Tag: benefits

We Don’t Know How To Talk About Vaccines

There is a dirty little secret about vaccines that people don’t seem to like to talk about.

No, it’s not about toxins or autism.

“Our systematic review did not reveal any convincing evidence on effective interventions to address parental vaccine hesitancy and refusal. We found a large number of studies that evaluated interventions for increasing immunization coverage rates such as the use of reminder/recall systems, parent, community-wide, and provider-based education and incentives as well as the effect of government and school immunization policies.

However, very few intervention studies measured outcomes linked to vaccine refusal such as vaccination rates in refusing parents, intent to vaccinate, or change in attitudes toward vaccines.

Most of the studies included in the analysis were observational studies that were either under-powered or provided indirect evidence.”

Sadaf et al on A systematic review of interventions for reducing parental vaccine refusal and vaccine hesitancy

It’s that we don’t really know how to talk about vaccines to vaccine hesitant parents, at least not in a way that we know will consistently get them to vaccinate and protect their kids.

Understanding Studies About Vaccine Hesitancy

Sure, a lot of studies have been done about talking to vaccine hesitant parents.

We have all seen the headlines:

  • Study: You Can’t Change an Anti-Vaxxer’s Mind
  • Pro-vaccine messages can boost belief in MMR myths, study shows
  • UWA study shows attacking alternative medicines is not the answer to get parents to vaccinate kids
  • Training Doctors To Talk About Vaccines Fails To Sway Parents

Does that mean that you shouldn’t try to talk to vaccine hesitant parents?

Of course not.

“How providers initiate and pursue vaccine recommendations is associated with parental vaccine acceptance.”

Opel et al on The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits

Just understand that these headlines are usually about small studies, which if they were about treating a child with asthma or strep throat,  likely wouldn’t change how you do things.

Why do anti-vaccine websites still post misinformation about fake recommendations to stop breastfeeding?
Why do people continue to believe misinformation about fake recommendations to stop breastfeeding?

In one study that concluded that “physician-targeted communication intervention did not reduce maternal vaccine hesitancy or improve physician self-efficacy,” the physicians got a total of 45 minutes of training!

So they shouldn’t have so much influence about how you might talk to parents about vaccines that you throw up your hands at the thought of talking to a vaccine hesitant parent and won’t even think about learning how to use the CASE method, why presumptive language might work, or about vaccination-focused motivational interviewing techniques.

The bottom line is that no matter what the headlines say, we just haven’t found the best way to talk to vaccine-hesitant parents and help them overcome their cognitive biases. And until more studies are done, none of the existing studies about anti-vaccine myth-busting should likely overly influence how you do things.

“Physicians should aim for both parental satisfaction and a positive decision to vaccinate. Researchers must continue to develop conceptually clear, evidence-informed, and practically implementable approaches to parental vaccine hesitancy, and agencies need to commit to supporting the evidence base. Billions of dollars fund the research and development of vaccines to ensure their efficacy and safety. There needs to be a proportional commitment to the “R&D” of vaccine acceptance because vaccines are only effective if people willingly take them up.”

Leask et al on Physician Communication With Vaccine-Hesitant Parents: The Start, Not the End, of the Story

If you spend any time talking to vaccine hesitant parents, especially those who are on the fence, you quickly learn that many are eager to get good information about vaccines and all want to do what is best for their kids.

It’s just hard for many of them to do what is best when their decisions are getting influenced by vaccine scare videos and many of the 100s of myths about vaccines that are out there.

“…while the drivers of vaccine hesitancy are well documented, effective intervention strategies for addressing the issue are sorely lacking. Here, we argue that this may be because existing strategies have been guided more by intuition than by insights from psychology and by the erroneous assumption that humans act rationally.”

Rossen et al on Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination

So while we need more studies on the best ways to talk to vaccine hesitant parents, don’t dismiss all of the ways that might be effective, such as:

It is also important to become familiar with the myths and anti-vaccine talking points that may be scaring your patients away from getting vaccinated on time.

Why is this important?

If a parent is concerned about glyphosate, you might not sound too convincing telling them not to worry if you don’t even know what glyphosate is.

What to Know About Vaccine Hesitancy Studies

While we learn better ways to talk about vaccines, so that vaccine-hesitant parents can more easily understand that vaccines are safe and necessary, don’t dismiss current strategies because of small studies and attention grabbing headlines.

