Transcript Communicating Public Health Policy During Periods of

Communicating Public Health
Policy During Periods of
Uncertainty About Vaccine
Safety
Diego Pineda, MS
Immunizations for Public Health (i4ph) Galveston, TX
Do Vaccines Cause SIDS?
According to
this poster,
they do.
Do Vaccines Cause SIDS?
“Based on this review, the
committee concluded that the
evidence favors rejection of a
causal relationship between some
vaccines and SIDS; and that the
evidence is inadequate to accept or
reject a causal relationship between
other vaccines and SIDS, SUDI, or
neonatal death. The evidence
regarding biological mechanisms is
essentially theoretical, reflecting in
large measure the lack of
knowledge concerning the
pathogenesis of SIDS.”
Institute of Medicine
Immunization
Safety Review:
Vaccinations and
Sudden Unexpected
Death in Infancy
Origins of Uncertainty
Uncertainty stems
from missing
information:
Scientific
uncertainty
 One-sided
information

Scientific Uncertainty
One-sided Information:
Nick’s story*
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*Based on a
story first
published in the
Winter 1999
issue of the
"Immunize
Georgia's Little
Guys"
newsletter of
Children's
Healthcare of
Atlanta.
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In the early 1990s, the Morris family from
Columbus, Georgia, saw the news about the scary
adverse events supposedly happening after DTP
vaccination.
They chose not to complete the series of shots for
their son, Nick—who had only had one dose by
then.
At age four, Nick contracted whooping cough.
Violent coughing attacks made him vomit and his
face turn blue. He had to be hospitalized with
pertussis complications that almost took his life
away.
Mr. Morris later said that the media frightened
him by stating the risks of the vaccine without
noting the risks of whooping cough.
Pubic Health Policy and
Vaccine Safety Issues
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Public health officials
compare the risk of
an adverse event of
concern with the risk
of the disease, based
on available data.
The results of their
analyses guide policy
recommendations
even in the absence
of all the desired
information.
The Dilemma
Even in the
midst of
uncertainty,
public health
officials have
to make policy
decisions!
Q: So, how do we
communicate
uncertainty?
A: Using the principles
of risk communication.
Risk Communication (RC)
RC is the
communication of
the probability and
uncertainty that a
particular hazard
will cause an
effect* (and of how
to manage that
risk).
* Calman KC. Communication of risk: choice, consent, and trust. Lancet 2002; 360:166-68.
The Risk Communicator’s
Goal*
Scientific
Assessment
Of Risk
Risk
Communicator
(Medical
Writer)
Public
Perception
Of Risk
* Adapted from Powell D. and Leiss W. Mad Cows and Mother’s Milk: The Perils of
Poor Risk Communication. McGill-Queen’s University Press, 1997.
Opposing Views of Risk
Expert’s View
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Scientific
Probabilistic
Acceptable risk
Changing
knowledge
Comparative risk
Population
averages
A death is a death
Public’s View
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Intuitive
Yes/no
Safety
Is it or isn’t it?
Discrete events
Personal
consequences
It matters how we
die
Opposing Views of Risk:
Example
Risk estimate from DTaP vaccine:
“Serious allergic reaction (less than 1
out of a million doses).”
 Expert’s view: “Very rare reaction.
So rare, we can’t even tell whether it
is caused by the vaccine.”
 Public’s view: “What if my child is
the one in a million?”
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Principle 1:
Understand the public
Find out what the public thinks—what
is its perception of the vaccine’s risk?
 Show empathy for the public’s beliefs
(even if their perception of the risk is
inaccurate) and correct them without
patronizing or ridiculing them.
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Principle 2:
Build or restore trust
Announce as early as possible
 Acknowledge uncertainty
 Don’t over assure—avoid saying,
“everything is fine”; people may find
it alarming
 Be transparent—communication
should be candid, clear, and
accurate.
