Concerns about a nationwide measles epidemic are growing with over 2000 cases now reported nationwide. Public Health England has launched an urgent "catch - up programme" to target the many thousands of children nationwide that were not vaccinated. Experts believe the cause is the 10-16 year-olds who missed out on vaccination in the late 90s and early 2000s, when concern around the discredited link between autism and the vaccine was highest.
Andrew Wakefield, a previously little known medical researcher's opinion published in 1998 hit a nerve and has had a profound impact on the response to a Government programme. Despite Government's attempts to calm parental fears Public Health England estimates a third of a million 10-16 year-olds are unvaccinated and as many haven't completed the course, putting the pre-MMR population at risk. In some boroughs, such as Lewisham, uptake is still as low as 70% so new ideas are needed. So why has Government failed to turn around public opinion until now?
First, Wakefield's views could not have anything like as profound an effect without amplification by influential media. As a mother with a one-year-old at the time of the report I remember how alarming the Sunday Times' reports were, and then doing a double take when the same paper took a lead in discrediting the doctor a few years later. Last week Jeremy Paxman apologised on Newsnight for the 'shameful role' that media played in giving disproportionate coverage to a small study and a maverick doctor.
Second, Government's trust ranking amongst the public is far lower than the scientific community. A poll on climate change by Opinium (April 2013) showed that people in the UK overwhelmingly trust scientists more than any other source to give them accurate information. By stark contrast 64% said they didn't think politicians could be trusted to give them accurate information. Expecting the public to accept Government advice when contradicted by medical experts proved to be short sighted. It was 12 years later that respected medics rallied to the Government cause, the Lancet Medical Journal withdrew the article and the Cochrane Collaboration - which compiles gold-standard reviews of medical evidence found "no association" between MMR and autism or a range of other conditions. But by then concerns were entrenched in public opinion.
Third, the target population is highly diverse and a 'one-size fits all' approach for communication and motivation hasn't worked. The European Centre for Disease Prevention and Control reported on health-communication-related obstacles to MMR. It highlighted a French study showing that in fact the higher the level of education among parents the greater resistance to mandatory vaccination. In Germany parents were shown to remember having had measles, mumps and/or rubella during their childhood and, it being a relatively mild illness. My own parents at the time commented that we all had them and they felt if treated correctly risk was low. By contrast health professionals did not provide me with information about the danger, both short and long-term, posed to my child. It was only when my daughter became severely ill following chickenpox that I realised how a relatively mild illness can effect an unlucky minority.
The latest scare will prompt many parents of unvaccinated children to act now that their children are older. However, heightened awareness will be short lived and dependent on the media agenda, so what changes could achieve a long term turnaround in the success of the MMR programme? It might be time to try other methods to trigger behavioural characteristics.
Public Health England should now turn to experts such as the Government's Behavioural Insights Team who apply the theory that human behaviour can be influenced by many things, such as a desire to conform, shame, vanity and gentle prompting or "nudging". So, for example, using similar tools applied to tax avoiders, parents could be reminded how many others in their local area, who they will want to conform with, have had their children vaccinated on time. In the case of MMR, sophisticated communication tools we have at our disposal today could allow a deeper understanding of the motivation of parents and which are most likely to resist.
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