Vaccination Fatigue: “Even in Germany children die from measles from time to time“

Severe childhood diseases occur less frequently due to vaccinations – but should you get your children vaccinated? A lot of parents seem to ask themselves this question, since the willingness to get vaccinated is dropping. MEDICA.de spoke with Doctor Cornelia Betsch, Psychologist/Academic council at the Erfurt University about the reasons and how to assess the pro and contra of vaccinations!01/04/2011

The vaccination recommendations
advise regular vaccinations for
children and infants; © panther-
media.net/Pauliene Wessel

MEDICA.de: Mrs. Betsch, why do you think Germany in particular is a land where people are tired of vaccinations?

Cornelia Betsch: Many physicians report that especially well informed and better educated people, respectively, turn into vaccine critics. The trend toward alternative medicine definitely also plays a role in this, as well as the opinions of midwives who in part are critical of vaccinations and of course have a large influence on young mothers or parents. In addition, the Internet certainly also plays a role in vaccination fatigue, since more and more people increasingly turn to the Internet if they want to get information about immunizations or just general health topics – and there they quickly find information that’s critical towards vaccinations. Although on the whole there are not many pages you can find on this, you virtually still cannot escape them, if you google the term “vaccination“. And on these pages you will consistently find arguments against vaccination.

The pages mention recurrent arguments, though these have long since been refuted: there is a very good Internet publication by the Robert Koch Institute on this subject, where this is presented in an easy to understand format. Often the problem though is to find reliable information on the Internet. There is a very strong imbalance. You can easily find pharmaceutical information that causes credibility issues in consumers, and you can also effortlessly find information that’s critical of vaccinations. In comparison, scientifically substantiated, neutral, informative and still comprehensible pages are harder to find.

MEDICA.de: Why do especially reputable sources of information fail in offering their knowledge on the Internet in such a way to where parents can access it without any hassles? For instance, should institutes be addressed specifically and shown what a great and informative homepage should look like?

Betsch: Yes – and this is actually happening. The German Federal Center for Health Education, in short BZgA, for instance created a new page titled impfen-info.de (vaccination-info.de), which very calmly and objectively provides information. In addition, there is the BzgA portal Kindergesundheit-info.de (Children’s Health-information.de), which provides information on topics centering on the well-being of children. They are very much aware of the fact that they are not as easy to find on the Internet and they are working on it.

MEDICA.de: Is there even a way to differentiate between unreliable and reliable Internet pages?

Betsch: The classification of individual pages, with a seal of approval for instance, is still in its infancy. But as a discerning consumer you should always ask yourself, what source is behind the information and whether something is supposed to be sold to me on this page. A look at the website credits is often helpful.

MEDICA.de: Would you recommend introducing compulsory vaccinations, just like there is a compulsory school attendance?

Betsch: During the Second National Immunization Conference, which recently took place in Stuttgart, there was a consensus against compulsory vaccinations – and also against a right to object, as it is being discussed for organ donations. A right to object would mean that immunizations are done on principle and that you would have to explicitly object to vaccination. The emphasis is placed on vaccination recommendations and the free decision of citizens. This of course entails a large need for information and the responsibility of the public authorities, to facilitate an individual cost-benefit decision by making reliable information available. It is perhaps important to know, that in Germany the Standing Committee on Vaccination at the Robert Koch Institute, in short STIKO, assumes this job for the consumer and gives corresponding recommendations.

 
Doctor Cornelia Betsch;
© private

MEDICA.de: You study the effects of vaccine criticism on the World Wide Web. What are typical pros and cons that are mentioned by users?

Betsch: A pro for vaccination of course is the protection against diseases, which an inoculation provides. Some diseases can result in very severe complications and secondary damages. What’s more, if a very high immunization protection is established within a population, we can potentially eradicate specific diseases. For example, this is being tried for measles, which so far however has not worked, because the vaccination rate is too low. Additionally, there is also a social aspect. We talk about “herd immunity“, if a significant number of people are vaccinated to where a virus cannot spread and that way even unvaccinated people, like for instance newborns, are protected.

In contrast, cons to immunization are arguments such as for instance the typical piggy back riding: “If everybody gets vaccinated, then I don’t have to get vaccinated, because the disease virtually doesn’t occur. “ Apart from that, also the occurrence of diseases whose causes are unclear, are proclaimed as a consequence of vaccinations and their side effects, respectively. This includes autism for example, multiple sclerosis or also allergies. However, time and again it was proven, that immunization does not cause an accumulation of these respective medical conditions.

MEDICA.de: That is to say, the actual side effects of immunizations are rather low?

Betsch: Immunization is an intervention into a usually healthy organism and just like any other drug, immunizations also have side effects. There are statistics kept on occurrences and in the approval- and recommendation processes based on the available data, costs and benefits are weighed up against each other. You can soon get exact information on this in the National vaccination schedule. Overall, the available vaccines are considered well tolerated. Naturally, what aspects are subjectively interpreted as side effects and how severely they are perceived, is a whole other story.

MEDICA.de: You just mentioned measles. What do you think about so-called measles parties?

Betsch: Measles are a very serious disease and we are fortunate that only few measles infections occur in Germany. For example, I have never personally seen a patient with measles. People, who are in the same boat, quite possibly underestimate the severity of this disease. But actually measles is a very severe disease, which can involve terrible complications. Even in Germany children die from measles from time to time and you should be aware of this when you send your child to a measles party.

MEDICA.de: From a psychological perspective, do people develop a blinder mentality, as in: I don’t know this, I have never seen it, and therefore it will not get me? Is this psychological mechanism in the way of vaccination protection?

Betsch: Your own experiences of course always have the strongest effect. If measles never occurred in your own surroundings, but a neighbor or a mother on an Internet forum reports severe injuries from immunizations, then of course it influences your decision.

We study the impact of such individual case reports, meaning personal reports about vaccine side effects, and we keep noticing that such reports have a very strong effect on risk perception and vaccination intention. We find that individual case reports even have an impact, if the people should actually know better, for example because we also provide reliable statistical information for them. The Internet is full of these individual case reports and contributes its part to vaccination fatigue.

MEDICA.de: Are you actually able to compete with factual information against this attitude?

Betsch: We cannot conclusively answer this question at the moment. By itself this of course would be desirable. By now we know from research that especially in the context of such vaccine-critical and often very emotional reports, emotional advertising for immunizations has rather adverse effects. One example for this would be using a fear appeal: your child might become mentally disabled after having the measles. This might work really well on billboards and shake people up, but if you directly face off one fear against another on the Internet, it might happen that people will not want to vaccinate themselves or their children at all anymore. So you can put it like this: If you want to advertise vaccinations, you should not do it by wielding an emotional horsewhip, but you should provide factual information instead.

The interview was conducted by Simone Ernst.
MEDICA.de

(Translated by Elena O'Meara)