ArticlePDF Available

Abstract

Today, the most recent in a long line of antivaccinationists are using modern media to sway public opinion and distract attention from scientific evidence. But there are steps we can take to avert the ill effects of these campaigns.
Perspective
The
NEW ENGLAND JOURNAL
of
MEDICINE
january 13, 2011
n engl j med 364;2 nejm.org january 13, 2011 97
smallpox was hindered by a bur-
geoning antivaccination move-
ment. The result was ongoing
smallpox outbreaks and needless
deaths. In 1910, Sir William Osler
publicly expressed his frustration
with the irrationality of the anti-
vaccinationists by offering to take
10 vaccinated and 10 unvaccinat-
ed people with him into the next
severe smallpox epidemic, to care
for the latter when they inevitably
succumbed to the disease, and ul-
timately to arrange for the funer-
als of those among them who
would die (see the Medical Notes
section of the Dec. 22, 1910, issue
of the Journal). A cen-
tury later, smallpox
has been eradicated
through vaccination, but we are
still contending with antivacci-
nationists.
Since the 18th century, fear and
mistrust have arisen every time a
new vaccine has been introduced.
Antivaccine thinking receded in
importance between the 1940s
and the early 1980s because of
three trends: a boom in vaccine
science, discovery, and manufac-
ture; public awareness of wide-
spread outbreaks of infectious dis-
eases (measles, mumps, rubella,
pertussis, polio, and others) and
the desire to protect children from
these highly prevalent ills; and a
baby boom, accompanied by in-
creasing levels of education and
wealth. These events led to pub-
lic acceptance of vaccines and their
use, which resulted in significant
decreases in disease outbreaks, ill-
nesses, and deaths. This golden
age was relatively short-lived, how-
ever. With fewer highly visible out-
breaks of infectious disease threat-
ening the public, more vaccines
being developed and added to the
vaccine schedule, and the media
permitting widespread dissemina-
tion of poor science and anecdotal
claims of harm from vaccines,
antivaccine thinking began flour-
ishing once again in the 1970s.
1
Little has changed since that
time, although now the antivacci-
nationists’ media of choice are
typically television and the Inter-
net, including its social media out-
lets, which are used to sway pub-
lic opinion and distract attention
from scientific evidence. A 1982
television program on diphtheria–
pertussis–tetanus (DPT) vaccina-
tion entitled “DPT: Vaccine Rou-
lette” led to a national debate on
the use of the vaccine, focused on
a litany of unproven claims against
it. Many countries dropped their
programs of universal DPT vac-
cination in the face of public
protests after a period in which
pertussis had been well con-
trolled through vaccination
2
The Age-Old Struggle against the Antivaccinationists
Gregory A. Poland, M.D., and Robert M. Jacobson, M.D.
Since the introduction of the first vaccine, there
has been opposition to vaccination. In the 19th
century, despite clear evidence of benefit, routine
inoculation with cowpox to protect people against
Articles from
the NEJM Archive are
available at NEJM.org
The New England Journal of Medicine
Downloaded from nejm.org at MAYO CLINIC LIBRARY on January 20, 2011. For personal use only. No other uses without permission.
Copyright © 2011 Massachusetts Medical Society. All rights reserved.
PERSPECTIVE
n engl j med 364;2 nejm.org january 13, 2011
98
the public had become compla-
cent about the risks of the disease
and focused on adverse events
purportedly associated with vac-
cination. Countries that dropped
routine pertussis vaccination in
the 1970s and 1980s then suf-
fered 10 to 100 times the pertus-
sis incidence of countries that
maintained high immunization
rates; ultimately, the countries that
had eliminated their pertussis
vaccination programs reinstated
them.
2
In the United States, vac-
cine manufacturers faced an on-
slaught of lawsuits, which led the
majority of them to cease vaccine
production. These losses prompt-
ed the development of new pro-
grams, such as the Vaccine Injury
Compensation Program (VICP), in
an attempt to keep manufacturers
in the U.S. market.
The 1998 publication of an ar-
ticle, recently retracted by the
Lancet, by Wakefield et al.