More on Vaccine Hesitancy Studies

 

How Effective Is the Flu Vaccine?

The flu vaccine works.

How well does it work?

It depends…

How Effective Is the Flu Vaccine?

What does it depend on?

“The vaccine effectiveness of seasonal influenza vaccines is a measure of how well the seasonal influenza vaccine prevents influenza virus infection in the general population during a given influenza season.”

WHO on Vaccine effectiveness estimates for seasonal influenza vaccines

Is the flu virus that is going around the same strain that was picked to be in the flu vaccine?

Once upon a time, we didn't have flu vaccines to help keep us healthy.
Once upon a time, we didn’t have flu vaccines to help keep us healthy.

Has the flu virus drifted, even if it is the same strain that is in the flu vaccine, becoming different enough that your protective flu antibodies won’t recognize it?

Is the H3N2 strain of flu virus the predominate strain during the flu season? H3N2 predominant flu seasons are thought to be worse than others.

In general, the flu vaccine is going to be less effective in a season where there is a poor match between the circulating strain of flu virus that is getting people sick and the strain that is in the flu vaccine, especially if it is an H3N2 strain that has drifted.

That’s why, since the 2004-05 season, the average flu vaccine effectiveness has been about 41%.

How Effective Is This Year’s Flu Vaccine?

It’s probably also why, every year, we seem to hear the same questions:

  • Should I get a flu vaccine? – yes, definitely
  • Will we have enough flu vaccines? – while historically there have been some delays and shortages, we have a very good supply of flu vaccine this year, between 151 to 166 million doses
  • How effective is this year’s flu vaccine???

Unfortunately, we really won’t know the answer to that last question until this year’s flu season really gets going.

What about reports that the flu vaccine effectiveness will be as low as 10% this year?

It is important to note that those reports are not based on flu activity in the United States and it has been a long time since we have seen flu vaccine effectiveness that low – the 2004-05 flu season. That was the year that because of a drifted A(H3N2) virus, “only 5% of viruses from study participants were well matched to vaccine strains.”

The 10% number is instead based on reports of Australia’s flu season, in which early estimates found that the A(H3N2) component of the flu vaccine was only 10% effective. Importantly, the overall vaccine effectiveness was much higher. Including other strains, the flu vaccine in Australia was at least 33% effective this past year.

“In the temperate regions of the Southern Hemisphere, influenza activity typically occurs during April – September.”

CDC on Influenza Prevention: Information for Travelers

Couldn’t we see a drifted A(H3N2) virus this year?

Sure, especially since an A(H3N2) virus will likely be the dominant strain, but so far “data indicate that currently circulating viruses have not undergone significant antigenic drift.”

“It is difficult to predict which influenza viruses will predominate in the 2017–18 influenza season; however, in recent past seasons in which A(H3N2) viruses predominated, hospitalizations and deaths were more common, and the effectiveness of the vaccine was lower.”

CDC on Update: Influenza Activity — United States, October 1–November 25, 2017

Again, it is too early to predict how effective the flu vaccine will be, but based on an undrifted H3N2 virus that is matched to the vaccine, you might expect an effectiveness between 30 to 40%.

It might be less if theories about egg-adapted mutations are true and are a factor this year.

“…some currently circulating A(H3N2) viruses are less similar to egg-adapted viruses used for production of the majority of U.S. influenza vaccines.”

CDC on Update: Influenza Activity — United States, October 1–November 25, 2017

It is also important to keep in mind that vaccine effectiveness numbers from Australia and the United States don’t always match up.

For example, in 2009, Australia reported an interim flu vaccine effectiveness of just 9%, but in the United States, the flu vaccine ended up being 56% effective! On the other hand, in 2014, the flu vaccine worked fairly well in Australia, but vaccine effectiveness was found to be just 19% in the United States.

Vaccine Effectiveness by Year
Australia United States
2007 60% 2007-08 37%
2008 NE 2008-09 41%
2009 7% 2009-10 56%
2010 73% 2010-11 60%
2011 48% 2011-12 47%
2012 44% 2012-13 49%
2013 55% 2013-14 52%
2014  50% 2014-15 19%
2015  ?% 2015-16 48%
2016  ?% 2016-17 42%
2017 33% 2017-18 ?%

What does all of this mean?

Not much.

