Out of order: The vaccine de-bait

Can we please stop calling the vaccine controversy a debate?

 

This is not a debate. This is two groups of people standing atop their personal mountains throwing unpleasant epithets and “evidence” at each other.

 

On one mountain, you have scientists and healthcare specialists throwing out statistics and medical jargon and epidemiology. On the other mountain, you have vaccine-cautioners showing photographs of sick vaccinated children (and correlating the two adjectives) and demands for individual freedoms and the defense of their child from potential harm.

 

Both sides are adamant about the absolute truth of their positions, and therefore, there is no point in discussion. The other side is either willfully stupid or lying to push forward an agenda, so there is no point in discussion.

 

Unfortunately, I think if an actual debate was held and, say, televised, science and healthcare might come out with the short end of the stick.

 

 

It’s not that the facts aren’t there. It is rather that the facts are largely indirect and require certain assumptions.

 

Unlike pretty much every other category of therapeutic, patients do not get better (e.g., an existing disease condition relapses or is cured) when they are vaccinated, but rather, they do not get sick. Or at least, we assume they did not get the disease because they were vaccinated. All we can truly measure is that they produced antibodies against the infectious organism. True placebo-controlled experiments would be unethical and might take decades to show statistical advantage.

 

Ah, but what about population statistics that show how the introduction of widespread vaccination led to large-scale reductions in the incidence of the disease? I am woefully ignorant of statistics (really should be better at them, but alas), but I don’t know that we can prove causation here, only be overwhelmed by the correlation (please correct me, if I am wrong).

 

And leaving aside any conversation about autism (which I believe is baseless), the fact is that all vaccines (as with all therapeutics) are associated with experienced adverse events (actual events, not just the risk of the event). While the rates of most of these events are incredibly low, they are not zero. That is the nature of the risk-benefit analysis for any therapeutic decision.

 

Unfortunately, the Western world has become incredibly risk-adverse and benefit-demanding, and this is where the statistical nature of science and healthcare runs up against the individual nature of health. A mother or father can hear all the statistics they want, but show them a single photo of a harmed child, and I can guarantee what direction they will lean. Having worked in medical marketing, I have seen it time and again.

 

“National measles vaccination programs effectively eradicated measles in Canada and the United States,” a health policy advocate may argue, but what does that really mean to a young parent with no exposure (apologies) to measles. I’m 51 years old and I have never seen anyone with measles who was more than itchy and miserable.

 

In a recent commentary in The Toronto Star, University of Toronto respirologist Sami Gupta discussed the current vaccination challenge.

 

“Studies show that didactic repetition of facts just doesn’t change behavior, and that our top-down and adversarial approach further polarizes communities and actually alienates parents.”

 

My marketing experiences suggest his comment is correct, but I also don’t think it goes far enough.

 

We talked about the idea of disease prevention, but tended to gloss over the low-but-not-zero risks of adverse events. Then, when the very rare adverse event does occur, usually with a photo of a forlorn child, we are caught in a sin of omission.

 

We talked about the power of herd immunity and are now seeing that used as ammunition against the vaccination of individuals. “If everyone else’s child is immunized, why should mine have to be?”

 

Unfortunately, because of the unique format of vaccines, I think we have to “stoop” to the level of the other side and focus on the risks of not vaccinating, at a personal level. No more statistics, no more history lessons, but rather anecdotes and photos of people with the infectious diseases. Yes, it is fear-mongering, but if we are honest about our own limitations, then it is at least balanced fear-mongering and is a starting point for a conversation rather than a shouting match.

 

Later tonight (as I write this column), the Canadian television news program The National is convening a panel to discuss the current vaccine conversation. I will be intrigued to see if they actually include a so-called “anti-vaxxer” on the panel to make this a true debate, or if it will be a panel of like-minded healthcare specialists espousing the official line—the “didactic repetition of facts” about which Gupta warned.

 

[Added note: The only place I have seen an actual debate on this topic was on The Nightly Show with Larry Wilmore on Comedy Central, which included a vaccine-cautioner on its panel. Read into that what you will.]