3
created
a worldwide controversy over the
measles–mumps–rubella (MMR)
vaccine by claiming that it played
a causative role in autism. This
claim led to decreased use of
MMR vaccine in Britain, Ireland,
the United States, and other
countries. Ireland, in particular,
experienced measles outbreaks
in which there were more than
300 cases, 100 hospitalizations,
and 3 deaths.
4
Today, the spectrum of anti-
vaccinationists ranges from people
who are simply ignorant about sci-
ence (or “innumerate” unable
to understand and incor porate
concepts of risk and probability
into science-grounded decision
making) to a radical fringe ele-
ment who use deliberate mis-
truths, intimidation, falsified data,
and threats of violence in efforts
to prevent the use of vaccines and
to silence critics. Antivaccination-
ists tend toward complete mistrust
of government and manufactur-
ers, conspiratorial thinking, de-
nialism, low cognitive complexity
in thinking patterns, reasoning
flaws, and a habit of substituting
emotional anecdotes for data.
5
Their efforts have had disruptive
and costly effects, including dam-
age to individual and community
well-being from outbreaks of pre-
viously controlled diseases, with-
drawal of vaccine manufacturers
from the market, compromising of
national security (in the case of
anthrax and smallpox vaccines),
and lost productivity.
2
The H1N1 influenza pandemic
of 2009 and 2010 revealed a
strong public fear of vaccination,
stoked by antivaccinationists. In
the United States, 70 million dos-
es of vaccine were wasted, al-
though there was no evidence of
harm from vaccination. Mean-
while, even though more than a
dozen studies have demonstrated
an absence of harm from MMR
vaccination, Wakefield and his
supporters continue to steer the
public away from the vaccine. As
a result, a generation of parents
and their children have grown
up afraid of vaccines, and the
resulting outbreaks of measles
and mumps have damaged and
destroyed young lives. The re-
emergence of other previously
controlled diseases has led to
hospitalizations, missed days of
school and work, medical com-
plications, societal disruptions,
and deaths. The worst pertussis
outbreaks in the past 50 years
are now occurring in California,
where 10 deaths have already
been reported among infants and
young children.
In the face of such a legacy,
what can we do to hasten the
funeral of antivaccination cam-
paigns? First, we must continue
to fund and publish high-quality
studies to investigate concerns
about vaccine safety. Second, we
must maintain, if not improve,
monitoring programs, such as
the Vaccine Adverse Events Re-
porting System (VAERS) and the
Clinical Immunization Safety
Assessment Network, to ensure
coverage of real but rare adverse
events that may be related to
vaccination, and we should ex-
pand the VAERS to make com-
pensation available to anyone,
regardless of age, who is legiti-
mately injured by a vaccine. Third,
we must teach health care pro-
fessionals, parents, and patients
The Age-Old Struggle against the Antivaccinationists
The Cow Pock — or — the Wonderful Effects of the New Inoculation.
J. Gillray, 1802. Courtesy of the National Library of Medicine.
The New England Journal of Medicine
Downloaded from nejm.org at MAYO CLINIC LIBRARY on January 20, 2011. For personal use only. No other uses without permission.
Copyright © 2011 Massachusetts Medical Society. All rights reserved.
n engl j med 364;2 nejm.org january 13, 2011
PERSPECTIVE
99
how to counter antivaccination-
ists’ false and injurious claims.
The scientific method must in-
form evidence-based decision
making and a numerate society if
good public policy decisions are
to be made and the public health
held safe. Syncretism between the
scientific method and unortho-
dox medicine can be dangerous.
Fourth, we must enhance pub-
lic education and public persua-
sion. Patients and parents are
seeking to balance risks and ben-
efits. This process must start with
increasing scientific literacy at
all levels of education. In addi-
tion, public–private partnerships
of scientists and physicians could
be developed to make accurate
vaccine information accessible to
the public in multiple languag-
es, on a range of reading levels,
and through various media. We
must counter misinformation
where it is transmitted and con-
sider using legal remedies when
appropriate.