“This season’s flu vaccine includes the same H3N2 vaccine component as last season, and most circulating H3N2 viruses that have been tested in the United States this season are still similar to the H3N2 vaccine virus. Based on this data, CDC believes U.S. VE estimates from last season are likely to be a better predictor of the flu vaccine benefits to expect this season against circulating H3N2 viruses in the United States. This is assuming minimal change to circulating H3N2 viruses. However, because it is early in the season, CDC flu experts cannot predict which flu viruses will predominate. Estimates of the flu vaccine’s effectiveness against circulating flu viruses in the United States will be available later in the season.”

CDC on Frequently Asked Flu Questions 2017-2018 Influenza Season

The reports about what happened in Australia should not have made headlines beyond Australia.

As you should get your family vaccinated if you haven’t yet.

The Flu Vaccine Works

Getting a flu vaccine has many benefits with few risks and can:

  • reduce your chances of getting the flu
  • reduce the chances that your newborn gets the flu if you get your flu shot while pregnant
  • lead to milder symptoms if you do get the flu
  • reduce your risk of being hospitalized
  • reduce your risk of dying from the flu

And while it isn’t perfect, getting a flu vaccine is certainly better than remaining unprotected and simply taking your chances that you won’t get the flu and complications from the flu.

What to Know About Flu Vaccine Effectiveness

Although the effectiveness of the flu vaccine varies from year to year, depending on how well matched the vaccine is to circulating flu virus strains, which strains are dominant, and whether they have drifted, it is always a good idea to get vaccinated and protected.

More on Flu Vaccine Effectiveness

How Many People Die in the USA Every Year from Being Vaccinated?

We know that vaccines work to save lives from vaccine-preventable disease.

If you are at all hesitant about vaccines and are doing your research, you have likely come across the myth that vaccines are more dangerous than the diseases they protect us against though.

This is only because most people don’t remember the pre-vaccine era when measles, polio, small pox, and diphtheria, etc., were big killers. So even though vaccine side effects are about the same as they always have been, they can become a much bigger focus for some people because they don’t see any of the mortality or morbidity from the diseases that the vaccines have gotten so good at preventing.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

It is at this crossover point that anti-vaccine folks are able to get away with pushing myths, such as like more people die from the MMR vaccine than from measles.

They don’t.

How Many People Die in the USA Every Year from Being Vaccinated?

Although vaccines are not perfectly safe, it is extremely rare for a vaccine reaction to be deadly.

“As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.”

WHO on Six common misconceptions about immunization

So why do anti-vaccine folks think that they are more common than they really are?

That’s an easy question to answer.

“Differentiation between coincidence and causality is of utmost importance in this respect. This is not always easy, especially when an event is rare and background rates are not available.”

Heininger on A risk-benefit analysis of vaccination

They often believe than anything and everything that happens after someone is vaccinated, even if it is weeks or months later, must have been caused by the vaccine. This discounts that fact that most people have a basic risk, often called the background rate, for developing these conditions that can coincide with getting vaccinated. It also explains why they believe in so many so-called vaccine induced diseases.

Another reason is that they also misuse VAERS reports when talking about vaccine deaths.

“In a review of reports of death following vaccination submitted to the Vaccine Adverse Event Reporting System (VAERS) from the early 1990s, the Institute of Medicine concluded that most were coincidental, not causally associated.”

Moro et al on Deaths Reported to the Vaccine Adverse Event Reporting System, United States, 1997–2013

Not surprisingly though, studies have shown that most of the deaths in VAERS are not actually related to vaccines.

In fact, most of the things that anti-vaccine folks blame on vaccines, including things you see in many of their vaccine-injury stories, are not related to vaccines.

How Many People Die in the USA Every Year from Vaccine-Preventable Diseases?

Fortunately, most people are vaccinated, and deaths from  vaccine preventable diseases are tremendously below what they were in the pre-vaccine era.

Most people will be surprised to know that they aren’t zero though.

People do still get vaccine-preventable diseases in the United States.

And tragically, people do still die of vaccine-preventable diseases in the United States.

