Heard the one about all those vaccinations overloading your kids’ immune systems? Of course you have. You can’t miss those myths online, and many of us hear them in practice too. We know they’re all spurious, but that doesn’t make them easier to dispel.
Vaccine deniers are causing huge impact globally, thanks to the influence of social media and perennial demise of common sense, especially when plausible-sounding alternatives are on offer at every click. You may think we have it bad here, with dropping vaccine rates, but the situation is catastrophic in countries like the Philippines, where a current measles outbreak is affecting 33,000 children.
I think that talking about vaccines in GP consultations is hard and may not even be fruitful. There isn’t the time to explain the difference between ethyl and methyl mercury, which a lot of the #antivax myths stem from; or that polio affected 1,000 children a day in 1988 worldwide, but 20 years later affected only 2,000 children in the entire year. We know the value of vaccines, but we don’t always have time or the right ways to extol this to our patients. Ten minutes is hardly enough to counter hours and hours of scrolling through online vax sites or YouTube channels.
Our efforts may be best targeted elsewhere.
Vaccination data figures from Public Health England show that trust in HCPs remains high – over 90% of parents feel their HCPs and the NHS are the best source of vaccine information, whereas only around a third consult online resources for vaccination information. Ninety per cent of parents vaccinate their children when due, and only 2% are vaccine refusers. So where are the others?
I don’t think we need to use clinic time to dispel vaccination myths at the potential expense of losing parents’ trust. While the health secretary targets social media sites and their vaccinations myths, we simply need to get the kids through the door.
We must work on the fact that certain groups of our patients aren’t in principle ‘anti-vaccine’, but accidentally end up unvaccinated for other reasons
As ever in general practice, access to appointments and availability are an important part of the picture. Parents missing appointments, forgetting or not being able to get one at a good time is part of this sorry picture, especially in the case of the MMR.
The UNICEF figures published in April show that, along with the US and France, we have the highest rates for children unvaccinated against measles. Whilst the DHSC should be targeting online too, in primary care we can improve things at a more basic level.
Primary care needs to recognise that it’s not simply the vaccine-deniers that are the issue with vaccination rates. Other barriers exist. Improving this will not get a wave of vaccine-refusers through the door, but it will improve numbers of those who are a bit less than eager. Data from the Royal Society of Public Health reveals that timing of appointments, availability and other commitments can limit vaccine uptake in those who would be keen if things were simpler and more convenient. For this cohort, many barriers can exist that we can counteract with logistics – ease of bringing other children to appointments, opening up walk-in clinics and flexibility around working parents.
We must acknowledge and work on the fact that there are certain groups of our patients who are not in principle ‘anti-vaccine’, but accidentally end up unvaccinated for other reasons: they are vulnerable, they miss appointments they meant to keep, or they can’t access the opportunities on offer. Low coverage of this kind is particularly seen in particular communities, such as travelling families and certain ethnic groups. For example, the Charedi community in north London are known to have poor vaccination rates. For them, this is not an objection, but rather logistics. Their families are large, often having upwards of 10 children. Simply accessing the vaccination appointments with nine other children in tow is impractical and vaccination rates drop off. So much so that figures from PHE reveal in these communities that vaccination status is inversely related to their birth order.
Much as with other areas for health provision and prevention, there is an inequality in vaccine uptake that we can try and address. Ensuring universally-available appointments at good times is critical to ensuring the beacon of 95% coverage. Access, reminders and recall systems are all important, as well as targeted approaches for our more vulnerable patient groups, and this is where the primary care focus for vaccinations should be.
I admire my GP colleagues on social media counteracting vaccine nonsense as I do myself, but in reality we need to set our sights elsewhere.
Dr Ellie Cannon is a portfolio NHS GP in London and broadcast media doctor