The diseases that we now seek
to prevent with vaccination pose
far less risk to antivaccination-
ists than smallpox did through
the early 1900s. Unfortunately,
this means that they can con-
tinue to disseminate false science
without much personal risk, while
putting children, the elderly, and
the frail in harm’s way. We can
propose no Oslerian challenge to
demonstrate our point but have
instead a story of science and
contrasting worldviews: on the
one hand, a long history of stun-
ning triumphs, such as the erad-
ication of smallpox and control
of many epidemic diseases that
had previously maimed and killed
millions of people; on the other
hand, the reality that none of
the antivaccinationists’ claims of
widespread injury from vaccines
have withstood the tests of time
and science. We believe that an-
tivaccinationists have done signifi-
cant harm to the public health.
Ultimately, society must recognize
that science is not a democracy
in which the side with the most
votes or the loudest voices gets
to decide what is right.
Disclosure forms provided by the au-
thors are available with the full text of this
article at NEJM.org.
From the Mayo Clinic Vaccine Research
Group (G.A.P., R.M.J.), the Department of
Medicine (G.A.P.), and the Department of
Pediatric and Adolescent Medicine (G.A.P.,
R.M.J.), Mayo Clinic, Rochester, MN.
1. Wolfe RM, Sharp LK. Anti-vaccinationists
past and present. BMJ 2002;325:430-2.
2. Gangarosa EJ, Galazka AM, Wolfe CR, et
al. Impact of anti-vaccine movements on
pertussis control: the untold story. Lancet
1998;351:356-61.
3. Wakefield AJ, Murch SH, Anthony A, et al.
Ileal-lymphoid-nodular hyperplasia, non-
specific colitis, and pervasive developmental
disorder in children. Lancet 1998;351:637-41.
[Retraction, Lancet 2010;375:445.]
4. McBrien J, Murphy J, Gill D, Cronin M,
O’Donovan C, Cafferkey MT. Measles out-
break in Dublin, 2000. Pediatr Infect Dis J
2003;22:580-4.
5. Jacobson RM, Targonski PV, Poland GA.
A taxonomy of reasoning flaws in the anti-
vaccine movement. Vaccine 2007;25:3146-52.
Copyright © 2011 Massachusetts Medical Society.
The Age-Old Struggle against the Antivaccinationists
ACOs and the Enforcement of Fraud, Abuse, and Antitrust Laws
Robert F. Leibenluft, J.D.
H
ospitals and physicians are
eagerly awaiting regulations
for accountable care organizations
(ACOs), which many observers
view as the best hope provided
by the Patient Protection and
Affordable Care Act (ACA) for
needed delivery system reform.
Starting in 2012, health care pro-
viders in ACOs that furnish ef-
ficient, high-quality care to
Medicare patients will share in
Medicare’s savings. Providers are
concerned, however, that in cre-
ating ACOs they risk violating
fraud, abuse, and antitrust laws.
1
To address these fears, the De-
partment of Health and Human
Services (DHHS), the Federal
Trade Commission, and the De-
partment of Justice, under the
direction of the White House, are
collaborating to provide waivers,
safety zones, and guidance to
providers.
An ACO, as defined by the
ACA, is an organization of health
care providers that agrees to be
accountable for the quality, cost,
and overall care of Medicare pa-
tients for whom they provide the
bulk of primary care services.
2
ACOs must have defined pro-
cesses for promoting evidence-
based medicine, reporting data
with which to evaluate the qual-
ity and cost of care, and coordi-
nating care. ACOs that meet
specified quality standards will
receive a share of the savings if
Medicare’s cost for the care of
their assigned patients is below
a certain benchmark. ACOs, along
with bundled payments and oth-
er payment innovations, are in-
tended to transform the health
care delivery system both by re-
placing fee-for-service payments,
which tend to increase utilization,
and by boosting collaboration
among providers so as to reduce
costs and improve quality.
However, providers organizing
ACOs may fear violating fraud-
The New England Journal of Medicine
Downloaded from nejm.org at MAYO CLINIC LIBRARY on January 20, 2011. For personal use only. No other uses without permission.