For example, in 2015:

  • there were at least 37 cases of perinatal hepatitis B infections
  • five infants and children less than age 5 years died of rotavirus disease
  • a 14-month-old died of Hib meningitis
  • an infant died of pneumococcal meningitis
  • a 3-year-old with congenital rubella syndrome died
  • at least two teens died of meningococcal meningitis
  • a woman in Washington died of measles – the immunosuppressed women was exposed to an outbreak in Clallam County that mostly included intentionally unvaccinated kids
  • 85 kids died of the flu

Of course, worldwide, especially in developing countries, the number of deaths are much higher, which is a good reminder of what would happen if more of us stopped vaccinating!

And it is an even better reminder that you have to look at the number of deaths from vaccine-preventable diseases today in the context that most people are vaccinated and protected.

If you are truly looking at a risk vs benefit analysis of whether or not to get vaccinated, it is still the great benefit of avoiding vaccine preventable diseases vs the very small risks of getting vaccinated that you should think about.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

It is also the small risks of getting vaccinated vs the much greater risk of going back to the pre-vaccine era if you decided to skip or delay any vaccines.

It is not that you have been scared into thinking that the risks of  vaccines outweigh their benefits.

“Millions of vaccinations are given to children and adults in the United States each year. Serious adverse reactions are rare. However, because of the high volume of use, coincidental adverse events including deaths, that are temporally associated with vaccination, do occur. When death occurs shortly following vaccination, loved ones and others might naturally question whether it was related to vaccination. A large body of evidence supports the safety of vaccines, and multiple studies and scientific reviews have found no association between vaccination and deaths except in rare cases.”

Miller et al on Deaths following vaccination: What does the evidence show?

It is not that the risk of getting a vaccine preventable disease is low because you might be able to get away with hiding in the herd.

It is not that the risk of getting a vaccine preventable disease is low because you are counting on everyone else in the world to get vaccinated and eliminate or eradicate the disease and your risk.

If too many parents who are on the fence start believing that their kids have zero risk of getting polio and other vaccine-preventable diseases and continue to skip or delay vaccines, then boom, we are back to the days when outbreaks would close schools and kids would suffer from the devastating effects of these diseases.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
Even the schools were closed in San Antonio when polio came to Texas in 1946.

While anti-vaccine folks won’t have such an easy time convincing people that these diseases are mild anymore, none of us want to wait for more outbreaks to occur before folks get the message that vaccines are safe and necessary.

What to Know About Vaccine Deaths

Despite what anti-vaccine folks would have you believe as they try to scare you away from vaccinating and protecting your kids, vaccines are safe and necessary and vaccine deaths are very rare.

More on Vaccine Deaths

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”

Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.

We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.

Costs Associated With Getting Sick

If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.

We should though.

Just look at how much it costs to control the recent measles outbreaks that continue to plague us.

“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.

Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.

It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

How do anti-vax folks usually counter this important message?

They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.

The Value of Vaccination

So yes, getting vaccinated is cost effective.

“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”

Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness

The value of getting vaccinated goes way beyond saving money though.

Most of the ways this has been studied in the past still leaves out a lot of important things, including:

  • increased productivity later in life following vaccination
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • vaccination-related benefits to macroeconomic factors and political stability
  • furthering moral, social, and ethical aims

Why are these important?

“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”

Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.

If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.

“We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.”

Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.

And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.

It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.

A great achievement at a great value.

What to Know About the Cost Savings of Getting Vaccinated

There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.

More on the Cost Savings of Getting Vaccinated

Expert Statements on Vaccines

The AAP published their first recommendations on vaccines in 1938.
The AAP published their first recommendations on vaccines in 1938.

Some parents are still confused about who they should listen to for advice about vaccines.

Is there really a controversy or a real debate going on about whether or not getting vaccinated is a good decision?

What do the experts say?

They say that:

And no, it’s not just one or two of them…

“Vaccines protect the health of children and adults and save lives. They prevent life – threatening diseases, including forms of cancer. Vaccines have been part of the fabric of our society for decades and are one of the most significant medical innovations of our time.”

More than 350 medical, professional and advocacy organizations in a 2017 letter to President Trump

It is the hundreds of thousands of experts at every major health organization around the world!

American Academy of Pediatrics

The American Academy of Pediatrics, an organization of 66,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists, has long advocated for the health and safety of our children.

“Vaccines are safe. Vaccines are effective. Vaccines save lives.

Claims that vaccines are linked to autism, or are unsafe when administered according to the recommended schedule, have been disproven by a robust body of medical literature. Delaying vaccines only leaves a child at risk of disease. Vaccines keep communities healthy, and protect some of the most vulnerable in our society, including the elderly, and children who are too young to be vaccinated or have compromised immune systems.”

