Vaccination, life-saving? (2007)

Only one generation ago, measles, mumps, and rubella were still common diseases. Today, we can hardly believe that whooping cough was the most widespread fatal disease among young children. To a large extent, we owe that progress to the vaccination programs the authorities have been organizing.

Recently new vaccines have become available, amongst others against the rota virus, the number one diarrhoea pathogen, requiring infected small children to be hospitalized, and the human papilloma virus, an important factor in developing cervical cancer. And it’s quite probable that others will be introduced in the coming years. In the future, the authorities will more and more often have to decide which vaccines to integrate in the vaccination scheme and/or to admit in the reimbursement package. Apart from scientific arguments, that decision will also be influenced by economic and societal factors.

A number of societal aspects of vaccinations have been described in this broad outline survey. The following themes have been developed, based upon interviews with Flemish and Dutch experts and an international literature search: whom to vaccinate and why, doubt of vaccine efficiency, communication around vaccination, vaccines for the future and vaccines for the third world. During a lunch debate, ‘Vaccination, life-saving?’, on the 12th of February 2008, the conclusions have been presented to an expert panel, with Prof. Stuart Blume (Universiteit Amsterdam), Dr. Chris De Laet, (Federal Health Care Expert Centre) en Dr. Vincent Janssens (Médecins Sans Frontières), and Prof. Pierre Van Damme (University of Antwerp).

Conclusions:
Carefully balancing pros and cons, risks and costs should be the number one concern of the vaccinating authorities and the vaccinators when introducing new vaccines. But it is also time to check whether there is sufficient support in Flanders for an extension of the vaccination scheme. In spite of the high vaccination degree in Flanders, specialists think that an increasing group of people have doubts about the provided vaccination program.

There is almost no serious research available in Flanders on vaccination mistrust and resistance. The official bodies usually ascribe a possible increase in vaccination scepticism to a new revival of the anti-vaccination movement, possibly in connection with anthroposophic ideas and homoeopathic medicine. Others consider that to be a simple argumentation: the doubt about vaccine efficiency is the result of a much more complicated combination of social tendencies, including ‘omission bias’, the experienced side effects of vaccines, the feeling that vaccination harms the naturalness of the process of pregnancy and birth, social interaction with like-minded groups, the lack of understanding of vaccinators vis-à-vis ‘difficult’ parents questioning their work and the increasing individualism in making health-related decisions, which is at odds with what a vaccination policy from an epidemiological perspective is aiming at.

A transparent communication, which does not ignore the uncertainties and lack of knowledge, while being present at every stage of the decision-making process about the introduction and reimbursement of new vaccines is of utmost importance. Any introduction of a new vaccine should always be preceded by an information campaign, set up by the authorities, in order to prevent the pharmaceutical concerns from obtaining an information monopoly. Maybe it is also time to think about the role of the authorities in organizing independent clinical research and the monitoring of vaccines. That might provide less biased data for outlining a vaccination policy.

Finally, the last chapter of the dossier, that discusses vaccines in the third world, looks at these discussions from a global perspective. It makes clear that making the right decisions on research into valid vaccines for developing countries, given the undeniable impact on public health, is a very profitable investment, certainly when the cost-benefit aspects are compared to those of introducing new vaccines in Flanders.