Copyright © 2011 Massachusetts Medical Society. All rights reserved.
... However, there is transnational organised opposition to vaccinations -an 'anti-vaccination movement'which questions the safety, efficacy, and even the necessity for vaccinations (Blume, 2006). There has been opposition to vaccines ever since the first vaccine was introduced in the 19th century (Poland & Jacobson, 2011). Today the anti-vaccination movement is more coordinated and has greater reach due to the internet and social media (Chiou & Tucker, 2018;Hussain et al., 2018;Kata, 2012;Megget, 2020;Ołpiński, 2012;Smith & Graham, 2019). ...
... Childhood vaccination rates have fallen below acceptable levels in certain geographic areas of the USA, UK, Europe Mallory et al., 2018;Sangha & Mac McCullough, 2020;Szilagyi et al., 2020) and in some pockets of Australia (Dawson & Apte, 2015), with subsequent outbreaks of measles, mumps, varicella and pertussis (Andrews et al., 2008;Damm et al., 2016;Mallory et al., 2018;Najjar et al., 2014;Sangha & Mac McCullough, 2020;Wood et al., 2015). Reductions in rates of vaccination have been costly to communities in terms of death and disease resulting from outbreaks of previously controlled diseases (Bass, 2015;Leggiadro, 2009;Nandi & Shet, 2020;Poland & Jacobson, 2011;Wang et al., 2020;Wong et al., 2020). ...
... Beyond developing an understanding of the psychology of unorthodox beliefs and unorthodox healthcare choices, it is important to develop evidence based health promotion strategies to encourage the uptake of best practice healthcare. It is critical that vaccine hesitant individuals are encouraged to vaccinate themselves, and even more crucial that vaccine hesitant parents are persuaded to allow their children to get vaccinated (Poland & Jacobson, 2011). However, there is little research to inform effective strategies to persuade the vaccine hesitant in the community (Sadaf et al., 2013). ...
Thesis
Full-text available
There are many people who choose alternative or unorthodox healthcare options that are not based on the best available evidence for efficacy and effectiveness. There has been a rejection of vaccination by sections of the population leading to suboptimal rates of vaccination, and increased rates of infectious diseases such as measles. Complementary and alternative medicines (CAMs) are also increasingly popular, despite the scarcity of clinical evidence for the efficacy and safety of many of these therapies. The goal of this thesis is to explore unorthodox worldviews that predict vaccine scepticism and use of CAM in order to inform the future development of persuasive strategies to encourage participation in evidence-based interventions. Four studies were undertaken to achieve this goal including (1) the development of a standardised measure of CAM utilisation using data from an archived population survey of Australian adults; (2) an investigation of explanatory factors, including personality (openness to experience), cognitive style, and a range of unorthodox beliefs, for the relationship between CAM use and vaccination scepticism, using an archived population survey of Australian adults; (3) an examination of associations between geographic or area-level socio-demographic factors and uptake of vaccination among 5-year old children throughout Australia, using a public health focused ecological methodology, and (4) conducting an online priming experiment, to assess whether increasing the salience of concepts of contamination and purity will produce changes in reactions to a range of health interventions, including vaccination and CAM. Following are the key findings. The first study developed a brief, summative questionnaire measure of CAM utilisation called the R-I-CAM-Q, to address a gap in previous research which was lacking a psychometrically sound, and quantitative measure of CAM utilisation. The main findings of the second study, a cross-sectional survey, were that Pro-CAM attitudes, rather than CAM-use, best predict vaccination attitudes; and that anti-vaccination and pro-CAM attitudes both correlate with the presumed antecedents of magical beliefs about health. The geographic/area-based study revealed that communities with lower rates of vaccination had relatively less disadvantage, and had relatively greater education and occupational status, suggesting that privilege puts people at risk. The priming experiment showed no experimental effect of priming for contamination or purity/naturalness. Nevertheless, higher levels of sensitivity to disgust were associated with lower ratings of the effectiveness of MMR vaccination, tetanus injection, antibiotics, and surgery. The results of these studies into how unorthodox or alternative worldviews predict vaccination scepticism and use of CAM, can directly inform the future development of evidence-based health promotion strategies which encourage the uptake of best practice healthcare, including vaccination practices.
