Pharmacists pride themselves as being the most accessible health professionals. In community pharmacy settings, pharmacists speak with hundred of patients per day, and are available (free, and without an appointment) for quick consultations. Building good relationships is a rewarding part of being a pharmacist, and the level of trust that can develop supports open dialogue on health issues.
So as a pharmacist, how do you react when one of your patients indicates antagonism to vaccines? Attitudes can range from from mild unease, to full-blown conspiracy theories. The reasons for rejection can be numerous. A first step to supporting open dialogue would be to understand the usual reasons for vaccine rejection.
Nicely, Anna Kata in the Department of Anthropology of McMaster University in Hamilton Ontario has analyzed and categorized these arguments. The paper, A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet set out to examine and analyze antivaccination websites. Google searches were used to identify the highest-ranked anti-vaccine sites using typical search strategies. Arguments were categorized and examined: What themes were common, and why were these arguments appealing? Eight antivaccination sites were eventually included and studied, including Global Research, Vaccine Liberation, Vaccination News, the Canadian Vaccination Risk Awareness Network, WHALE.to, Vaccination, Vaccination Debate, and Wikipedia’s “Vaccine Controversy” page.
Here are the themes Kata identified:
Safety and Effectiveness: Safety themes are universal on antivaccination sites. Every single site surveyed claimed vaccines were poisonous, caused illness, and and contained poisonous substances..antifreeze, formaldehyde, mercury, and so on. Illnesses linked to vaccines includes autism (of course), AIDS, asthma, leukemia, SIDS, and more. Additional common claims included:
- vaccines weaken the immune system
- vaccines don’t actually provide immunity
- vaccines didn’t result in the elimination of smallpox/measles/etc, it was public health/nutrition/poverty
- vaccine preventable diseases are trivial. Measles is “mild”, smallpox was “harmless”, etc.
Alternative Medicine: Most antivaccination sites promote alternative medicine. Treatments like herbal medicines, homeopathy, naturopathy, chiropractic or acupuncture were positioned as superior to vaccination. Common sentiment included:
- “natural” methods of disease prevention are superior
- allowing children to experience illness is a better approach
- rejection of germ theory: claiming illness is a result of imbalanced bodily conditions, “dis-ease”, vital force, etc. Ad hominem attacks against Pasteur were noted.
- rejection of scientific, clinical and epidemiologic evidence
Civil Liberties: Civil liberty arguments appeal to parental/self rights and make accusations of totalitarianism/fascism. (One argument I noted before the H1N1 vaccine arrived in Canada were claims that the military was prepared to force vaccination on all citizens of Canada.) A common story is that of a parent who had their child taken away by social services for not being immunized.
Conspiracy Theories: Conspiracy theories are endemic, and showed up on every antivaccination site reviewed. Anti-science rhetoric is common. Sites almost always claim there is a mass cover-up involving manufacturers, governments, regulators, and health professionals. Typical claims include:
- vaccination is motivated solely by profit-driven pharmaceutical companies
- viruses like H1N1 were created in a laboratory (by Big Pharma, or the World Health Organization) to control the population
- vaccinations are a tool of the World Health Organization/Illuminati/etc to control the world/implement the New World Order
- regulators have no interest in protecting the public, they are beholden to Big Pharma
- vaccines are a socialist/conservative/Democrat/Republican plot
- health professionals are profit-focused and beholden to industry
- health professionals are in denial or are blind to the true effects of vaccines
- health professionals actively and deliberately under-report adverse events to vaccines
- physician that speak out against vaccines (e.g., Andrew Wakefield) are lauded or martyred, no matter how discredited
- vaccination is a tool to kill/sterilize/exert mind control of the population
Morality, Religion, and Ideology: Morality and religious objections were identified on 25% of web sites surveyed. Common arguments included:
- God created a perfect immune system
- vaccines are cultured in the tissue of aborted fetuses
- animals are tortured in the manufacture of vaccines
- vaccines are tested on children in third world countries
Misinformation and Falsehoods: Demonstrably false statements are common on antivaccination sites. The authors noted that there is no evidence of self-criticism in the anti-vaccination community, where unsupportable statements were rarely challenged. Misinformation can be difficult to spot without knowing the data, but commonly includes:
- misleading interpretations of vaccine studies
- misleading use of statistics
- false statements about the presence/absence of thimerosal in vaccines
- statistics/prevalence of communicable disease or diseases such as autism
- unsupportable claims (e.g., smallpox was not contagious, polio caused by diet, rabies is psychosomatic)
Interestingly, the only website noted to be free of misinformation was Wikipedia’s “Vaccine Controversy” page, which, at the time the author did her survey, was “current, unbiased, and properly referenced.” It was felt to be the most credible and balanced of all the websites surveyed.
Emotive Appeals: Personal testimonials are very common, and typically include narratives from parents who attribute injury to vaccines. Interactions with government, medicine, and the scientific establishment are positioned as “us versus them” battles.
What’s a pharmacist in a postmodern society to do?
As long as there have been vaccinations, there have those that oppose them. The underlying themes have changed little since the 18th century, despite the demonstrable successes of vaccines. Kata suggests this indicates the presence of deeper social and political tensions that manifest as different arguments, depending on the era: Where civil rights and government distrust were historically more common, today, rejection of scientific evidence and of the science-based model of disease seems more prevalent, with a growing embrace of different (non-science-based) models of disease. But each person’s reason for rejection may be different, and it may manifest in how they interact with health care professionals. Some may trust the pharmacist, and others may see the pharmacist as just a cog in the industrial-pharmaceutical complex.
The internet brought democratization of information. Web 2.0’s social networking has led to the evolution of new social networks that make it easy for anyone with fears of vaccines to find the confirmation bias needed to reassure themselves that vaccines are bad. Kata implicates much of the modern antivaccination sentiment to postmodern concepts of society. To the postmodernist, there are no facts, only truths, and all truths are socially constructed. Because they’re socially constructed, they are subject to the biases and prejudices of the observer. This places the observer as the final arbiter of truth, regardless of expertise. To the post modernist, even basic science is to be questioned, because how can we “REALLY” know? The consequence of postmodernism is that the opinion of the pharmacist or physician becomes just that: one opinion that is considered alongside all others, including those without any relevant expertise or education.
It’s clear that the reasons for antivaccination sentiment can vary, and not all arguments are amenable to the simple provision of education or evidence. Having an understanding of the underlying issues that each patient may bring forward, and their underlying perspective on science, facts, and evidence can help pharmacists comprehend the nature of common anti-vaccine arguments. By keeping the lines of communication open, and being prepared to recognize vaccine misinformation, pharmacists can work to build trust and reinforce their voice as credible, trusted sources of information.
To our health professional readers: What are your strategies for dealing with anti-vaccine sentiment among your patients?
Photo from UNICEF Sverige under Creative Commons licence.