How to Communicate About an Ongoing Epidemic of Historic Proportions

Making a certain disease a thing of the past is the greatest achievement possible in any healthcare pursuit. This is why the declaration of measles eradication in the United States in 2000 was such a historic achievement; a viral disease that is known to cause excess death in children was one step closer to no longer existing.

It is troubling, then, that just 19 years later, there is the possibility that the US will lose the distinction of having eradicated measles due to an erosion in rates of vaccination of US children. For those of us who have worked on vaccines for decades, the underlying phenomenon is not new; there has been a steady increase in patient or parent concern about vaccination safety, on the basis of discredited reports and ongoing activist efforts to undermine public faith in medical science.

The problem that we face is one of medical education and communication, and not one of vaccine efficacy or safety. Vaccines are effective, safe, and have few side effects, as has been demonstrated time and again with rigorous evidence. Instead, a combination of factors has created a drop in “vaccine confidence” among the public. As a medical communications and education company with over 20 years of experience in vaccination, we see an opportunity for medical communicators to rise to the challenge and improve confidence in vaccines.

At IMSci, we use the phrase vaccine confidence based on lessons learned in working with one of our clients, a major pharmaceutical company, who have worked with multidisciplinary stakeholders, including members of the Vaccine Confidence Project, a group which makes an effort to spread accurate information about vaccination and improve public understanding of this vital public health intervention. “Vaccine hesitancy” has become a common phrase to refer to concerns over vaccine safety. However, this term puts us immediately on the defensive in communications about vaccination. Instead of improving something, it forces us to say we need to “combat” vaccine hesitancy or some similar type of construction. Improving vaccine confidence is more positive-and is a goal within our reach.

We believe that this goal is within the reach of the medical communications community because we have worked on programs about vaccine confidence and found there is great demand for educational materials that help HCPs communicate the importance of vaccines to patients. In another example, our work with another major pharmaceutical company on a pneumococcal conjugate vaccine involved the creation of a guidebook for HCPs who are faced with vaccine-hesitant patients. The rationale of this material was that not all patients and parents who are concerned about vaccination are at the extreme end of the anti-vaccination movement. Some have simply heard frightening stories and have questions that they need answered.

The goal of the handbook that we created, in collaboration with this client and a group of opinion leader advisors, was to provide HCPs with the tools they needed to confidently recommend vaccines to their patients. Above all other factors, HCP recommendation is the most influential on patient decision-making. Those recommendations produce better vaccine confidence in patients if they are backed by quality facts and quality education about the benefits of vaccines. This document was tremendously successful and saw high levels of HCP demand. Thousands of copies were distributed to HCPs who felt they could benefit from clear and concise explanations of vaccine effects, in order to instill vaccine confidence in their patients.

In the same vein, we also encourage the use of what is called “the presumptive approach” in vaccine recommendations. At times, patients who do not feel fully confident about an intervention need encouragement that it is a good idea. Working on a Tdap vaccine, we created a promotional speaker deck that included tips for speaking to patients in a way that presumes the need for vaccination. A patient is more likely to accept vaccination if their HCP says, “So we have a vaccine to give you today” rather than “Is there a vaccine that you’d like to get?” This is the presumptive approach, and it can help patients understand that vaccination is a necessary public health measure.

Another element of communications to improve patient vaccine confidence is transparency. Vaccine manufacturers are subjected to high levels of quality control scrutiny and regulatory oversight-and they willingly accept these requirements because the safety of vaccines is vitally important. However, the public, government officials, and HCPs are not always aware of the efforts and care that is taken to make sure that vaccines are safe. With several of our clients, we have worked to create slide sets and videos that describe the manufacturing process and the safety precautions that are taken. These materials help to provide straightforward, plain language explanations about vaccine manufacturing that improve transparency, and thereby, vaccine confidence, among key stakeholder groups.

As an established and experience medical communications group, we believe that the medical communications challenges faced by vaccine products are not something that one agency can handle alone. Instead, we feel it is important for all medical communications professionals working together in this space to collectively strive for positive and effective messages about vaccination. A drop in vaccination rates for key diseases is a human problem that confronts us all, we believe it important that all medical communicators be armed with tools and tactics that can help us improve vaccine confidence. The consequences of failures in vaccine communication are too dire to act otherwise.

Specifically, we look to the example of Japan, where the introduction of the HPV vaccine Gardasil, a product that we have represented, was initially met with high vaccination rates and great success. However, after unverified safety concerns were brought to the Japanese government by special interest groups with a religious conservative background, vaccination was dropped. Now, Japan faces excess cases of HPV and potentially of cervical cancer, which may result in entirely preventable deaths for reasons having more to do with fear than evidence.¹

Contrast this with the Gardasil experience in Australia, where the government and society have embraced the availability of a cancer vaccine in a universal vaccination program. This vaccine has offered them the chance to protect their population against HPV-related cancers and diseases. Australia’s prudent decision in this case has resulted in substantial declines in genital warts and cervical precancers, with the expectation is that as these patients age, rates of cervical and other HPV-related cancers in Australia will also drop.² One recent estimate indicates that Australian vaccination measures could prevent as many as 13.4 million cervical cancer cases by 2069, with incidence falling below a threshold of 4 cases per 100,000.³

In the example given for Japan, communication of unverified concerns defeated a successful vaccination program. We believe that this story is, in its way, inspiring to the notion that communications and education can influence the success of vaccination programs. Communications raise these concerns, and communications can help to reassure the public about the safety of vaccines. Medical communications and education is a field that has grown at a tremendous pace in the 21^st century, bringing new tactics and exciting capabilities to the dissemination of healthcare information as well as an expanding host of professionals able to achieve great things. Given the challenges that are faced in improving public confidence in vaccination, now is the time for medical communicators to bring their skills to bear on this challenge. We hope that our sharing some of our experience serves both to inform and to inspire our colleagues in this vital endeavor.

References

• Matsumoto K, Yaegashi N, Iwata T, et al. Reduction in HPV16/18 prevalence among young women with high‐grade cervical lesions following the Japanese HPV vaccination program. Cancer Sci. 2019. doi: 10.1111/cas.14212

• 90% decline in genital warts in young Australians. UNSW News. https://kirby.unsw.edu.au/news/90-decline-genital-warts-young-australians. Accessed November 6, 2019.

• Simms KT, Steinberg J, Caruana M, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020–99: a modelling study. Lancet Oncol. 2019;20(3):394-407

Barbara Blasso, president; Stephanie Brewer, PhD, EVP, managing director, chief scientific officer, IMsci (International Meetings & Science), a Wunderman Thompson Health Company.