A defining experience of my HHS internship thus far, the National Vaccine Advisory Committee (NVAC) meeting on June 9-10 brought together leading national and international experts in vaccine policy to D.C. NVAC was established in 1987 to assist the Assistant Secretary for Health in making recommendations regarding vaccine development, safety, efficacy, and supply to help achieve the goals of the National Vaccine Program. There are 17 voting members and 12 non-voting positions representing various federal agencies. NVAC convenes three times each year to discuss pertinent immunization-related updates and to track the progress of key issue working groups. Current working groups focus on HPV, maternal immunization, and vaccine confidence. This meeting covered a variety of issues and voted in three working group reports for approval. I’ll focus on two topics that were covered in depth.
The 2014-2015 California measles outbreak and its relevance to California’s Senate Bill 277 were discussed from both state and national perspectives. As we all know, schools require that students receive a particular vaccination regiment before enrollment. However, many reasons for exemption, including for medical reasons and religious, philosophical, and personal beliefs, are in place in many states. SB 277 prohibits personal belief exemptions to school vaccination requirements and in effect would increase pediatric vaccine usage rates. While the scientific arguments behind vaccination are unwavering and experimentally proven, many parents acknowledge their personal right to choose to vaccinate or to abstain. Thus, while this legislation is not technically a vaccination mandate, the issue is essentially being treated as such by the public. How can scientists, healthcare providers, and policymakers promote higher vaccine confidence in an already hesitant and skeptical populace?
Vaccine confidence is the belief that vaccination and the processes surrounding the development, distribution, and delivery of vaccines serve the best health interests of the public (The Vaccine Confidence Project). Access to clean water, considered a basic human right, is the only mechanism that has superseded vaccination in reducing the burden of infectious diseases, disability, death, and inequity worldwide. Extensive data proving this point has been published, and noteworthy examples such as the smallpox eradication movement further attest to the success of vaccination. Pseudo-scientific efforts that link vaccines to autism are unfounded. Vaccine adverse reactions are certainly not the norm.
Adequate and appropriate health communication is critical on community and individual levels to promote vaccine confidence. For instance, providers can adopt what is known as the “presumptive strategy” to encourage family vaccination. While ACIP-recommended childhood vaccines are normally accepted with little hesitancy, newer vaccines such as Gardasil and Cervarix to prevent HPV infection and cervical cancer are not as widely accepted and have not been routinized in the adolescent and teen vaccine schedules. Provider strategies such as altering questions like “How do you feel about getting Gardasil today?” into declarative statements like “It’s time to get your first dose of Gardasil today” have a profoundly influential effect on vaccination rates, as confirmed by pediatricians with whom I spoke earlier this week. When physicians demonstrate this sort of confidence in the vaccine, it is likely that patients and their families will also feel this same confidence. If we are told “It’s time to draw some blood” instead of asked “Can I draw some blood now?” (did you know patients can actually decline to have blood drawn?), why can’t the same be done for vaccination?
I had the wonderful opportunity to meet scientists, physicians, and health policy scholars to discuss these issues and more and to learn about the decisions they made at pivotal moments in their personal careers. I even met a Rice and BCM alumnus who was currently serving as an NVAC member! Interestingly, the most valuable piece of advice I received was actually from a conference attendee. If you want a political career, you should first have a career outside of politics. So…is it OK to endorse Ben Carson for 2016 now? #goals