Posted by: rebeccajrobare | September 12, 2011

“Straight Talk About Vaccines”

Warning: Some of the content below is strident, snarky, and possibly mean in the direction of people who make false claims about a subject in which I have fourteen years of post-secondary education. In other words, towards people who make authoritative claims about subjects in which they have no authority. As you can see, this drives me nuts. Read at your own risk.

Scientific American has a great article about vaccination, which you can read here. I wanted to add a constructive comment to this article, but (to be blunt about it) Oh! the stupid! Take, for example, the comment of one reader who seems to believe that there may be a link between vaccines and autism, that “until we know what causes autism, we don’t know what doesn’t cause autism.” (This is not a direct quote from the comment. To find it again, I’d have to go re-read the first page of comments, and I’m just not putting myself through that again.) That is not how science works. Science works through the disproving of hypotheses; the claim that vaccines cause autism has been thoroughly disproven. A decade of research has shown that (1) the original claim was made via falsified data, and (2) that vaccinated children and non-vaccinated children develop autism at the same rate, and (3) there is no mechansim by which a vaccine or any of its components can cause autism. At least, that’s my understanding of the current scientific consensus. If you know of primary sources that contradict any or all of these points, I would very much like to read them.

But I didn’t actually ask you all here to rant about people who don’t understand science and endanger communities by choosing to leave their children unvaccinated. I asked you here because I have a little idea, and while I don’t have much knowledge about how it could be implemented, I want to know what you think.

The Scientific American article suggests that pediatricians who must talk to parents about vaccinating their infants have a great deal to cover at the same well-baby visit, and have only about 20 minutes in which to cover it all. This leads to the physician not being able to follow up with a parent who says he or she chooses not to vaccinate their children, or who agrees but does not bring the child in for vaccines. Could not a nurse have this conversation with the parent? Or, if the nurses do not have time for this conversation (because they are already working in the pediatrician’s office, and presumably their time is filled by the work they already have) why not suitably trained individuals, perhaps employed by public health departments, to follow up with these parents and discuss why vaccination is the right choice? You could have one per whatever number of people in a region, who could contact by phone or home visit, or immediately in the pediatrician’s office.

There are objections for such a scheme. Rural areas would likely be underserved, as they are in medicine in general. Such individuals might be unable to affect the vaccination rates for a region even through repeated contact with recalcitrant parents, because it’s very difficult to change the mind of a closed-minded person. But a trial of such a program could employ some small number of people and have the potential to dramatically impact the public health of a community through the better creation and maintenance of herd immunity.

Thoughts?

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Responses

  1. forgive my ignorance, but are vaccines government funded, or do people have to pay for them? Are they tax deductible in any way? I hate that one must incentivize parents to care for their children, but it might help, if this isn’t the way of it already

    • That’s a really good question. I did some quick research on cdc.gov and found that insurance plans are supposed to pay for all vaccines without a co-pay, and that a government-funded program is available, and covers children who would not otherwise be vaccinated through ability to pay. I don’t know whether parents know about such a program, though, or how difficult it is to be found eligible. I do agree that government funding for vaccines, or some other sort of incentivization, might be an asset, though I also agree that in an ideal world it shouldn’t be necessary.

  2. I would suggest that your idea of having people from the department of health follow up is something that should be implemented on a trial basis. But I would make one change to the plan.
    First I would suggest that the people following up should come from the insurance company (because making them come from the department of health is another expensive layer to add to the government, and doctors as you say don’t have time; but it gives insurance something to do that actually benefits the patient), and second I would suggest adding some sort of a benefit to those that come in (so you know if you get the vaccinations that will benefit your child then your premium goes down %5). This way the cost of funding “followups” is not carried by already overwhelmed doctors or the government, but it uses an already existing network, and that network is put to use to help the patient. In addition, this also means that on top of the many medical reasons that can be brought up, if those aren’t enough, there is also a financial benefit to you getting the care that will help your children. Of course this adds the obvious bias that the person following up WANTS you to get vaccinated, but that’s sort of the point anyway.

    The worst case scenario is that a few people waste there time if patients are to recalcitrant, and the best is that dozens or hundreds of patients get better care.

    Anyway those are my thoughts, I am not of course an expert on this subject.


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