Fernando Stein, MD, FAAP, President and Karen Remley, MD, MBA, MPH, FAAP, CEO/Executive Vice President, American Academy of Pediatrics

Vaccine friendly pediatricians who are pushing non-standard, parent-selected, delayed protection vaccine schedules are leaving kids at risk for vaccine-preventable diseases.

“Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.”

AAP on Countering Vaccine Hesitancy

Vaccines are necessary.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

Society of Pediatric Nurses

“Immunizations are safe and effective in promoting health and preventing disease.”

SPN Position Statement on Immunizations

National Association of Pediatric Nurse Practitioners

Established in 1973, with more than 8,500 members, the National Association of Pediatric Nurse Practitioners (NAPNAP) is the professional association for pediatric nurse practitioners (PNPs) and all pediatric-focused advanced practice registered nurses (APRNs).

“NAPNAP supports the prioritization of immunization education for parents, guardians and other caregivers of infants, children, and adolescents. This education must include the most current scientific evidence related to vaccine safety, risk, benefits and current resources available to ensure that parents and caregivers receive adequate information about immunizations. This includes, when necessary, relaying the risk of not immunizing their child and potential devastation that can occur when a child is infected with a vaccine-preventable disease. It is incumbent that a PNP also be aware of misinformation in the public domain and provides the correct information to the public as well as the health care community.”

NAPNAP Position Statement on Immunizations

American College of Preventive Medicine

“Vaccine-preventable diseases were a major cause of mortality and morbidity in the United States in the 20th century. With the advent of immunizations, there have been dramatic rates of decline in these diseases. Clinical studies have shown vaccines to be efficacious and cost effective.  ”

ACPM on Childhood Immunizations

American College of Obstetricians and Gynecologists

Founded in 1951, the American College of Obstetricians and Gynecologists (The College) represents more than 58,000 members.

“Health care providers and patients should be aware that the reassuring safety data for use of the aforementioned vaccines in pregnancy are compelling, and there is no link to vaccine administration and miscarriage. An added benefit to immunizing during pregnancy is the potential for disease prevention in newborns by way of passive antibody transfer to the fetus. Hence, offering pregnant patients influenza and Tdap vaccines is an avenue to protect newborn infants at a critically vulnerable time and before neonates can be vaccinated.”

ACOG on Immunization for Pregnant Women

American Public Health Association

The American Public Health Association was founded in 1872, the APHA represents over 25,000 public health professionals.

“And further noting that the Institute of Medicine has recently released a report10 describing the U.S. immunization system as “a national treasure that is too often taken for granted” and calling for substantial increases in federal and state allocation of funds to support immunization infrastructure; therefore

Reaffirms its support for immunization as one of the most cost-effective means of preventing infectious diseases;”

APHA on The Need for Continued and Strengthened Support for Immunization Programs

American Medical Association

The American Medical Association, which was founded in 1847, has just over 240,000 members.

“The AMA fully supports the overwhelming body of evidence and rigorous scientific process used by the Advisory Committee on Immunization Practices which demonstrate vaccines are among the most effective and safest interventions to both prevent individual illness and protect the health of the public.”

William E. Kobler, MD, member of the AMA Board of Trustees.

Immune Deficiency Foundation

“The development of immunizations for common bacterial and viral infections has represented a major advance in the battle against microbial organisms that constantly threaten the welfare of humankind and particularly the pediatric population. However, the alarming increase in nonimmunized persons could lead to a return of the epidemics seen in the past.

…critical need for maintenance of herd immunity in the population at large. It is particularly important for family members of patients with defective T and B lymphocyte–mediated immunity to receive all of the available standard immunizations (excluding live poliovirus).”

Medical Advisory Committee of the Immune Deficiency Foundation on Recommendations for live viral and bacterial vaccines in immunodeficient patients and their close contacts

American Nurses Association

The American Nurses Association (ANA), founded in 1896, represents “the interests of the nation’s 3.6 million registered nurses.”

“To protect the health of the public, all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). All health care personnel (HCP), including registered nurses (RNs), should be vaccinated according to current recommendations for immunization of HCP by the CDC and Association for Professionals in Infection Control and Epidemiology (APIC).

