I lost a patient this season, an infant, to pertussis. After falling ill he lived for nearly a month in the intensive care unit on a ventilator, three weeks of which was spent on a heart/lung bypass machine (ECMO) due to the extent of the damage to his lungs, but all our efforts were in vain. The most aggressive and advanced care medicine has to offer couldn’t save his life; the only thing that could have saved him would have been to prevent him from contracting pertussis in the first place.
He was unvaccinated, but that was because of his age. He was part of the population that is fully dependent on herd immunity for protection, and that is exquisitely prone to a life-threatening course once infected. This is a topic we’ve covered ad nauseum, and I’m not inclined to go into greater depth in this post. Suffice it to say his death is a failure at every level; we, both as medical professionals and as a society at large need to do a better job of protecting our children from preventable diseases.
Different approaches are required if we hope to improve our rates of vaccination. Though we devote a great deal of time and effort on this blog addressing the various issues surrounding vaccination, none of us are so deluded (believe it or not) as to think that our posts will be persuasive to all of our readers, much less the general public. In fact, I’d broaden that statement further, and say that the medical community in general is delusional if we think we can resolve the public health threat posed by the undercurrent of distrust in the vaccination program on our own. No number of studies, consensus statements, or ad campaigns by the CDC, WHO, AAP, AAFP, etc (not to mention countless blog posts) will be sufficient to maintain the public trust in the vaccination program. We need public support as well.
I’m not saying the work done by the medical community has been a wasted effort, far from it. The vaccination program (along with the rest of modern medicine) must continue to be held to the highest possible scientific standard, we must perpetually re-examine our practice and recommendations, and we need to improve the communication between the public and medical communities. These projects are absolutely essential. However, the fact remains that no matter how strong the science may be, how large and uniform the expert consensus, how eloquent the argument, people are far more likely to be swayed by the opinion of a trusted friend, the actions of their peers, or the words of a celebrity, and we are fools to ignore that fact.* Sometimes, different approaches are required.
Here is one example of a different approach: this Sunday, Penn & Teller’s “Bullshit” closed out their season by addressing the anti-vaccination movement. Orac provided a review of the episode on Respectful Insolence, and I don’t have much to add to his analysis. The show is characteristically blunt in their opinion, heavily slanted toward entertainment rather than informational content, and doesn’t shy from ad-hominems… in other words, you won’t find a transcript on SBM any time soon. On the other hand, most of their arguments were sound, well grounded in science, and they didn’t even consider creating a false-balance.
I am certain Penn & Teller’s finale will do nothing to sway hardcore anti-vaccinationists, and its style is likely to turn off some others, but nevertheless the show has its place. There is a fraction of the population for whom a blunt statement of fact and righteous anger (and Penn can provide both in spades) is exactly the type of presentation they need to see.
Here’s another example, and one that, while less flashy than Penn & Teller’s effort, is likely to have a broader appeal and greater impact in the long run. In Atlanta, Georgia this September is a rather sizable (~40,000 people) convention called Dragon*Con. Our skeptic friends at Skepchick.org and the newly formed “Women Thinking Free Foundation” are launching their their “Hug Me! I’m Vaccinated” education campaign at Dragon*Con, and have organized a local pertussis vaccination clinic during the event. In coordination with the local health officials, they are providing free TDaP vaccinations for any Dragon*Con participant, as well as information and educational materials.**
I love this type of project. As a public outreach effort Skepchick and Women Thinking Free Foundation are doing everything right by:
- Choosing to address an issue, pertussis, that is currently in the public eye
- Finding a venue with people from all over the nation (and world), thus reaching multiple communities with their message
- Coordinating with the local public health service to provide accurate information and safe services
- Targeting a population, primarily young adults, that represent a primary reservoir of pertussis and that have or will soon have children requiring vaccination
- Going out to the people to provide cost-free vaccines, thus eliminating the barriers that finances, a lack of access to health care, or even sheer apathy may present
- Providing a positive example as both parents and peers, and in doing so filling a gap in public communication the medical community can never fill on its own
That last point is perhaps the most important, and the easiest to emulate. It doesn’t take access to a TV show or a Herculean effort to coordinate a vaccine drive to make a difference. It doesn’t even require a confrontation. You have more influence over the people in your life than any public health official or blog will ever have. Just speak up, let people know you got your kids vaccinated today, let them know you got vaccinated!
As we strive to improve the quality of care and communication from the medical community, seeing concerned citizens stand up to make a difference in whatever way they can, no matter how large or small their sphere of influence, gives me hope. Hope that maybe, just maybe, this might have been the last child I’ll ever fail to save from pertussis.
* I can see some accusing me of hypocrisy here for advocating the use of celebrity and personal anecdotes to provide support for vaccination. It’s been said before, but let me be clear: Jenny McCarthy (as an example) is not wrong because she’s a celebrity, or a mother, because she’s not medically educated, or because she’s providing her own personal anecdotal experience. She’s wrong because the basis for her arguments and anecdotes begins and ends at her celebrity/motherhood status instead of with facts and evidence; she is wrong because she misrepresents the state of objective reality.
** If you feel inclined to help, the Women Thinking Free Foundation is accepting donations on their website linked above to offset the cost of this and future outreach and educational projects.