Q&A with Tara Haelle: Time to Overhaul How We Talk About Health

Tara Haelle is a freelance science and multimedia journalist who specializes in writing about vaccines, infectious disease, pediatrics, prenatal health and other areas of medicine. As part of the National Immunization Awareness Month (NIAM) guest series on the MHA@GW blog, we spoke with her about recent incidences of vaccine-preventable disease in the United States, how media reporting influences individuals’ health care decisions, and evidence-based parenting.

Since last winter, there have been outbreaks of measles in the U.S., a disease that was declared eliminated in 2000. Recent incidences have been frightening because they’re manageable in a world where nearly everyone gets vaccinated, but some people use personal reasons to avoid them. What needs to change in the conversation to prevent future diseases and superbugs from becoming a full-fledged outbreak?

There needs to be a big overhaul in the way we talk about immunization to remove shame and finger-pointing from the conversation. I’ve found that some of the people who promote immunizations cite biological research but don’t also refer to social science research. However, there’s a lot of research on what convinces people to get vaccinated. What doesn’t work is shaming people and finger-pointing … and that’s what’s going on in conversations today. There also needs to be a change in how doctors talk to patients about immunizations. Patients have real concerns, and given rampant misinformation online and in the media, their concerns aren’t unreasonable. People can’t get all of the information they need about immunizations on Google. But some doctors ask, “Why don’t you trust me?” when patients ask questions. That’s the wrong attitude. Skepticism is healthy, and many doctors aren’t well-equipped to handle all the concerns about immunizations that vaccine-hesitant parents may have during a 15-minute checkup. The problem is insurance companies don’t reimburse doctors for the extra time, so most can’t afford to spend more time with patients going over these concerns. I would love to see a complete overhaul of the health care system in which insurance companies could empower doctors to spend time with their patients to build trust and show them evidence to improve immunization rates. Doctors need to be empathetic and compassionate, and not dismissive. I understand the perspective of a doctor who spends years in training and residency and is the subject matter expert. I can understand how doctors would feel insulted when patients say they don’t trust them. But it’s not about doctors, it’s about the big picture. It’s about patients versus vast amounts of misinformation, not patients versus doctors. There will be some people you can’t reach, but a lot more vaccine-hesitant people can be reached with empathy and compassion.

What are your thoughts on laws like S.B. 277, a law passed this summer in California, that eliminate personal and religious exemption from vaccines for school-aged children? Why aren’t other states passing similar laws?

Other states aren’t passing similar laws because they don’t have the same unique situation California did that precipitated the law. California experienced huge pockets of non-immunizing parents, which was already resulting in low levels of herd immunity, a whooping cough outbreak in 2010, and the most recent measles outbreak in 2014 at Disneyland, the “happiest place on earth.” These conditions built up over time and brought the demand for an immunization mandate to a head. California also has pediatrician and senator Richard Pan, who sponsored the bill and was dedicated to its success. In most states, there are small but vocal anti-vaccine communities, but pro-vaccine parents aren’t ardently pro-immunization; they just do what typical parents do. The things that would spur them into similar action as in California would be a direct threat to their children and an outbreak of a disease. I do see states tightening their immunization laws. One example would be, instead of removing the personal belief exemption from immunizations, requiring all parents to go to a 10-hour health department presentation in order to be exempt. This idea sounds substantial and intense on purpose. Research has shown that when you make exemptions harder to obtain, more people will get immunized. Dr. Saad Omer at Emory University discusses tipping the balance of convenience to improve rates of immunization. If you tip the balance of convenience, or if parents who are immunization-hesitant find it more difficult to get exemptions, they will more often take the path of least resistance and get children immunized instead of taking the time-consuming course.

How did you enter the world of health and science reporting, and what has it taught you about how Americans are receiving and understanding health information in media? How does the media inform our conversations about vaccinations?

I came to health reporting from several different paths. I took different writing opportunities in graduate school, did a fellowship and went to a National Association of Science Writers conference. The birth of my first son was the biggest part of the journey because I was curious about parenting issues, and I wanted to know what the evidence said about best health practices. The news wasn’t providing that information because stories didn’t contain enough details about the strength of medical studies and how many studies were conducted on different topics. I decided to start reporting on health and parenting because if I had these questions, I knew other parents must too. I believe that technology has grown faster than our ability to understand technology, and media literacy is weak in this country and throughout the world. People haven’t been adequately trained to assess information, its reliability, the reliability of its sources and its validity. I believe it’s the job of health reporters to fill that role for their readers because they are trained in those areas. Instead, there’s a lot of “churnalism,” wherein news websites print press releases and titles of medical studies without significant context or explanation of what the results mean. Information without context is dangerous, and it’s important for me to provide that context to my readers so they can make educated health decisions.

Your blog is focused on “evidence-based parenting.” Can you define that term?

Evidence-based parenting means looking at what evidence exists, how strong it is, what caveats and risks exist, and evaluating how it relates to my children and me. It does not mean that there’s only one way to parent. Evidence-based parenting’s stance on immunizations isn’t “go vaccinate your kid.” It means “here’s the evidence on immunization, and if you look at all of it, the benefits far outweigh the risks.” Based on the evidence available about vaccinating, reasonable parents who are able to look at the evidence objectively would get their children vaccinated. Here’s an example: There’s a lot of evidence that supports the claim that there are numerous benefits to breastfeeding, but that doesn’t mean women should be shamed for not breastfeeding. Women may feel like they are denying their children health benefits, but the reality is that systemic support to encourage breastfeeding in this country doesn’t exist. The evidence shows that there are benefits to breastfeeding, but they may be minimal in light of other circumstances, such as a mother who works two jobs, has no time off, and becomes stressed or depressed about not providing breast milk to her children. The evidence must be taken into consideration given an individual’s circumstances to make the best choices for themselves. Evidence-based parenting encourages making personal decisions based on scientific evidence on the risks and benefits that exist within the context of each family’s circumstances and values.

Who isn’t getting vaccinated, and why?

There are two groups of people not getting vaccinated: the children of parents who have safety concerns about immunizations, and people who don’t have access to health services. Parents with safety concerns are often dismissed or mocked by their physicians for asking questions, and many may take advantage of immunization exemptions in their state. People who don’t have access to health services might be limited by lower income or education, difficulty leaving work to physically access health care, or a variety of other socio-economic factors.

What do you do, professionally and personally, to encourage immunization for people of all ages?

I’m very involved in a lot of Facebook groups and message boards, and I do a lot of one-on-one talking with individuals about questions they have about immunizations. I find out what people’s fears and concerns are and address them in a way to make them feel heard and not dismissed. I’m the co-founder of a Facebook page called the Vaccine Page and serve as one of 11 admins in the health space to answer the community’s questions about immunizations.

Tara Haelle is a Forbes contributor whose work also appears in NPR, Scientific American, Slate, Politico, HealthDay, and elsewhere. She co-wrote The Informed Parent: A Science-Based Guide to the First Four Years, due April 2016, with science journalist Emily Willingham. She also blogs about evidence-based parenting at Red Wine & Applesauce and creates resources for journalists to report on medical research for the Association of Health Care Journalists. Follow her on Facebook and Twitter.