As stated in the Code of Ethics for Nurses (ANA, 2015, p. 19), RNs have an ethical responsibility to “model the same health maintenance and health promotion measures that they teach and research…,” which includes immunization against vaccine-preventable diseases.”

ANA Position Statement on Immunizations

Autism Science Foundation

“Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”

Autism Science Foundation on Vaccines and Autism

The American Association of Immunologists

The American Association of Immunologists (AAI) is the largest professional association of immunologists in the world, representing more than 7,600 basic and clinical immunologists.

“Recent outbreaks have brought increased attention to vaccine- preventable diseases and have highlighted the need for robust and timely immunization to reduce preventable sicknesses and deaths. AAI strongly urges full adherence to recommended vaccination schedules and views vaccines as efficacious for individuals and crucial to public health.

Research has repeatedly confirmed that vaccinations are safe and highly effective for all healthy children and adults, and any suggestions to the contrary have been discredited. Ongoing vaccine research continually reaffirms its safety and efficacy, including the number of vaccines administered at any one time and the recommended vaccination schedule.”

The American Association of Immunologists Statement on Vaccines

American Osteopathic Association

“The American Osteopathic Association supports the Centers for Disease Control and Prevention in its efforts to achieve a high compliance rate among infants, children and adults by encouraging osteopathic physicians to immunize patients of all ages when appropriate ; supports the HHS National Vaccine Implementation Plan; and encourages third- party payers to reimburse for vaccines and their administration.”

AOA on Immunizations

National Association of School Nurses

#TodaysSchoolNurse is “grounded in ethical and evidence-based practice, are the leaders who bridge health care and education, provide care coordination, advocate for quality student-centered care, and collaborate to design systems that allow individuals and communities to develop their full potential.”

“It is the position of the National Association of School Nurses (NASN) that immunizations are essential to primary prevention of disease from infancy through adulthood.

The school nurse is well-poised to create awareness and influence action to increase the uptake of mandated and recommended immunizations. The school nurse should use evidence-based immunization strategies, such as school-located vaccination clinics, reminders about vaccine schedules, state immunization information systems (IIS), strong vaccination recommendations, and vaccine education for students, staff, and families.”

NASN Immunizations Policy Statement

American Academy of Family Practice

“With the exception of policies which allow for refusal due to a documented allergy or medical contraindication, the AAFP does not support immunization exemption policies.”

AAFP Immunization Policy Statement

American Academy of Allergy, Asthma & Immunology

The American Academy of Allergy, Asthma & Immunology (AAAAI) is a professional organization with over 7,000 members, including allergists/ immunologists, in the United States and 73 other countries.

“Immunization is perhaps the greatest public health achievement of all time, having significantly reduced the morbidity and mortality of many infectious diseases. Routine immunization of children, adolescents, and adults provides substantial protection from a large number of infectious diseases…

Patients who have experienced adverse reactions to vaccines might unnecessarily be advised to avoid subsequent immunization, which could have important adverse personal and population health consequences. Although there are some adverse reactions to vaccines that constitute absolute contraindications to administration of future doses, most such reactions do not preclude subsequent immunization. Patients who have experienced an apparent allergic or other serious adverse reaction after receiving a vaccine warrant evaluation by an allergist/immunologist. Also, patients with preexisting health conditions that might predispose to adverse reactions to vaccines could benefit from such an evaluation. In most cases, a risk-benefit analysis will favor subsequent immunization.”

AAAAI Practice Paramater on Adverse Reactions to Vaccines

CJ First Candle

“There seems to be a common misconception that vaccines are somehow associated with SIDS deaths. This is not true! Experts warn that the risk of leaving your baby unprotected is 1,000 times greater than any increased risk for SIDS. Because infants receive many immunizations during the critical development period from two to six months of age, and 90 percent of SIDS deaths occur within this time frame, it is only logical that many SIDS victims have recently received vaccines. This does not mean that the immunization had anything to do with the infant’s subsequent sudden and unexpected death. The cause and effect of immunizations and SIDS has been comprehensively studied for more than two decades. In fact, in countries where immunization schedules are different from those in the United States, the peak incidence of SIDS is still between two to four months.”

CJ First Candle on Immunizations

Infectious Disease Society of America

Founded in 1963, the Infectious Diseases Society of America (IDSA), with over 9,000 members, represents physicians, scientists and other health care professionals who specialize in infectious diseases.

