Understanding the Impact of Vaccines: A Conversation with the National Public Health Information Coalition

Why immunize? Throughout August, National Immunization Awareness Month (NIAM), MHA@GW set out to help answer that question through a series of guest posts and interviews. Recently, we sat down with the National Public Health Information Coalition (NPHIC), which partners with the California Immunization Coalition, the Vermont Department of Health, and the Centers for Disease Control and Prevention (CDC) to spread the word about NIAM and raise awareness about why vaccinations are so important.

When did NPHIC begin working on National Immunization Awareness Month with the CDC?

Nancy Erickson (NE), communication director of the Vermont Department of Health:

This is the third year that we’ve offered the NIAM toolkit through NPHIC and worked with CDC’s National Center for Immunization and Respiratory Diseases.

Catherine Flores-Martin (CM), director of the California Immunization Coalition:

When we first took this on, most of the materials already existed and they had been in need of refreshing. So it was really fun to work with Nancy and the folks at CDC and NPHIC to be able to refresh these for not only the content but also for social media use.

Brad Christensen (BC), communications director of NPHIC:

One of the great features of the toolkit is that it’s broken down into four different weeks with a different focus each week. That keeps the whole campaign fresh throughout the entire month and it helps to really increase our coverage.

NE:

I think speaking for Vermont — but I think it’s true for California and for a lot of other states — it’s been really important over the last several years to have voices that are loud and clear out there that are for vaccines. This is a tool that can really help a lot of those voices get out there in a concerted way, throughout the month of August but also throughout the year.

BC:

People need reminding. They don’t remember the dangerous nature of some of these diseases and the benefits of immunization. For example, studies have shown that the measles virus really can wreak havoc on the immune system and leave those who have been infect with measles vulnerable to various other infectious diseases for up to three years. So the importance of immunizations cannot be understated.

NE:

Another thing that’s great about the toolkit is that all the information in it has been reviewed by CDC, so that makes it easier for state health departments to know that it’s good, credible, up-to-date information. They can just essentially cut and paste as much as possible and customize for their own news and issues and localities. We’ve added many more tools — mostly through CDC, but also through a lot of the partner organizations. Infographics and videos and podcasts and posters and things that can be really pushed especially through social media. 

CM:

I know that we’ve encouraged people to take these materials, but mostly the tweets and the Facebook posts, and to personalize them. I know that some groups just use them exactly as they’re written, which is really time saving, but … if there’s any way to localize it or personalize it for my health organization perspective I encourage people to do that.

BC:

If you can tie it to something that’s going on locally either in terms of news or in terms of immunization coverage for your community or your state, that’s a great help as well in terms of garnering coverage.

Are there any new activities or initiatives that you’re looking to try in the next few years to increase the impact of this awareness month?

BC:

I think obviously just continuing this effort each August and making the toolkit better and better as we go along each year and finding out new ways to spread its impact such as the Thunder Clap this year.

What do you all think needs to evolve to prevent these diseases and these superbugs — such as the Disneyland measles outbreak — from becoming full-fledged outbreaks? What needs to change in the conversation?

CM:

As a result of the measles outbreak, we in California ended up passing a bill that removed the personal belief exemption from school-required vaccinations. So in other words, parents can’t just say, “I don’t believe in vaccines” unless a child has a medical reason. As of January 1, 2016, all children [in California] need to be vaccinated before they go to school. So that was a big deal for us here. One of our strategies is to remind people during the back to school time in August that you’ve got to get your vaccinations.

Locally, we’re trying to celebrate the statement that was made by our legislators and our governor about vaccines. Yes, the science is correct. We don’t want to focus on some of the very bad messages and lies that are out there about vaccinations, and the negative advertising … that’s associated with the bill.

NE:

That’s true for Vermont as well. We also went through a legislative session this year that ended surprisingly in removing the philosophical or personal belief exemption for vaccines required for school entry. It was right down to the wire but what really helped was that we actually had moms and doctors testifying as passionately as anti-vaccine [advocates]. Our health commissioner was able to put it in really personal terms about the children who are too young or cannot get vaccinated for medical reasons. They have no protection.