... Motivation includes individuals' intention, willingness, and hesitancy to get vaccinated. Although individuals have been conflicted or opposed to receiving vaccinations since modern inoculation was introduced 200 years ago [94][95][96][97], the use of the term "vaccine hesitancy" to describe this phenomenon is a relatively new and suddenly ubiquitous construct. The increased popularity of this term is evident by the burgeoning number of publications using this construct, as evidenced by a search conducted by this author (see Figure 1). ...
... Although individuals have been conflicted or opposed to receiving vaccinations since modern inoculation was introduced 200 years ago [94][95][96][97], the use of the term "vaccine hesitancy" to describe this phenomenon is a relatively new and suddenly ubiquitous construct. The increased popularity of this term is evident by the burgeoning number of publications using this construct, as evidenced by a search conducted by this author (see Figure 1). ...
Article
Full-text available
Human papillomavirus (HPV) vaccination prevents cervical, head and neck, and anogenital cancers. However, global HPV vaccine coverage falls short of global targets and has seen unexpected and dramatic declines in some countries. This paper synthesizes the impact of HPV on the global burden of cancer and the potential benefit of HPV vaccination. Approximately 5% of the world’s cancers are specifically attributed to HPV. While the greatest global burden of HPV is cervical cancers in low- and middle-income countries, HPV-associated head and neck cancers are increasing in high-income countries and have surpassed cervical cancer as the primary HPV-associated cancer in some countries. Therefore, it is also critical to improve gender-neutral HPV vaccination. Understanding the modifiable drivers of vaccine acceptance and uptake is important for increasing HPV vaccination. The Behavioural and Social Drivers of Vaccination framework is broadly applied to identify key factors associated with HPV vaccination including domains concerning practical issues, motivation, social processes, and thinking and feeling. Among the behavioural strategies available to reduce the incidence and mortality of cancer, increasing HPV vaccination stands out as having unrealized potential to prevent disease, financial cost, and psychological distress. An understanding of the shifting burden of HPV and the factors associated with vaccination can be leveraged to regularly measure these factors, develop interventions to promote vaccine uptake, and improve global HPV vaccine coverage. Future research in diverse contexts is necessary to investigate the barriers and facilitators of global HPV vaccination.
... Another potential limitation is that the entire study or research that extracted from (web searches, review, analysis and context) was conducted by a single researcher. While it would have been ideal to reply on multiple reviewers and assessment of interrater reliability, that was not feasible for this study [14]. ...
Article
Full-text available
The 2017 National Immunization Program (NIP) provide vaccination against tuberculosis, diphtheria, tetanus, polio, pertussis, hepatitis B, invasive Haemophilus influenzae serotype b disease, measles, rubella and human papillomavirus infections. The Timorese health system is faced with the search for a model of the National Health Strategic Plan (NHSP 2011-2030) work plan for its health system, which is adequate to the current and future needs of its population. In addition to preventing these deadly diseases, vaccination of newborns and expectant mothers, integrated into programs such as Timor-Leste Expanded Vaccination Program (EVP). The overall objective of study characterizes the perception of the population and health professionals about the NIP under of this investigation. Methods: This is a cross-sectional and mixed-methodological study of qualitative and quantitative descriptive type of methods, including observations, closed interviews and focus group discussion (FGD). A study population was carried out amongst people between the ages of 18-25, 26-35 and 36-45 years old of whom came to the health centers, health post level and hospitals in municipalities, to accompany their infants and children for vaccine, in accordance with the current vaccination schedule. Results: In the quantitative questionnaires were interviewed (n=212:54%) of Timorese population and health professionals (n=185:46%) total (n=395:100%). The chi-square value 12.401 (p value=0.05) of populations and 75.751 (p value=0.5) of health professionals. Indeed, there was no-significant difference. Using regression multivariate of Hosmer and Lemeshow test, it was found that in both models all has a correlation with the scale greater than 0.2 value. However, we summarized and verified that those models were significantly valid because, under rate of a correlation's significance value 0.5. Conclusion: The results presented would contribute to the development of strategic planning and action of health administration and management policies, especially in the promotion of vaccination in the Timorese community. Policies that reflecting the characteristics and needs consequently for the well-being of the population. Population in general and particular the mother of infants and children of 0 year of age can be protected from infectious diseases.
