The Health Minister Kim Hames suggested that the reporting of adverse events to either the Therapeutic Goods Administration Branch of the Commonwealth Department of Health and Ageing or to the Public Health Division of the State Department of Health led to confusion which inevitably resulted in a delayed response to the crisis.
The Communicative Disease Control Directorate was also criticised for their delayed response to the crisis and their inability to communicate results in a timely manner and to the key players, such as the WA Health Department.
The paper recommended a number of improvements to the reporting of adverse events post-vaccination including “further improving the quality of information provided to the general public on vaccine benefits and side effects, so that parents can continue to make informed choices.” This is an interesting finding and one which I will investigate further in my next blog as to how information on vaccines is delivered to the community, in particular through the mass media.
Poor communication and complex reporting systems for adverse events post vaccination led to a slow response of government officials when it came to withdrawal of the seasonal flu vaccine for children under five. An independent review into the flu crisis found that only limited clinical trials (low 100s) were performed in children aged between 6 months and 3 years of age. The number of participants in the clinical trial was about average for the seasonal flu vaccine however it is very difficult to find any data from the TGA website as to whether an increased risk of febrile convulsions was observed in this trial. By April the number of febrile convulsions believed to be triggered from Fluvax had been reported at 9 per 1000 children, up form one per 1000. The review ordered by Health Minister Kim Hames suggested that the reporting process was confusing and did not allow for quick collation of data on events such as these.
Professor Terry Nolan and Peter Richmond, members of the Health Department’s Australian Technical Advisory Group on Immunisation and currently advising the government on the recent seasonal flu vaccine controversy, have declared they are also members of CSL’s vaccine advisory board for which they receive payment. CSL is the manufacturer of Fluvax Junior, which was removed from shelves in April after adverse events of up to nine times the average were reported in WA.
Public distrust of scientific experts and the development conspiracy theories suggesting collusion between science, government and industry are fuelled in instances such as these. Nolan and Richardson were at pains to point out however that no payment had been received with regards to this advisory role and that it was in the public interest to have scientific experts in such a role. Professor Doherty also expressed the need for such scientists to be involved in the advisory process and that due to the limited number of experts in specific fields, such as immunisation, it was impossible to find individuals that were completely independent of government or industry.
Professor Doherty, a Nobel prize winning scientist and vaccine expert, believes that it is important for scientists such as himself to avoid any conflict of interest when advising industry and the public. In a recent article in The Australian he stressed that he did not have any links with industry, which would inhibit being able to speak freely. Having recently been appointed the key investigating scientist into this years seasonal flu vaccine that triggered febrile convulsions in 100 children, Professor Doherty was obviously aware of the publics lack of trust of so called experts that are not truly independent of industry. In fact, the Australian article also declared that two government immunisation advisers had declared links with the manufacturer of the flu vaccine.
After the presentation by Pierre Fourier, where he highlighted the hurdles facing the vaccine industry, which I have mentioned above, an attendee asked the direct question as to how he thinks the anti-vaccination movement can be addressed. Surprisingly, he admitted that this is not an area that is being formally addressed by vaccine scientists at this time but believed that this must change. Currently the scientific experts in this field are loosing their voice in the public arena, Pierre suggested that perhaps we need to have experts that do not just tout the rhetoric of the vaccine industry but communicate with facts supported by overwhelmingly convincing data that is available. He also suggested that these experts should not be from industry, due to the lack of trust with these institutions but should come from elected government and independent healthcare organisations.
A recent study by Anna Kata examined the role of the internet as a tool for disseminating misinformation and found that if the word “vaccination” was applied to the Google search engine 71% of the sites would be classified as anti-vaccination. Interestingly, when the word “immunization” was applied no anti-vaccination sites were found. This was thought to be because these lobby groups do not believe that vaccination confers immunity. They also examined the content criteria of anti-vaccination websites and found the main areas covered were the safety and efficacy of vaccines, the promotion of alternative medicines, infringement of civil liberties, conspiracy theories with regards to big pharmas quest for profits and collusion, and morality and religion. Moreover, the majority of websites were found to contain misinformation on vaccines and the selective use of research data to promote their stance.
So how can the accurate information get communicated to the public to at least have an equal voice in this debate in this medium? According to Kata, education is important but has not proven to be greatly successful over the decades that this debate has raged. More importantly, she suggests it is to understand and acknowledge what drives the public to support such lobby groups such as; the search for alternate models for health, ownership of ones healthcare needs, and the increasing lack of trust government and healthcare institutions.
Katta A., A postmodern Pandora’s box: Anti-vaccination misinformation on the Internet, Vaccine 28(2010) 1709-1716
The internet is quickly becoming the primary source of information on any subject these days, including individual’s health. In the US an estimated 75-80% of internet users obtain information regarding health issues online. In 2006, 16% of internet users searched for information regarding vaccination.
One of the main reasons for this increase is the ease at which information can be obtained and it is a cost-effective alternative to visiting the local GP. It is also the fact that individuals can feel that they are in control of their own health choices and not reliant on health professionals, a group of individuals the public increasingly distrusts.
However, the internet can be a source of misinformation due to the fact there is no filter or review process for the material that is published. As a result, information published online by anti-vaccination groups carries as much weight as reliable well researched information. Individuals that search sites for vaccine information are likely to believe that this information is true. A paper published in 2005 showed that parents that chose not to vaccinate their children were more likely to have obtained their information from the internet.
Salmon DA. et al., Factors associated with refusal of childhood vaccines among parents of school-aged children: a case study. Arch Pediatr Adolesc Med 2005;159(5):470-6.