“The Infectious Diseases Society of America (IDSA) recognizes the great benefits that vaccines provide for the public health. Substantial scientific evidence demonstrates vaccines’ enormous value in protecting individuals and populations from serious and life-threatening infections. Scientific evidence also demonstrates the overall safety of vaccines. Communities are most effectively protected when all are immunized.

Studies demonstrate that the easier it is to receive an exemption, the higher the rate of exemptions in a particular state. As the number of exemptions increases, the risk of vaccine – preventable disease increases. Therefore, states must make every effort to minimize the number of its citizens exempted from immunization mandates. Such exemptions make the state legislatures who grant them, as well as the individuals who receive them, responsible for placing the remaining state population at greater risk of acquiring potentially fatal infections.”

IDSA Policy Statement on State Immunization Mandates

The Arc of the United States

“Prior to widespread immunization in the United States, infectious diseases killed or disabled thousands of children each year. The near elimination of intellectual disability due to measles encephalitis, congenital rubella syndrome, and Haemophilus influenzae type b meningitis or Hib can be contributed to vaccines.”

The Arc Facts About Childhood Immunizations

American College Health Association

“The American College Health Association (ACHA) strongly supports the use of vaccines to protect the health of our individual students and our campus communities. In recognition of the vital role that vaccine coverage plays in community immunity (herd immunity), ACHA discourages use of nonmedical exemptions to required vaccines.”

ACHA on Immunization Recommendations for College Students

What to Know About Expert Statements on Vaccines

Over the years, hundreds of organizations representing millions of families, health care providers, researchers, patients, and consumers,  have repeatedly expressed their unequivocal support for vaccines, because they understand that vaccines work and that they are safe and necessary.

More on Expert Statements on Vaccines

What Are the Risks of Vaccines?

Vaccines are very safe, but they are not 100% risk free.

They are certainly not as high risk as some anti-vaccine folks will have you believe though.

“Vaccine hesitation is associated with perceived risk. Since vaccine-preventable diseases are rare, an adverse event from a vaccine is perceived by the parent to be of greater risk. Risk perception is critical.”

AAP on Addressing Common Concerns of Vaccine-Hesitant Parents

And when you consider their great benefits, it is easy to see why the great majority of parents get their kids fully vaccinated and protected against all recommended vaccine-preventable diseases.

Risk Perception and Vaccine Hesitancy

Even though the risks and side effects of vaccines are very low, some people think that they are much higher. This is often amplified because of vaccine scare stories and the misinformation found on anti-vaccine websites.

“No intervention is absolutely risk free. Even the journey to a physician’s office with the intention to receive a vaccination carries the risk of getting injured in an accident. With regards to risks of vaccination per se, one has to distinguish between real and perceived or alleged risks.”

Heininger on A risk–benefit analysis of vaccination

Other problems with risk perception include that some people:

  • can be more likely to avoid risks that are associated with an action or having to do something vs. those that involve doing nothing or avoiding an action, even if inaction (skipping or delaying a vaccine) is actually riskier
  • often think about risks based on their own personal experiences (you remember someone’s vaccine injury story), rather than on scientific evidence

These biases in the way we think about risk can actually lead us to make risky choices and they help explain why some people are still so afraid of vaccines. Parents might think the risk of a possible side effect, some of which don’t even exist, is worse than the risk of getting a vaccine-preventable disease, getting someone else sick, or starting an outbreak. Parents also often underestimate the risk of their decision to not vaccinate their child.

“As much previous research claims, this study confirms that individuals characterized by greater trust of healthcare professionals and the possession of more vaccine-related knowledge perceive higher levels of benefits and lower levels of risks from vaccinations.”

Song on Understanding Public Perceptions of Benefits and Risks of Childhood Vaccinations in the United States

So what’s the answer? It is likely for folks to get better educated about vaccines, including getting a good understanding of both their benefits and risks.

What Are the Risks of Vaccines?

Again, vaccines are not 100% safe or risk free.

Most vaccines have some common, mild side effects, which might include (depending on the vaccine):

Vaccine Information Statements from the CDC highlight the risks of each vaccine.
Vaccine Information Statements from the CDC highlight the risks of each vaccine.
  • fever, typically low-grade
  • redness or swelling where the shot was given
  • soreness or tenderness where the shot was given
  • fussiness
  • headache
  • tiredness or poor appetite
  • vomiting
  • mild rash
  • diarrhea
  • swollen glands

How commonly do they occur?