“One of the messages that’s reflected throughout the toolkit is that a strong provider recommendation is really, really important [in order] for parents to feel confident in their decision to vaccinate.” — Nancy Erickson

One of the messages that’s reflected throughout the toolkit is that a strong provider recommendation is really, really important in order for parents to feel confident in their decision to vaccinate. So part of the reason for this toolkit is to help the provider as well. So it’s another audience for the toolkit. This just makes it easier for those voices to be confident and heard.

BC:

We’re thankful that American parents’ views about childhood vaccines have become more favorable over the past year. This is according to a new poll by The University of Michigan C.S. Mott Children’s Hospital. It showed that compared to just a year ago, 34 percent of the parents polled believe vaccines are more beneficial than they thought a year ago and 61 percent believe vaccines are still beneficial (no change since last year), but only 5 percent think vaccines are less beneficial than they thought last year. I think the tide is turning toward a great community acceptance of vaccines.

NE:

I agree with that. It’s important to make an effort to provide parents, health care professionals and others with information they feel they can trust. That was the idea behind the launch of our website OkaytoaskVp.org in Vermont. Over time, having that credible, easy-to-access information that acknowledges that people have questions and even addresses those questions has really helped us along the way.

CM:

For us, this is kind of getting away from NIAM a little bit but it’s all connected. This is about giving the right resources because I love what Nancy has done in Vermont — it’s OK to ask questions because sometimes these parents that are hesitating feel very threatened by the physician-patient interaction and think, “They’re going to be mad at me, they’re going to tell me what to do, and I’m afraid to challenge them. Therefore, I’m just going to say no to vaccines sometimes.” Physicians must acknowledge those fears and say it’s natural to be afraid of five needles coming at your little baby at once, but here’s why it’s important.

So working also with the providers, as Nancy said, and the parents. Telling them it’s OK to ask. It’s OK to have these concerns. It’s natural but this is why it’s important and this is why we really, really need you to do this. So it’s just changing the conversation. That’s what I’ve been talking to a lot of people.

California recently passed a bill (SB 277) that eliminates personal exemptions for vaccines. Do you think that other states will follow that lead and start passing similar laws or do you think this was a unique scenario?

CM:

I definitely think that other states are thinking about it. They’re being encouraged, not only by the provider groups, but also by media. The media was really supportive during this bill. We only had one major newspaper in California that didn’t come out in favor of it and we had [support from] several national papers.

What populations do you think are not getting vaccinated and why is that?

NE:

We certainly know that adults aren’t getting the vaccines they need. There’s [also] a lot of emphasis on teen and preteens now [getting] the HPV vaccine and other vaccines that they need. Every single age group there’s a need for promoting the vaccines that you need at each stage in your life. You’re not just done in childhood.

CM:

Demographically, it’s a challenge because — in California and I think in some other Western states especially — the people that used to refuse vaccinations were people that were more concerned about the government telling them what to do. Other folks were feeling very confident in their healthy lifestyle: drinking clean water, eating healthy food, and living very healthy lives was enough and therefore they didn’t need any medications. For some people it’s fear of vaccines. Over the last 10 years I’d say in California at least but I think it’s true in other areas that as parents who have the luxury of not vaccinating their children because if their child does get sick they can be home with them or they feel like everybody else is vaccinated so my child is safe and I don’t see the need, things like that.

In California there are a lot of well-educated, well-to-do areas that have the largest number of personal belief exemptions. It’s not the urban pockets of California [or the] Central Valley, where we have a lot of migrant children. [In well-to-do areas], parents influence other parents, so that’s why [it] is really important to take a stand. It really is a statement from our public health and health care providers that we’re at risk now; we don’t want to see disease and possible death and disability in our community, period.

