Misinformation has fueled the antivaccination movement, but health care providers who disseminate credible information can help reverse declines in immunization rates, according to expert witnesses, who testified today before the US Senate Committee on Health, Education, Labor and Pensions.

The hearing, “Vaccines Save Lives: What Is Driving Preventable Disease Outbreaks?” sought answers to the antivaccination movement that has led to a reduction in immunization rates in the United States. Unvaccinated individuals have been cited by the CDC as the root cause of recent measles outbreaks in the state of Washington and in other regions across the country.

“There are pockets in the United States that have low vaccination rates,” said Sen. Lamar Alexander (R-TN), the committee’s chairman. “Not only has the FDA found them safe, but vaccines save lives.”

Vaccine refusal is high in the United States, and that rate is rising, along with a number of parents claiming nonmedical exemptions, said John McCullers, MD, professor and chairman of the Department of Pediatrics at the University of Tennessee Health Science Center and pediatrician-in-chief at Le Bonheur Children’s Hospital, both in Memphis, Tennessee.

According to McCullers, uninformed opinions shared through social media are leading to vaccine hesitancy for some parents, and Alexander said that consumers who share false information are contributing to the recent public health issues of outbreaks.

“Countless studies have shown that vaccines are safe,” Alexander said.  

In his testimony, Ethan Lindenberger, a newly vaccinated high school senior in Norwalk, Ohio, said that his mother is anti-vaccination.

He obtained immunization despite her disapproval.

According to Lindenberger, his mother sought validation for her beliefs that vaccines are unsafe through like-minded websites and social-media interactions.

He said that he began to question his mother’s antivaccination stand when others challenged those beliefs, expressed through social media, with strong criticism.

Lindenberger began researching immunization on his own, sourcing materials published by the CDC, medical journals, the World Health Organization, and other credible sources, he said.

“Information is at the forefront of this matter,” Lindenberger told the Senate committee.

“I was able to make a clear, concise and scientific decision," he said. "That is why education is so important and why misinformation is so dangerous.”
 
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In a statement issued for the hearing’s record, the American Society of Health-System Pharmacists (ASHP) also acknowledged consumer use of available online resources to glean information about vaccines, instead of seeking counsel from health care professionals.

“It is the health care professional, however, who has the most accurate information related to vaccine safety, efficacy, and public health benefits,” officials with the ASHP said, in the statement.1

According to the organization, critical factors that influence a decision to vaccinate or not include:1
  •  Trusting the health care provider.
  •  Feeling satisfied by the discussion.
  •  Understanding that vaccination is part of the cultural norm.
  •  Believing in the social contract of herd immunity.
  •  Having positive past experiences with vaccinations and wanting to prevent disease.
Fear of vaccines is stoked by a false report in a British journal that claimed vaccines are a cause of autism, McCullers said.

Despite being retracted by the journal and debunked by subsequent studies, the report is often cited by parents who choose not to vaccinate their children.

“There is no evidence at this time that vaccines cause autism,” McCullers said.

That statement was endorsed by the 4 other hearing witnesses upon questioning by Alexander. Aside from Lindenberger, they are John Boyle, chief executive officer and president of the Immune Deficiency Foundation; Saad Omer, MBBS, MPH, PhD, a professor of epidemiology and pediatrics at Emory University in Atlanta, Georgia; and John Wiesman, DrPH, MPH, the secretary of health for the Washington State Department of Health.

A study published Monday in the Annals of Internal Medicine is the latest to note a lack of connection between the measles, mumps, rubella vaccine to autism.2

The CDC reported 206 cases of confirmed measles in 11 states, from January 1, 2019 through February 28, 2019.3

In Washington State, 71 cases of the virus have been confirmed during the recent outbreak, Wiesman said.

He said the state has already spent about $1 million in its efforts to curb the outbreak.

Measles alone caused more than 500,000 illnesses each year in the United States, prior to the vaccine being introduced, and about half those patients with severe complications died as a result, according to McCullers.

By 2000, measles was considered eradicated in this country.   

“The last decade has brought numerous outbreaks to the United States,” McCullers said. “These outbreaks are strongly associated with vaccine refusal.”

Sen. Patty Murray (D-WA) said the fact that vaccines have been preventing measles for more than 50 years means that many people in the United States have never experienced the virus.

“A new generation of parents may not realize just how dangerous measles is,” she said.

Alexander shared a similar sentiment as he recalled polio affecting his community as a small child.

"I had classmates that lived in iron lungs," he said. "Polio is just 1 of the diseases we have eradicated in the US, thanks to vaccines."

Boyle, who has an X-linked agammaglobulinemia  condition, also spoke about the danger of unvaccinated populations.

A preventable disease, such as measles, can be life-threatening to people who are immunocompromised, which makes recent outbreaks especially terrifying to parent of children with certain conditions, he testified.

“If people stop vaccinating, the safety net of community immunity will fail, and their children will be the first casualties,” Boyle said. “My life, as well as thousands of others who are immunocompromised, depends on community immunity.”

Herd immunity does, in fact, help prevent outbreaks of preventable diseases, Murray said.

She noted that 90% of the community needs to be immunized in order to protect those who cannot be vaccinated, for reasons that could be medical-related.

In Clark County, Washington, where measles outbreaks are ongoing, the vaccination rate is below 70%, Murray said.

“These outbreaks are a sign that we need to do more to prevent vaccine hesitancy,” she said.

Other vaccine-preventable diseases mentioned during the hearing include hepatitis A, HPF, influenza, and pneumococcal.

Pharmacists, as the most accessible patient care providers, should embrace their roles as trained immunizers and are prepared to do more to administer, educate on, and screen for vaccines in their communities, the ASHP said.

In addition, pharmacy personnel should be enabled to do more in responding to disease outbreaks, such as initiating the appropriate therapy and reporting surveillance data, according to the organization.1 

In addition to improving communication between health care providers and their patients and caregivers, those providing testimony to the Senate committee had other recommendations.

Omer suggested reimbursing physicians for resources and time spent on counseling consumers about vaccinations.

He urged Congress to continue prioritizing vaccine safety research and to work on making reimbursements to health care providers more attainable.

Help is also needed from the federal government with funding and resources to provide the public with credible information about immunization, Wiesman said.

Although the CDC is encouraging vaccine outreach programs in high-risk communities, the available resources and staffing to implement these programs are not up to the task, he said.

Wiesman requested an increase in the CDC’s budget to help communities provide these services.

“Everyone has the right to live in a community free of vaccine-preventable diseases,” he said.
 
In Wake of Measles Outbreaks, Another Study Dispels Myths Surrounding MMR Vaccine


References
  1. American Society of Health-System Pharmacists. Hearing on: "vaccines save lives: what is driving preventable disease outbreaks?" Statement for the record [email]. ASHP. Created March 5, 2019. Accessed March 5, 2019.
  2. Inserro A. In wake of measles outbreaks, another study dispels myths surrounding MMR vaccine. American Journal of Managed Care. March 4, 2019. ajmc.com/newsroom/in-wake-of-measles-outbreaks-another-study-dispels-myths-surrounding-mmr-vaccine. Accessed March 5, 2019.
  3. CDC. Measles cases and outbreaks. cdc.gov/measles/cases-outbreaks.html. Updated March 4, 2019. Accessed March 5, 2019.