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Principle 3:
Share dilemmas
Let the public know the reasons
behind the policy decisions and the
dilemmas faced
 Be open to suggestions—the public
may help you decide
 Example: the potential risk of
thimerosal versus the actual risk of
vaccine-preventable diseases
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Principle 4:
Be open
Coordinate efforts and collaborate
with other organizations—
professional groups, industry,
government agencies, physicians
 Make joint communications
 Respond to the media in a timely
manner—meet their deadlines and
provide enough background
information
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Principle 5:
Communicate clearly
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Explain the known science in lay terms
Speculate responsibly—express your
expectations, acknowledging you could
be wrong
Use risk comparisons to help put risks in
perspective
Balance the use of anecdotes and data
(statistics)
Separate science from pseudoscience
Principle 6:
Show compassion*
Show empathy for those suffering
from the “alleged adverse event”—
for instance, recognize the burden
of parents of autistic children
 Avoid distant, abstract, unfeeling
language about deaths, injuries,
and illnesses—they are all
tragedies
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* Vincent T. Covello, Peter M. Sandman, and Paul Slovic. Risk Communication, Risk Statistics,
and Risk Comparisons: A Manual for Plant Managers.
Q: Do these principles
warrant success?
A: Not necessarily. Risk
communication is not
risk-free.
Vaccines and Autism: A Case of
Failed Risk Communication?
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1999 – High Uncertainty
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Announced early
Scientific uncertainty acknowledged
Collaboration between AAP and HHS
Interagency Vaccine Group
2007 – Low Uncertainty
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Strong science rejecting the link (IOM 2004)
But the issue is still alive in the media (and
in court!)
Vaccines and Autism: Why it
won’t go away (just yet)
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Vaccines have always caused controversy
No established cause for autism
Public mistrust of the current risk
assessment and management
Misinformation widely available
Conflicts of interest (perceived and real)
Pseudoscience
Risk perception driven by the media
Media Triggers*
1.
2.
3.
4.
5.
6.
7.
8.
Questions of blame.
Alleged secrets and attempted cover-ups.
Human interest through identifiable heroes,
villains, etc. (as well as victims).
Links with existing high-profile issues or
personalities.
Conflict.
Signal value: What’s next?
Many people exposed to the risk, even if at low
levels (It could be you!)
Strong visual impact (pictures of suffering)
* Bennett P. Understanding responses to risk: some basic findings. In: Bennett P and Calman K
(Editors).Risk Communication and Public Health. New York: Oxford University Press, 1999.
Fright Factors*
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Risk is involuntary
Risk seen as inequitable
Risk seen as inescapable
Risk is man-made
Hidden and irreversible damage
Damage to children
Risk poorly understood by science
Contradictory statements from responsible
sources
*Bennett P and Calman K (Editors). Risk Communication and Public Health.
New York: Oxford University Press, 1999.
Research shows that
information alone does not
generally lead to changes
in behavior.*
We have to restore trust!
* Lundgren R. and Mcmakin A. Risk Communication: A Handbook for
Communicating Environmental, Safety, and Health Risks (3rd edition).
Columbus, OH: Battelle Press, 2004.
How to Restore Trust
Addressing public concerns with
actions, even in the midst of
uncertainty (like removing thimerosal
from vaccines or strengthening
vaccine safety research)
 Striving for credible and open risk
assessment and management
 Not withholding contrary information
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How to Restore Trust
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(cont)
Trust the public
That they will understand the science
(if they don’t, maybe it is our fault!)
 That they will follow your directions
(risk management) if you let them
participate in the process
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“This isn’t a fight between
hysterical vaccination opponents
and calm, rational vaccination
proponents. Both sides, at their
worst, behave like children — one
side shrill, the other patronizing,
and neither entirely honest.”
Peter Sandman, Risk Communication expert
http://www.psandman.com/gst2005.htm#autism
Suggested Reading
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Slovic, P. The Perception of Risk. Sterling
VA: Earthscan Publications, 2000.
Bennett P and Calman K (Editors). Risk
Communication and Public Health. New
York: Oxford University Press, 1999.
Lundgren R. and Mcmakin A. Risk
Communication: A Handbook for
Communicating Environmental, Safety, and
Health Risks (3rd edition). Columbus, OH:
Battelle Press, 2004.