When Anecdote Trumps Evidence
Brian J Ward Colloque Blue 2013
WHAT !!Another talk
about vaccine hesitancy?
raspeberry.blogspot.com
Changing Perception of Vaccines Angel Dust
Tools of the Devil
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1990 1992 1994 1996 1998 2000 2002 2003 2005 2006 2007 2008 2009 2010 2011 2012
Vaccines are ‘Good’
Vaccines are ‘Bad’
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unforgettablebeattt.blogspot.com
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Yadayadayada VaccineYadayada Yada Yadayada
Sudden Death
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Yadayadayada VACCINEYadayada Yada Yadayada
SUDDEN DEATH
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Blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah , blah,Blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah
shrinknextdoor.com
Is There a Debate?
cartoonstock.com
This depends uponhow you define the word ‘debate’ …
The Committed and the Hesitant?
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bitchlifestyle.com
Demonizing the opposing view is rarely productive
colorlines.commarriedwithbusinessblog.comcanadafrancais.com
homosapienssaveyourearth.blogspot.com
studyforwomen.blogspot.com
eliotburdett.com
Perhaps We All Need A
‘Time-Out’?
panchtatva-blog.blogspot.com
What Do They See?
shutterstock.com
shutterstock.com
shutterstock.com
shutterstock.com
fasttrack.nutoonpool.combest-of-web.comstartribune.com
Some Vaccines Are Now Blockbusters
Resources Devoted to Vaccine Programs (USA)
M Davis. Price as a double-edged sword in thegolden era of vaccines. Human Vaccines 2010
fasttrack.nutoonpool.combest-of-web.comstartribune.com
Vaccine community should take the lead
in transparency
Conflict of Interest Statement (Last 5 Years)
Position in Pharma Medical Officer for Medicago Inc. (Oct 2011 - present)
Consulting Pfizer, Merck, Novartis, GSK, Sanofi Pasteur
MSSS, US Dept of Justice (Vaccine Compensation Programs)
Contracts Vaccine trials for virtually all companies
Shared Awards
Shared CIHR Team grant (Laval U, GSK)
CIHR-Industry grant (Medicago)
Shared CQDM grant (Medicago, Laval U, SNC Lavalin)
Occasional Speakers Honoraria
Pfizer, Sanofi Pasteur
Investments (sadly) Nil
colourbox.com
Big Pharma Approach, Including‘Whatever the Market will Bear’
Pricing Strategies have a Cost
shutterstock.com
Are We Sending AClear Message?
Vaccine Organizationin Canada
Local Authorities Tend to beQuite Dogmatic
Sophisticated Parents Often Confronted by Mixed Messages
Aside from program issues, therereally aren’t many cogent arguments against some flexibility … • age at MMR or varicella (any vaccine) • number of doses - menC - HBV - HPV
Sloth, poor parenting and procrastinationmeant our 3 kids got MMR at 15, 16 and 18 months of age …
Why weren’t childservices called?
De Serres G et al. CID 2012)
With vaccines, we are building our boat and sailing it at the same time
David Heymann, World Health Organization
nauticexpo.com
Absence of a National Program Great for Science
but has Consequences
Each Jurisdiction Needs to be More Humble (and
Flexible) about its Programs
senseiwisdom.com
suethomas.ca
What possible excuse can there be for the lack of
a national vaccine registry in 2012?
shutterstock.com
What Does the New Parent Experience?
thehealthyhomeeconomist.com unicef.ca
transcanadacoyote.blogspot.com
Needles are Not a Huge Factor … but they ARE a Factor for Some
Why are we Still Using this Medieval Tool?
• first used in Roman times • mostly for sucking stuff out (Egypt/Iraq) • 1844 - first subcutaneous injection with a hollow needle (Ireland) • 1853 - first ‘hypodermic’ syringe
for medical purposes (UK)
allposters.com
There are many reasons to target development of NEEDLE-FREEvaccines: • taking the needle out of the equation • HCW safety • keeping ‘sharps’ out of environment • probably better immune responses
Mitragotri S. Immunization without needles. Nat Rev Immunol. 2005 Dec;5(12):905-16.
The ‘It’s Good Enough’Attitude is Probably NOT Good Enough
For Vaccines
shutterstock.com
Are we all too ‘invested’ in vaccine programs to respond appropriately
to problems?
alaska-in-pictures.com
Our Defensive Reflexes are Well-Developed
Answer the following questions.YES or NO answers only:
YES NO
Measles vaccine uses a live (weakened) virus
This virus can persist for years
This vaccine can kill some children
This vaccine is probably as dangerous as OPV that we no longer use because of its risks
Major vaccine makers working on a safer measles vaccine?
gettyimages.com
OK - I can see see a few hands raised to speak… but we’re not done yet
More questions - same rules:YES NO
Adverse events can happen years post-vaccine
Vaccines licensed only after years of surveillance
Immunity after natural infection often for life
Immunity after vaccination is also lifelong
Some vaccines contaminated with animal viruses
Vaccine makers have monopolies on some products that are worth many millions of dollars
Governments & academics can independently confirm company claims for all vaccines
These questions are obviously unfair and biased …
However - each ‘yes’ or ‘no’ has some truth in it.
Each is a building block of the anti-vaccine argument
We’ve made safer vaccines for: • rabies • pertussis • polio • even smallpox
upmc-biosecurity.org
• Can’t neglect old vaccines chasing new targets • As we approach eradication of measles … will the current vaccine be safe enough?
• Insist that products in Canada can be studied independently
• Work harder to understand how vaccines work and how adverse events occur
• Support programs to compensate those who are truly harmed
humboldtsentinel.com
The Committed and the Hesitant?
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If We Don’t Like the ‘House’ that Vaccine Opponents have Built …
Perhaps We Should Work to Remove Some of the Bricks
that We’ve Given Them
pediatrics.about.com
A First Step in Dealing with VaccineHesitancy Might be a Look in the Mirror
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