It depends on the vaccine and side effect, but they range from about 1 in 50 to 1 in 3 people. These side effects are typically mild and only last a day or two. And they don’t cause lasting problems.

While not all possible side effects are mild, those that are more moderate or severe are much more uncommon. Febrile seizures, for example, only happen after about 1 out of 3,000 doses of MMR and some other vaccines. And while scary, febrile seizures, crying for 3 hours or more, or having a very swollen arm or leg, some other uncommon vaccine side effects, also don’t cause lasting problems.

Fortunately, the most severe side effects, including severe allergic reactions, are only thought to happen in less than 1 out of a million doses. And although these types of severe reactions can be life threatening, they are often treatable, just like severe allergic reactions to peanuts. For others, like encephalitis, although they are table injuries, it isn’t clear that they are even side effects of vaccines, since they occur so rarely.

All of these side effects can be reported to the Vaccine Adverse Event Reporting System (VAERS), either by your doctor or yourself.

“No medical product or intervention, from aspirin to heart surgery, can ever be guaranteed 100% safe. Even though we will never be able to ensure 100% safety, we know that the risks of vaccine-preventable diseases by far outweigh those of the vaccines administered to prevent them.”

World Health Organization

In addition to side effects, some other risks of getting vaccinated might include that your vaccine didn’t work, after all, although vaccines work very well, they are not 100% effective. You might also, very rarely, be given the wrong vaccine or the right vaccine at the wrong time.

Many other things, including so-called vaccine induced diseases, aren’t actually a risk of vaccines at all. Remember, autism, SIDS, multiple sclerosis, and shaken-baby syndrome, etc., are not a risk of vaccines.

What to Know About the Risks of Vaccines

Any small risks of getting vaccinated, including side effects that are often mild, are not a good reason to think about skipping or delaying a vaccine, especially when you thoughtfully consider all of their great benefits.

More About the Risks of Vaccines

What Are the Benefits of Vaccines?

Vaccines are safe, effective, and necessary.

They are neither 100% safe nor 100% effective.

That doesn’t make them any less necessary though.

It’s easy to see why when you look at all of the benefits that vaccines have given us.

Perceptions of Risks vs Benefits of Vaccines

One of the reasons that some parents become vaccine-hesitant is that they forget about the many benefits of vaccine.

That’s not surprising, as the better vaccines work, the less obvious their benefits are to everyone. After all, few people remember what it was like in the pre-vaccine era.

A measles epidemic hit New York City in 1951, as this front page NYTimes article reports.
A measles epidemic hit New York City in 1951, as this New York Times article reports.

That makes it easy to for some people to downplay the benefits of vaccines.

Unfortunately, at the same time, some parents might over-estimate the risks of vaccines. And that makes it even easier for them to justify a decision to skip or delay their child’s vaccines.

What Are the Benefits of Vaccines?

For most of us, the greatest benefit of any vaccine is that it keeps us from worrying that our kids will get a vaccine-preventable disease. If they do get sick, we don’t worry that every fever is measles or that every cough is pertussis either.

“It is also much cheaper to prevent a disease than to treat it. In a 2005 study on the economic impact of routine childhood immunization in the United States, researchers estimated that for every dollar spent, the vaccination program saved more than $5 in direct costs and approximately $11 in additional costs to society.”

NIH: National Institute of Allergy and Infectious Diseases

Among the other benefits of available vaccines are that:

The benefits of vaccines become more obvious when folks stop vaccinating.

immunization-program-stages
As more people are vaccinated and diseases disappear, they forget how bad those diseases are, skip or delay getting their vaccines, and trigger outbreaks. Photo by WHO

What happens?

Invariably, we start to see outbreaks.

Then they quickly remember why vaccines are necessary, vaccines rates go up, and the outbreaks get under control.

And everyone understands that all of great benefits of vaccines far outweigh any of their small risks. They also begin to hopefully understand that not everyone can attempt to hide in the herd or follow an alternative immunization schedule. That too can simply lead to more outbreaks, as the number of unvaccinated folks increases, at least temporarily.

What to Know About the Benefits of Vaccines

The great benefits of vaccines, which include that they have saved millions of lives, far outweigh any small risks.

More About the Benefits of Vaccines

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