Colorado is high on many health and lifestyle lists for which the state should be proud. But the recent Centers for Disease Control and Prevention report that Colorado has more kids who skipped their required series of vaccinations than any other state during 2012-2013 is not one of them. Unfortunately, the recommendations by the task force that the state health department convened in reaction to the report, will most likely not improve those statistics. The complexity of child immunization decisions seems to have escaped them.
The task force addressed only individual decisions without providing information that would elicit community concerns. And research has shown that the solution to encourage individual participation by requiring holdouts to sit through an educational session would be woefully ineffective.
The first deficiency in the recommendations is that they do not provide enough information to allow communities to determine if they are facing a public health issue. The CDCP assumes that “group immunity” is achieved if 90 percent of the children in the group are immunized. The information the task force should have provided is whether the number of unvaccinated children in Colorado reduces the population immunity below 90 percent?
Even more important, the overall statistics should have been disaggregated to determine if there are pockets (communities) at risk because their ratio is below 90 percent. Non-vaccinated children in pockets are more dangerous because they are more liable to create epidemics than if they are spread around the country among protected kids. Evidence indicates that the large measles and whooping cough outbreaks in California and the 2012 Colorado pertussis episode, despite some defects discovered in the pertussis vaccine that was administered, was worsened because of such pockets. To understand the issue it is essential for communities such as La Plata County, or even as small as Durango, to know their risk ratio. A low number should energize council members, health professionals and the media to play a more active role.
The second deficiency is the task force’s recommendation that parents who don’t want their kids vaccinated be required to sit through an educational session. That suggestion assumes that a failure to vaccinate is caused by parents’ poor understanding of immunization, or their being too busy to get them vaccinated. And, when given scientific facts, they will change their minds. Nobel laureate Daniel Kahnemen’s book Thinking Fast and Slow and others’ work on immunization decisions (Nature, Jan. 27, 2011) show why that assumption may have very limited validity.
According to this body of research, decisions about vaccinations are not usually made based on scientific evidence, or at one moment in time. They are the result of lifestyle choices acquired over a long period. In fact, those parents who refuse vaccinations are more likely to have a university education than those who accept the procedure, indicating that resistance is not from ignorance but ideological. Scientific arguments alone have been shown to not sway those beliefs, and, in fact, may even increase the believers resolve to not immunize.
It is also important to note that the predominate lifestyle in those communities in California where the recent whooping cough and measles outbreaks occurred, was one committed to natural products, organically grown food, home schooling and bicycle transportation (The Economist, May 5, 2012) There is nothing wrong with those activities. However, that lifestyle is often accompanied by a strong distrust of anything unnatural, and vaccinations often fall into that category. That distrust also accounts for the fear that vaccines cause autism to linger in those communities long after such a connection has been thoroughly disproved.
Added to this ideological commitment, is that today’s parents are among the first in history with no memory of the maiming and killing caused by polio, tetanus, diphtheria or measles that occurred before vaccinations were available. This history gap leaves parents vulnerable to naturopathic, Asian and other alternative health practitioners who tell them their kids don’t need to be vaccinated. Instead, they advise having them consume the various herbs and supplemental concoctions they prescribe to strengthen the child’s immune system. None of these treatments have ever been shown in controlled clinical trials to be effective in improving immunity.
It may be possible with strong involvement from community leaders who understand the scientific evidence and that ideology not ignorance is largely responsible for parents choosing to skip vaccinations, that strategies could be devised to push up immunization rates. Obviously, that would be the desired approach. But some experts believe that the only way holdouts will understand the danger is for them to experience it (Nature, May 26, 2011). They believe that when information about disease outbreaks is spread through Facebook and Twitter it will convince more holdouts to change their minds. At least the teenage unprotected may realize the danger they are in.
Garth Buchanan holds a doctorate in applied science and has 35 years of experience in operations research. Reach him at gbuch@frontier.net.
