories to help the promotion that they do. We're trying to ensure that it's available to everyone. There are new delivery models, and we're talking not just the childhood vaccinations. So in the last flu season, you could get your vaccine at your pharmacy. I personally went down and had mine at the pharmacy at one of the grocery stores. It was extremely convenient. I didn't have to make an appointment. You just went in, you got your vaccine, you bought your groceries. It was great. The provinces are trying to put in place registries so they know who's been vaccinated or not, so they can potentially target folks through messaging to encourage them. We keep repeating to folks it's the single most intervention ever. It saves so many lives and so much disease so we keep giving the message over and over again, combined with a variety of other mechanisms to try and encourage people to have their vaccine and keep their children's vaccines up-to-date. The other thing we've done is that we have our free ImmunizeCA app. What that will do is when you register yourself or your children in that, it comes with the province-specific list of recommended vaccines and will have reminders, lots of positive information explaining vaccines and the side effects. So there are a whole variety of mechanisms we're using.
Q: In a perfect world, are there further measures that you'd like to see us at least considering?
Dr Gregory Taylor: No, I think these are working. The vaccine uptake as far as we know has been stable for the last few years, 95%. We have to continue to do these because if we don't the worry is [the vaccination rate] may go down. That last little bit sometimes is very difficult. And we're continuing to come up with positive messaging to normalize vaccines, continuing to encourage physicians just to make it a routine part using alternative delivery mechanisms, and public messaging as much as possible. You do have to remember that in Canada these outbreaks are still relatively small. I mean we don't want to see any measles but 400 people in B.C. is relatively small and we may see some serious side effects, I don't know. But I think we have to keep it in a balance and continue with the same approach as we're doing now.
* This interview has been edited for length and clarity