... However, our review indicated that influenza vaccine hesitancy still exists. Hesitancy and mistrust in vaccines are not new findings, having been reported since the 18th century [58]. Complacency, confidence, and convenience are three important considerations to address in order to overcome vaccination hesitancy [59]. ...
Article
Full-text available
Poorer outcomes have been reported with COVID-19 and influenza coinfections. As the COVID-19 pandemic rages on, protection against influenza by vaccination is becoming increasingly important. This study examines how COVID-19 has influenced influenza vaccination intentions from a global perspective. A literature search was conducted on Embase, PubMed, and CNKI from 1 January 2019 to 31 December 2021 for articles reporting rates of influenza vaccination pre-COVID-19 (19/20 season), and intention and/or uptake of influenza vaccination post-COVID-19 (20/21 season). The changes in vaccination intention and reasons for changes were reported. Subgroup analyses were performed by region, gender, age, and occupation. Newcastle Ottawa Scale was used for quality assessment of the articles. Twenty-seven studies with 39,193 participants were included. Among 22 studies reporting intention to vaccinate in 20/21, there was increased intention to vaccinate (RR 1.50, 95% CI 1.32–1.69, p < 0.001) regardless of age, gender, and occupation. The remaining five studies reporting vaccination intention and uptake in 20/21 showed a similar increase (RR 1.68, 95%CI 1.20–2.36). Important determinants include historical vaccine acceptance, and perception of influenza severity and vaccine safety. The COVID-19 pandemic has increased intention to vaccinate against influenza internationally. The pandemic could be a window of opportunity to promote influenza vaccination and decrease vaccine hesitancy.
... With the introduction of the National Immunization Schedule in the 1950s, the acceptance of vaccination was increased. 10 After the 27th World Health Assembly, Expanded Programme on Immunization (EPI) was launched globally in May 1974. 11 In India, the Minister of Health and Family Welfare adapted the EPI against 6 tuberculosis, pertussis, diphtheria, tetanus, polio and measles. ...
Article
Full-text available
With the introduction of vaccines, mortality and morbidity among children have significantly reduced. While a good proportion of the population accepts the vaccine, still a gap remains in the immunisation coverage in India. A growing number of people are delaying or refusing the vaccines. This phenomenon is called “vaccine hesitancy.” In spite of the tremendous effort to develop an effective COVID 19 vaccine, a major deterrent for coverage of the same is vaccine hesitancy towards the approved and future COVID-19 vaccination. Consideration and addressing the determinants for such hesitancy is the need of the hour to surge the vaccine coverage. The databases were searched for English- language articles. The data were extracted from PubMed, Web of Science, Google Scholar databases and websites including WHO, UNICEF etc. Keywords such as vaccine hesitancy, vaccine acceptance, parents, confidence, counselling etc were used. This review was done to explore the history and factors responsible for vaccine hesitancy
... As early as the 18th century, people hesitated to vaccinate against smallpox. 1 One of the most remarkable pieces of evidence of this is an anti-vaccine picture published in the magazine Punch during this time period. 2 In the picture, people who received smallpox vaccination developed features of cows. ...
