Lawrence J. Losey, MD, FAAP Downeast Association of Physician Assistants Sunday River, Maine February 6, 2015 Dealing with “No”— Vaccine Hesitancy 2015

›“You’ve seen one, you’ve seen one!” ›Build Relationship based on Respect ›Identify What Objection Is ›Validate Their Concern ›Present Evidence ›Keep Dialogue Open Over-Riding Principles

›Goes back to smallpox, the first vaccine ›Early 1800’s first mandates ›Vaccination vs. inoculation ›Compare 1950’s to 1980’s onward ›“Modern” Hesitancy started in 1980’s—”Evidence of Harm” documentary on DTP vaccine History of Vaccine Hesitancy

›Religious—More Than Christian Scientists –Disbelief in medicine –Objections to ingredients ›Gelatin—porcine contents ›Fetal Cells –Distrust of the West ›Specific Concerns –Autism –SIDS –Family History of Effect –HPV Vaccine Will Make My Child Sexually Active ›Non-Specific Concerns –Too Many Vaccines Overwhelming the Immune System –Too Many Ingredients, Chemicals That Are Toxic –Diseases Aren’t That Bad –Not Natural –Skepticism of Government and BIG PHARMA Reasons for Hesitancy

›Depends On Relationship With Provider ›Depends On Strength Of Provider’s Recommendation ›Depends On Repetition ›Depends on External Events: e.g. Disneyland ›Depends on Factual Basis for Concerns ›Modest Efficacy Overall Effectiveness of Interventions

2-Yr old Immunization Rates By County Maine CDC, ImmPact derived

Legislation Vaccine Requirement Support for Immunization Programs Relationship Care for the kids! Listen! Water on limestone RESPECT! Public Sentiment Speak Out! Encourage Scientific Literacy Internet inoculation ›Legislation ›Relationship ›Public Sentiment Multi-Pronged Approach

In 1736 I lost one of my sons, a fine boy of four years old, by the small-pox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen..” Benjamin Franklin, Autobiography