Tough Medicine

Vaccinations: Why fear-mongering won’t win either side of the argument, but fear mitigation might.

I get overly worked up when I defend vaccines. Because basically, I think that you deciding not to vaccinate your children is going to result in the end of the human race. There will be successive and inevitable waves of disease and every one of us will die horrible, nasty deaths and it will be all your fault because it was preventable.

Reality check: Probably not.

But it’s clear how divisive the issue has become and how easily we slide into our respective extremes of position.

I find it ineffective to reason with anti-vaxxers, because reason isn’t what keeps people from getting vaccinated. Fear and intangibles are. I can try to tackle every objection to vaccines head-on with fact and statistic, but when it comes to fear, anecdote holds greater sway than science. If someone tells you that their child was ‘never the same’ after receiving the shot, it’s hard to put your own child at risk with that at the forefront of your mind.

There’s a lot at stake for parents. Being responsible for the well-being of a tiny human is an overwhelming burden and it’s hard to knowingly and willingly put your child (potentially) in harm’s way, especially when that choice is to treat them for illnesses that they don’t have yet and may never be exposed to. Vaccines are insurance. You may never need them. And in the same way that a lot of people make the decision not to buy insurance and opt to take the risk, some parents play a game of weighing the odds and forego the vaccines.

But there is a reason why vaccines, like car insurance, are mandatory. For the very reason that the risk to self and others by not being vaccinated far outweighs the risk to the individual of negative effects.

And there are negative effects. I am not going to sugar-coat it. There is a potential risk for a negative reaction to each and every vaccine.

Just like there is a potential risk for a negative reaction or outcome to any treatment or medication, or in fact, any action in life.

I am not here to minimize how scary that is.

What I am asking for is perspective.

If we return to my own personal fear-based scenario above, the odds of there being a worldwide epidemic due to some parents not vaccinating their children are minimal. What is reasonable to expect is that with increasing numbers of parents refusing to vaccinate, we will continue to see pockets of outbreaks of diseases that should have been eliminated by now. Children (and adults) will suffer (and some will die) unnecessarily from diseases that could have been easily prevented.

For an anti-vaxxer, the greatest fear is harm to their child. But the reality is that the risk of your child experiencing a serious negative reaction to vaccines is minimal. You put them at greater risk when you put them in your car. The risk of adverse reactions to penicillin is far greater, but most parents would not refuse antibiotics to treat a child’s infection. The risk of adverse reactions to measles, mumps, whooping-cough and flu are higher (especially in children under five) still.

The problem with hot-button issues is that it quickly becomes habit to slip into rhetoric when debating either side of the issue. Emotion is summarily dismissed as irrationality, with a focus on bolstering our arguments with facts and figures. I’m certainly not going to suggest giving up on statistical evidence or the science supporting vaccines. But I am willing to concede that every decision which is made in terms of risk management ultimately involves a gut decision. Until we acknowledge the emotion and fear surrounding the issue, there will be little positive movement in vaccination rates (and worse, they are likely to continue a steady decline).

More needs to be done to assuage the genuine and at times crippling fear that parents feel, and to do that we need to acknowledge negative outcomes. Parents need a game plan.

There is a tendency in medical circles to downplay risk without recognizing that an essential component of risk management is the ‘Plan B’. In evaluating any worst-case scenario, there is always a plan of treatment or course of action to continue to mitigate negative outcomes.

Parents need to know that negative outcome is not doublespeak for ‘irreversible damage’. In the same way parents are advised that pain can be treated with anti-inflammatory medication and that allergic reactions can be treated with epinephrine, for each negative outcome there needs to be an explanation of a treatment plan.

The problem with fear is that when it is based in reality, even when it is proportionally distorted, it is impossible to entirely dismiss. And that’s not a bad thing. Fear is useful when it protects us, just not when it paralyzes us. If we are to keep that fear in check, we need the tools to manage the anxiety it elicits.

The war against anti-vaxxers won’t be won with intimidation or statistics, and most importantly won’t be won if we treat it as a war at all. Intimidation only fuels fear.

If strides are truly going to be made in vaccination compliance, it will be through the acknowledgement of fear and risk, and via a change in attitude in terms of how we manage fear-based trepidation as a cooperative effort between parents and physicians.

/rk