How the science of convincing doctors to be skeptical changed

This month, Germany finalized a plan to require all schoolchildren to get vaccinated for autism, in an attempt to prevent further outbreaks of the disease that the government says has been going unnoticed in many parts of the country. Health care workers, particularly those caring for severely autistic children, have accused the government of overstepping its constitutional mandate and putting the health of every German in jeopardy. Critics say the new plan, which is scheduled to take effect in 2015, will have a hugely negative impact on the health care system.

But just a few years ago, making vaccines mandatory was highly controversial — indeed, highly unthinkable. For example, all five European countries whose records have been kept have reported an even split between strong opposition to mandatory vaccination and strong support for allowing parents to decide whether their children could be immunized. Germany, however, had always favored allowing parents to decide based on personal beliefs.

Related Image Expand / Contract German Children will soon be required to get vaccinated. (AP)

In the spring of 2013, David Ascher and Anne-Frédérique Brugler of the University of Utah reported that the parents of children enrolled in Switzerland’s system of compulsory vaccination were less likely to have private medical insurance than Swiss-born parents. In France, about half of the parents responded that having the option to opt out had made them uneasy. In Britain, the survey found that 85 percent of parents polled opposed mandatory vaccination for their children. Even in the U.S., a survey of U.S. health care professionals, conducted in 2009 by the “Know the Science” campaign of researchers and medical societies, found that “90 percent said that parents should have the right to decide whether to vaccinate.”

So what did scientists, physicians and policymakers do about these findings? They began to examine whether public officials and public health officials had been encouraging people to be skeptical about vaccines. The result was a radical new approach in vaccine reform.

“I would say that people have become more knowledgeable, and more politically engaged, in the resistance to this sort of vaccination law,” Ascher and Brugler report. “They may not like the vaccine law itself, but they are having a very direct impact on the bottom line.”

Ascher and Brugler study of public attitudes towards mandatory vaccine law in Spain is seen as one of the most authoritative in Europe. Some 37 percent of the parents they surveyed thought that “in general, vaccination is used in a proper way,” while 35 percent believe that “there are too many who can ignore the vaccine.” Meanwhile, 86 percent said that “vaccination must be made compulsory to protect the health of children.” Among parents with private health insurance, 70 percent believed that vaccination is used in a proper way, and 81 percent said that mandatory vaccination should be made compulsory.

Ascher and Brugler also report that the parent opposition to compulsory vaccination had shifted over time. In 2003, the Spanish government changed the law requiring that students be vaccinated for five diseases. Beginning in 2007, students were forced to take a vaccine for whooping cough. And starting in 2008, they were required to receive at least one shot for a single disease.

In those two years, the number of measles cases declined by 60 percent in the Spanish population and by 92 percent in the school population, Ascher and Brugler reported. The health care systems of Spain’s health care providers performed very well during the shift, in fact. Two weeks after the 2008 change, the two health care centers that had been vaccinated reported to the government that 2.8 times more “infections” than they had in the previous year.

Ascher and Brugler conclude that “universal vaccination can make positive contributions to public health, but only if there is an effort to talk about it in a less antagonistic way.” Through their advocacy work, they are seeing considerable results.

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