Kids on the coast

Most Australian parents (on average, 93%) choose to vaccinate their children.* However, in certain areas, these rates are much lower. Recent reports have estimated that only around 70% of children are fully vaccinated in areas such as Northern NSW and the Sunshine Coast hinterland.
So, let’s pretend the pro vs. anti-vaccination argument breaks out at your next family barbecue. You might hear something like this (which, by the way, are pretty much the same arguments you’d have heard 150 years ago):


Just short of actual fisti-cuffs, they turn to you and ask: “What do you think?”

You can see the problem here. All the above arguments are over-simplified, overly emotive, and offer no room for any discussion. By seeking out the most controversial and conflicting opinions, then publishing the comments offered by the most ardent defenders of either viewpoint, many media outlets also tend encourage this `all or nothing’ mentality.
 
State of confusion

The internet, while a wonderful tool, can also encourage this kind of extreme thinking. There is a mountain of contradictory information to wade through, much of it involving the kind of scientific language you normally wouldn’t find outside of a university. Doing your own research is great, but you have to admit there’s a certain arrogance in thinking that internet access, a good brain and a medical dictionary is equivalent to having a degree in, say, microbiology.

As you leap from one perspective to another and back again, it’s tempting to just go with whoever sounds the most persuasive.
Looking for the truth? Good luck. Assertions, graphs and statistics are thrown around like coins by a drunken sailor, sometimes with equal care as to their aim. It’s a shame they don’t come with warnings: “May be out-of-date, missing vital information, or selectively scaled, edited or interpreted to reinforce a certain viewpoint”.

If in doubt, get a maths-savvy friend to help you check them out. Websites or organisations might claim to be “pro-informed-choice” or “information sites” although they clearly represent only one side of the discussion. Lumping all vaccines and diseases in together is certainly convenient, but it can be frustrating to those who are seeking accurate information.
 
It all adds up!

Then there is the psychological phenomenon called ‘confirmation bias’. Basically this means that each one of us is more likely to notice, remember, and put more faith in, information that agrees with what we already think. Conversely, we tend to forget, disregard, or not even notice information that contradicts our established opinion. If it’s hard for you to be open-minded, imagine someone who’s spent years with their feet very firmly in one camp or another suddenly switching sides! No wonder no-one wants to admit that a particular point made by the ‘others’ could be correct.
Examples of flaws in the standard arguments

For example, arguing that pharmaceutical companies are above reproach, or that assurances of safety should never be questioned, is a bit rich when one considers the history of drugs such as Thalidomide and Vioxx. On the other hand, unless you’re prepared to deliberately or accidentally overlook a vast amount of evidence, it’s hard to seriously argue that vaccination does nothing to confer immunity or lower the rate of disease.

In some cases, research studies are quoted, along with assertions that they support a particular argument, but if you actually go and read the original study (or studies) you may find otherwise. Both sides of the debate are keen on calling into question others’ motivations. Sometimes, however, it’s not as simple as the frequent call to ‘follow the money’. Reputations, subtle indirect pressures, and emotional factors also come into play. How many doctors, media organisations, and government bodies have links to pharmaceutical companies? Are any anti-vaccinationists connected to compensation law firms?

And it’s all so scary!

As one anonymous commentator said, “it’s much easier to frighten than to educate”. Making a decision based on fear is NOT the best way to arrive at a clear-headed judgement on an important topic. Yet you don’t have to look far to find both anti and pro-vax information which focuses heavily on horrifying examples of children who have suffered death or disability as a result of either diseases or vaccination reactions.
But what about…..?

Meanwhile, back at the barbecue, your anti-vax sister-in-law is now yelling that most kids wouldn’t get so sick if they didn’t eat so much junk food. Your cousin, who’s a pro-vax GP and father-of-four, screams that of course good nutrition and healthy habits are important, but they can’t provide the immune system with an antibody ‘test run’ the way a vaccine can.

She says her kids are homoeopathically immunised; he whips out a piece of paper and reads: “Both the British and Australian Homeopathic practitioners’ administrative bodies state that homeopathic prophylaxis shouldn’t be considered an alternative to immunisation.”

“This never would have happened in my day,” whispers your mother, “We respected the medical profession. I still remember when polio crippled little Mary down the street – they had to close the swimming pool. And all those people having chest x-rays for tuberculosis….”

Some people say that vaccinations have become a victim of their own success – making childhood diseases so uncommon that we’ve become blasé about the risks. Others say we’ve become ‘vax-happy’, wanting to vaccinate for too many things, and cramming too many vaccinations into a shorter time frame. (Although most doctors assert that if a child’s immune system wasn’t designed to cope with multiple challenges simultaneously, babies and children would be unable to survive in a world full of people, dust, dirt and bacteria.)

Personal decision or not?

Now your sister-in-law is saying her choice not to immunise is a personal one, while your GP cousin says she’s a free-loader, taking advantage of herd immunity. Yep, you can forget going to bed early, because they’ll be going round in circles for hours.

Whether you’re pro- or anti-vax, you would most likely agree that the rate at which a disease spreads, and is passed on within a community, will rise or fall depending on the number of people who can mount a sufficient immune response.

No vaccine is 100% effective. Like it or not, most childhood disease vaccines `work’ (are effective in creating an immune response) on about 70% - 80% of those immunised. Immunity may be incomplete, and `wear off’ over time. That’s why an immunised person can still get the disease, although usually a milder version.

Within each community, there may be some people who can’t, or choose not to, be immunised (including pregnant women and babies). So diseases can be spread by either immunised or non-immunised people, depending on the disease, the level of exposure, whether a vaccine (if given) worked, and how long ago it was given, and individual response.

Air and motor vehicle travel provide the means for diseases to be introduced within hours to a new population. The statistical reality is that the greater number of people in a community who’ve recently been immunised, the harder it is for a disease to spread.

As the controversy deepens and continues, realistic and frank discussions are hard to come by. Here are a couple of things worth remembering:

• The actual chances of your child suffering as a result of your decision to either vaccinate, or not vaccinate, for childhood diseases, are quite low.

• Diseases can sometimes cause lifelong effects and/or deaths, and vaccinations sometimes cause serious adverse reactions. Any of these things is tragic for all the families involved, and should not be discounted by either side.

Whether you do, or don’t vaccinate, each choice involves a level of risk. Assess it realistically. And remember, just because you agree with something someone says, you don’t have to agree with everything.

Weighing up the facts:

• Is the source credible? For example, is it based on reputable, peer-reviewed studies? (More than just one or two?) Is it up-to-date? Is there an alternative explanation to the one given?

• Do you understand the information? Need to know more about what peer-reviewed actually means? Who can you ask for help?

• Is it widely supported, or do the same names and references keep popping up as the only ones with this viewpoint?

• When you check out the original studies or sources, do they agree?

• Is the provider of the information trying to advertise or sell anything? Do they have an emotional or psychological bias? Does this have any bearing on the credibility of the information?

• Does the provider of the information have any other vested interest (obvious or hidden)?