One of the nation’s foremost experts and advocates of vaccines, William Schaffner, MD, is the recipient of multiple honors and awards from infection prevention and control groups, and currently serves as medical director of the National Foundation for Infectious Diseases (NFID) in Washington, DC. A longstanding board member of Hospital Infection Control & Prevention, Schaffner is a professor of preventive medicine at Vanderbilt University in Nashville. He is a liaison member representing the NFID on the CDC’s Advisory Council on Immunization Practices (ACIP).
HIC asked Schaffner to comment on the current state of the antivaccine movement and the return of some childhood diseases like measles in the following interview, which has been edited for length and clarity.
HIC: You say we are going to be dealing with this antivaccine mindset and its resulting impact on public health for some time.
Schaffner: Yes, we are going to have continuing “vaccine hesitancy” as well as more explicit antivaccination sentiment. It’s not going to go away. Sad but true. There is this educational gap, and that is going to continue. If anything, it will expand as we create more vaccines to prevent more diseases.
The antivaccine sentiment is so deeply rooted. In my experience, and also in talking to my colleagues, it is very difficult to change the mindset of people who are intensely antivaccine.
HIC: We certainly saw that in the reported tetanus case. What kind of approaches could be taken?
Schaffner: One of the things that has received little discussion is the educational component. We really need to look at the health curriculum of middle school and high school students. Some colleagues and I have taken some brief looks at this. Certainly not a survey, but we’ve made some inquiries.
Our sense is that the diseases that vaccines have prevented are almost never discussed. They may be mentioned fleetingly. Vaccines themselves — their benefits, how they work, why it is important to get them — are dealt with in a very sporadic and insufficient fashion. If that is true generally — and I believe it is — then we should not be surprised that as high school graduates get older and become parents, they don’t have the background to understand vaccine-preventable diseases and why their baby needs a number of inoculations in order to prevent these diseases.
We, in the medical and public health community, have to look to partner with the educational community. We have to get the curriculum in middle school and high school beefed up about vaccines and vaccine-preventable diseases.
HIC: There is this prevailing myth that prior to the vaccine, kids just went through measles infection like some benign rite of passage.
Schaffner: I’ve had discussions with colleagues who tell me the same thing. You have a discussion with a young mom who says, “Everybody used to get measles. It’s an illness with a rash. It comes and goes — what’s the big deal?” That is a total misunderstanding of what a severe, nasty infection measles usually is — making children uncomfortable for a week and a half or two. Never mind the complications of otitis media, pneumonia, encephalitis, and children dying of measles. When you tell them, they say, “I never heard that.”
The young trainees in medical school are people who come out of our society. There are some surveys indicating that these young people are not as educated about the vaccine-preventable diseases and are not themselves convinced that all these vaccines are necessary.
We must look to our own environments in nursing schools, medical schools, and other health-related professions to make sure that we don’t take the commitment of young trainees in nursing and medicine for granted. We have to teach them.
HIC: Do we need more vaccine state laws or regulations?
Schaffner: I think all 50 states have to begin enforcing the daycare and school immunization laws. They need to look very critically about whether they should permit religious and personal belief exceptions. There are states that have eliminated those. The two most well-known are West Virginia and Mississippi, both of which are very socially and politically conservative. They seem to have done that with great success, so there are lessons there. California has been added on recently.
Even the states that have these exemptions ought to look to them with care. And frankly, we ought to review the practices of physicians who glibly provide erroneous medical exceptions that are not valid. They ought to be obliged to explain their practice and if necessary have their practice supervised and corrected. I think it is unethical to provide a medical exemption that is not valid.
HIC: Antivaccine protestors are an online presence, but many attended the last CDC ACIP meeting in February.
Schaffner: It was evident in the October meeting that there were a number of antivaccine folks there. They were saying on social media that many more would come to the next ACIP, and there was an avalanche of people registering. The CDC enhanced security and put the proverbial velvet rope between the public seating and the members of the committee. Security was wonderful and everybody behaved, so that was very nice.
The ACIP organizers created a 75-minute public comment period in the tradition of transparency. They had a whole list of people signed up for public comment. As is always the case, they had three minutes each. There were prompts so they kept to their three minutes, and they were good about it. They had ample opportunity to make their positions known, and everybody on the committee, including all the liaison members, remained. Decorum was maintained, and it was all very civil.
HIC: Thankfully, that was the case, but recent congressional testimony by some public health officials in Washington state described negative messages on social media from antivaccine groups.
Schaffner: So far, I have been spared, but some of the ACIP members tell me they are starting to get communications from these antivaccine folks.
