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GlaxoSmithKline (NYSE: GSK ) announced last week that it's seeking approval for the first-ever malaria vaccine. The news is remarkable for two very different reasons. It's the first vaccine to show any real effectiveness against the global scourge of malaria, which kills an estimated 600,000 people a year — most of them children.
GSK's breakthrough also highlights a curious discrepancy. Its malaria vaccine is being welcomed by African health officials even though it only offers a 25%-50% efficacy rate. Across the Atlantic in the U.S., growing numbers of consumers are forgoing vaccines that are far more effective against diseases including whooping cough and measles, and communities around the country are seeing outbreaks as a result.
Better access won't solve the problem
Part of the issue stems from poverty and inadequate health care access. Families living in poverty are less likely to have fully immunized kids. In states with their own health care exchanges and expanded Medicaid, the barriers of cost and access will fall in January, because immunizations will be free under the new law.
But in the 21 states that haven't expanded Medicaid, an estimated 7 million poor Americans will fall into a gap that disqualifies them from Medicaid without qualifying them for ACA subsidies. It's unclear how many of those people will be able to keep up with the recommended immunization schedule through schools and free clinics.
The other group that's not following vaccine guidelines for measles and whooping cough is parents in communities where there's mistrust of modern medicine and/or the government. Obamacare won't affect their choices. They're opting out based on information from discredited researchers like Andrew Wakefield, unqualified celebrities and conspiracy theorists.
It's tempting to dismiss these parents as outliers, but they are outspoken to the point that some parents feel intimidated to say they support vaccines, and their choices are causing outbreaks like the huge whooping cough surge in California in 2010 that killed 10 infants and sickened 9,000 people, as well as last month's north Texas measles outbreak.
What's in it for parents?
Consumers always ask what's in it for them, and modern parents tend to research every step of the child-rearing journey. Vaccine makers and public health agencies have left a void in the American conversation where a compelling description of vaccine benefits should be, and anti-vaccine advocates have filled that gap with scary claims about what could happen if you vaccinate your child. There are risks associated with vaccines, such as allergic reactions, but the notion that vaccines cause autism has been thoroughly debunked.
The benefits of immunizations should be obvious. But so should the benefits of eating right and exercising, and we still hear about them every day. We live in a society where the absence of vaccine-preventable disease has rendered shot benefits invisible — until someone brings home measles from abroad and shares it with the unvaccinated members of his congregation.
Dry reports from an epidemiological perspective don't speak to the mother who's heard erroneous claims that the MMR shot could give her son autism. Vaccination campaigns aimed at parents of newborns don't click with parents of tweens and teens, who still need boosters. (Full disclosure: I used to worry about thimerosal in vaccines and delayed some of my oldest child's shots with my doctor's input. These days we follow the schedule to the letter.)
Smart marketing can make shots matter
Parents and the rest of us should be reminded of three main upsides to a robust vaccine program. The first and most obvious is reduced risk of illness and death — an unfortunately hard case to make when most of us have never met anyone who survived smallpox or spent time in an iron lung.
For parents who are convinced they're doing right by their kids by opting out, and for adults who mistakenly think their childhood shots still protect them, an appeal based on the next benefit could have an impact: Keeping herd immunity high (a 95% vaccine rate for pertussis, for example) protects our most vulnerable people. Babies too young for shots, children and adults undergoing cancer treatment, pregnant women, and others with valid medical reasons to opt out depend on the rest of us to keep group immunity high.
Sanofi Pasteur (NYSE: SNY ) and the March of Dimes take this approach with their Sounds of Pertussis campaign. Actress Sarah Michelle Gellar talks about the risks that unvaccinated adults pose to newborns and urges parents, grandparents and caregivers to get pertussis boosters. The campaign is a compelling reminder to adults that their health affects the babies in their lives.
Not everyone knows a newborn, though. A campaign featuring older children and adults who rely on herd immunity would put a sympathetic human face on the risks of skipping vaccines and spark a conversation about our individual responsibility toward sick people, even if they're total strangers. Our personal vaccine choices can be as much of a public-health contribution as donating blood or joining the bone-marrow donor registry.
If protecting their children and vulnerable members of society doesn't get vaccine holdouts to take action, it's worth reminding people of the hassle and expense of illnesses like measles and whooping cough: lost work and school days, child care problems, hospitalization, and in some cases follow-up therapy. In other words, "Your child might not ever get whooping cough but if she does, here's how it's going to turn your life upside down."
Here in the U.S. we have the tools to keep measles, whooping cough, and other nasty infections in check, and we are so lucky that we don't have to think about protecting our kids from malaria each and every day. What we need now is a healthy dose of smart marketing from pharmaceutical companies and public health groups to remind us of exactly what's in that syringe for us.
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