Article
Full-text available
Evidence for the validity and reliability of the World Health Organization's 10-item vaccine hesitancy scale (VHS) in different settings is not sufficient, especially for criteria validity. This study aimed to assess the validity and reliability of the VHS using child vaccination data in China. A cross-sectional survey was performed with parents of 19-48-month-old children at six vaccination clinics in Wuxi City between September and October 2020. The VHS was revised to category A (expanded program on immunization, EPI) VHS and category B (Non-EPI) VHS. Factor analysis was used to confirm the latent domain and to assess the model structure. The average variance extracted (AVE) was calculated to assess convergent validity, and Cronbach's α and composite reliability (CR) were used to determine internal consistency. The association between VHS scores and children's vaccination status was examined to assess criteria validity using logistic regression. The survey response rate was 75.3% (n = 802). Two factors were identified, explaining 64.60% and 63.34% of the common variance in categories A and B VHS, respectively. The Cronbach's α of > 0.7 and CR of >0.7 in the scale indicated the VHS has acceptable internal consistency. The AVE values indicated that convergent validity was not ideal for the VHS. There were no statistically significant associations between VHS scores and vaccination status, indicating that the criterion validity was not ideal. The VHS needs improvement before becoming a standard survey tool.
... Casi 200 años después la viruela es erradicada, gracias a las campañas intensivas de vacunación; el último caso fue reportado a finales de los años 70 del s. xx. La viruela se eliminó, pero las personas que se resisten a la vacunación aún persisten (Poland & Jacobson, 2011). ...
Article
Full-text available
Purpose Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed. Design/methodology/approach Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online. Findings This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities. Originality/value While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.
Article
Full-text available
To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by anti-vaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines. Given the safety and cost-effectiveness of whole-cell pertussis vaccines, our study shows that, far from being obsolete, these vaccines continue to have an important role in global immunisation.
Article
Full-text available
The British Vaccination Act of 1840 was the first incursion of the state, in the name of public health, into traditional civil liberties. The activities of today's propagandists against immunisations are directly descended from, indeed little changed from, those of the anti-vaccinationists of the late nineteenth century, say Robert Wolfe and Lisa Sharp.
Article
Summary Background We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder. Methods 12 children (mean age 6 years (range 3-10), 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined. Findings Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age- matched controls (p=0·003), low haemoglobin in four children, and a low serum IgA in four children. Interpretation We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
Article
We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder. 12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined. Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children. We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.
Article
An outbreak of measles occurred in Ireland between December 1999 and July 2000. The majority of cases were in north Dublin, the catchment area of The Children's University Hospital (TCUH). Details of all of the 111 children attending the hospital with a diagnosis of measles between December 1999 and July 2000 were prospectively entered into a database. Charts were subsequently reviewed to extract epidemiologic and clinical details. National figures were obtained from the National Disease Surveillance Centre. In the study period 355 attended TCUH with a serologic or clinical diagnosis of measles, and 111 were admitted (47% female, 53% male). The main indications for admission were dehydration in 79%, pneumonia or pneumonitis in 47% and tracheitis in 32%. Thirteen children (11.7% of those admitted) required treatment in the intensive care unit, and in 7 of these mechanical ventilation was necessary. There were 3 deaths as a result of measles. Public health measures to curb spread of the disease included promotion of immunization for susceptible children nationally and recommending administration of measles-mumps-rubella vaccine (MMR) from the age of 6 months, in North Dublin. This outbreak of measles posed a major challenge to the hospital and the community for the first half of 2000. The national MMR immunization rate before the outbreak was gravely suboptimal at 79%, whereas the rate in North Dublin, the catchment area of TCUH, was <70%. Three children died as a result of a vaccine-preventable illness.
Article
In a scholarly analysis of widely held misconceptions, Gilovich provides a classification scheme of common flaws in reasoning seen in contemporary society. He broadly categorizes these flaws as having cognitive determinants or in having motivational and social determinants. In this survey, the authors examine the various claims against routine childhood and adult vaccines as made by the more public and more organized entities of the anti-vaccine movement as well as those made apparent by surveys of parents and other groups of individuals. The claims illustrate the breadth of reasoning flaws while providing a basis for anticipating and correcting them.
Measles outbreak in Dublin
  • J Mcbrien
  • J Murphy
  • D Gill
  • O M Cronin
  • C Donovan
  • Cafferkey
McBrien J, Murphy J, Gill D, Cronin M, O'Donovan C, Cafferkey MT. Measles outbreak in Dublin, 2000. Pediatr Infect Dis J 2003;22:580-4.