Public Health

Buddy Creech, MD, MPH, on Vaccine Hesitancy

As our collective digital presence grows, so does the circulation of fake news, misinformation, and non-expert opinion. This has led to an increase in vaccine hesitancy among the public. To combat this hesitancy, researchers like Buddy Creech, MD, MPH, are helping to ensure vaccine safety by performing relevant and timely research.

Ensuring vaccine safety as a response to vaccine hesitancy was also Dr Creech’s topic of discussion at the 37th Annual Conference on Pediatric Infectious Diseases.1

Buddy Creech, MD, MPH, is associate professor of pediatrics in the Division of Infectious Diseases and director of the Vaccine Research Program at Vanderbilt University Medical Center. We caught up with Dr Creech after his session.

INFECTIOUS DISEASES CONSULTANT: Your session was about ensuring vaccine safety in light of vaccine hesitancy. Can you tell us more?

Buddy Creech: Vaccine hesitancy is a challenge to pediatric health in the United States. One source of vaccine hesitancy is anxiety over concerns for vaccine safety. This anxiety arises from anecdotes from friends and family, personal experiences with vaccines, social media posts, and other, sometimes less reputable sources of health information. Given that anxiety over vaccine safety appears to be a driver in vaccine hesitancy, I would argue that one of our prime responsibilities is to evaluate vaccine safety as carefully and comprehensively as we can.

My session focused primarily on the use of next-generation technologies to characterize vaccine responses and to look for signals that might be correlated with common adverse events after vaccination, such as fever, arm pain, feelings of achiness, and rashes. We may also be able to use these technologies to address more rare complications following vaccination. 

ID CON: The World Health Organization (WHO) defines “vaccine hesitancy” as a “delay in acceptance or refusal of vaccines despite availability of vaccination services.”2 How do you address vaccine hesitancy with your patients?

BC: Our approach often has to be different than the frontline community pediatrician’s might be. As infectious diseases specialists, we receive referrals both during and after potential vaccine side effects. For instance, we may see patients who are experiencing rash after an influenza vaccine, and we are asked to comment on whether receiving the influenza vaccine in the future would be safe. In addition, we may talk with families who have had a family member experience a rare adverse effect that occurred around the time a vaccine was given (e.g., Guillain-Barre syndrome). In these cases, the pediatrician often asks us to talk about the science of vaccines, the likelihood of these events occurring, and answer other questions the family may have.

The other ways we deal with vaccine hesitancy is in conducting rigorous clinical studies of vaccine safety throughout childhood and adulthood. By ensuring the overall safety of our vaccines, we think we can address the primary driver of vaccine hesitancy. 

ID CON: In your opinion, what has to be done and by whom (or what organizations) to reduce vaccine hesitancy in the United States?

BC: We have several challenges to addressing this problem of vaccine hesitancy. First, we need to ensure that when people seek information about vaccines and vaccine safety, that credible information is readily available. There will always be individuals who spread misinformation, both intentionally and unintentionally. As a result, we need to ensure that accurate information can be retrieved by those who are seeking more education in this matter.

Second, we need to have reliable information to report—that means continued work in vaccine safety. For those of us working in vaccine research, we must be committed to publishing results from studies as quickly as we can so that the information can be disseminated appropriately. Third, we need to use advances in research technology to answer questions that were impossible to answer before, looking at the changes in gene expression, protein production, and metabolic changes post-vaccination so that we can understand, even more completely, the body’s response to immunization.

But one aspect of vaccine hesitancy is more philosophical. Tom Nichols3 calls it the “death of expertise,” where we have seen an increase in self-reliance and a rejection of expert advice at a cultural level. When this occurs, we as vaccine experts, physicians, or public health officials struggle to find the right message to convey to those who have rejected the widely accepted recommendations of those who know the most about the subject. 

ID CON: What are your key take-home messages for pediatric infectious diseases specialists today?

BC: Most individuals who express vaccine hesitancy do so with the singular motive to keep their children safe. As a physician, this clearly resonates with me, as my vocation asks that we dedicate our lives to the service of humanity, respecting the autonomy and dignity of our patients (Declaration of Geneva, 1948).4 Where we differ is that we recognize that prevention is preferable to cure (modern Hippocratic Oath, 1968),5 and we affirm that vaccines have been clearly established as safe means to prevent some of the world’s worst diseases.

It is our duty to conduct high-quality science to confirm the safety of vaccines using every technology at our disposal, and we must communicate this to our patients in the most effective means possible. My advice is to seek to understand the source of vaccine anxiety and address it head on. Scientific inquiries into the safety of vaccines continue to affirm their safety across the lifespan; this is good news for those hoping to keep their children safe from infection.

References:

  1. Creech CB. Ensuring vaccine safety is critical as we respond to vaccine hesitancy. Talk presented at: 37th Annual Conference on Pediatric Infectious Diseases; July 28-August 2, 2019; Vail, CO. https://cmetracker.net/CHCOLCME/Files/Brochures/39496.pdf. Accessed July 3, 2019.
  2. Immunization, Vaccines and Biologics: Addressing Vaccine Hesitancy. World Health Organization. https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/. Updated September 21, 2018. Accessed July 3, 2019.
  3. Nichols TM. The Death of Expertise: The Campaign against Established Knowledge and Why it Matters. Oxford, United Kingdom; Oxford University Press; 2017.
  4. International code of medical ethics. World Medical Association. https://www.wma.net/wp-content/uploads/2018/07/Decl-of-Geneva-v1948-1.pdf. Published October 1949. Accessed July 3, 2019.
  5. International code of medical ethics. World Medical Association. https://www.wma.net/wp-content/uploads/2018/07/Decl-of-Geneva-v1968-1.pdf. Published August 1968. Accessed July 3, 2019.