NE:

I agree with everything Catherine said. Our research in Vermont showed that it was the better off, well-educated parents who did the most questioning about [vaccines]. It also showed that they were very connected socially, especially online, and that’s why social media and a web-centered campaign made a whole lot of sense for [us].

BC:

I’ve got a Los Angeles Times editorial that just kind of brought it into focus I think. This is quoting from that editorial and it’s not my quote. It says the anti-vaccination movement is a corner of the United States that is backsliding into medieval ignorance. Alarmingly, it finds a welcoming embrace from the most affluence and ostensibly educated communities such as Morin County. Entertainment figures such as the starlet Jenny McCarthy and talk show host Katie Couric have played their role in spreading the darkness.

How does media influence the conversation about the importance of vaccines in 2015?

BC:

I think all of the coverage about the Disneyland measles outbreak and other outbreaks across the U.S. [in the] last year has helped changed people’s views about the benefits of vaccines. I think that has, in an odd way, helped out.

NE:

[In Vermont] it started with Pertussis. We didn’t really get any of the measles but that was in the background after our big Pertussis outbreak. I think as Catherine said, the media coverage [regarding] this idea of parents’ choice has really changed, and it’s changed in the fact that there is not a debate over the science of vaccines.

“All of these outbreaks have garnered quite a bit of coverage both locally and nationally, and I think people are starting to wake up about the importance of vaccines.” — Brad Christiansen]

BC:

Last year was really a huge year. There were so many outbreaks. There was the mumps outbreak involving National Hockey League (NHL) players. There was a big measles epidemic of more than 350 cases that began among unvaccinated Amish in Ohio and Pennsylvania, and a mumps outbreak of more than 450 cases stemming from students at Ohio State University. All of these outbreaks have garnered quite a bit of coverage both locally and nationally, and I think people are starting to wake up about the importance of vaccines.

“I think [the process of passing SB 277] helped some journalists understand that this is one of those situations where there are not two sides. There’s fact and there’s opinion.” — Catherine Flores-Martin]

CM:

One of the other things about media coverage this year: there [have] been some reporters in California [and internationally] that have consistently written pretty positive stories, but this year we had even more. So a lot of my time spent early this year was around writing research and data along with educating a little bit about the concerns of parents. I think [the process of passing SB 277] helped some journalists understand that this is one of those situations where there are not two sides. There’s fact and there’s opinion, and in addition to that opinion there are some crazy people out there. “We’re not against vaccines, we’re for safe vaccines, we just want to have parent choice,” — but it’s all a spin. I think that helped some of the journalists see that this isn’t a two-sided issue. It’s not a debate. It’s not really a controversy.

How can people participate in NIAM?

BC:

By simply going to the toolkit, which is available to everybody — individuals and organizations — and using its many resources as frequently as possible during the month. Even in terms of going back to school, you can use it to make sure you’re up to date on all your immunizations.

NE:

What’s interesting to me during NIAM is the number of organizations and individuals I haven’t heard of or seen before … using hashtags like NIAM15. What I’m interested in is when nontraditional partners are sharing things about immunization and then encouraging [the public] to have conversations. If you have concerns [about vaccines], educate yourself about [them] first and then share that information [with] your network.

It is hard because you don’t want people to get into arguments. [But] I think it’s really important to call out bad information. Just say, “That’s not true.” No, mercury is not in vaccines. There aren’t monkey brains. It’s important to educate yourself first.” — Nancy Erickson

It is hard because you don’t want people to get into arguments. [But] I think it’s really important to call out bad information. Just say, “That’s not true.” No, mercury is not in vaccines. There aren’t monkey brains. It’s important to educate yourself first and then be able to call people out on it in a nice way.

CM:

Keeping positive; to correct information is important.

NE:

There actually is a role for a lot of different groups, whether it’s Meals on Wheels, Boy Scouts or garden clubs reminding people about their flu shot every year. You need to have that conversation now with your doctor about vaccinating your child.

Click here to access the National Immunization Awareness Month toolkit (also available in Spanish) and other educational resources, including graphics that can be shared on social media. This interview has been edited for length.