Monday, February 6, 2012

Addressing Low Childhood Vaccination Rates: A Population Health Management Perspective

What's the one issue that drives the most doctors crazy?  The Disease Management Care Blog suspects it's persons who refuse basic vaccinations.  That's because physicians are inculcated from the first day of their education with triumphant stories of how basic science and public health joined forces to banish many common and fatal infectious diseases. 

Not getting your shots is crazy.

DMCB readers are probably aware of how childhood U.S. vaccination rates are dropping.  While we continue to wonder just how any parent or guardian could let that happen, here's a handy summary on the story behind the story: the New England Journal has an article on Improving Childhood Vaccination Rates:

Total U.S. rates of vaccination remain greater than 90%, but there are some pockets of the country with rates just over 50%. That's where there have been outbreaks of disease leading to some pointless deaths.

Parents (or guardians) opposed to vaccination are unlikely to change their minds.  That's why high vaccination rates among the remainder of children are important to create herd immunity.

There are four approaches to achieving high vaccination rates:

1. Make shots free and think about paying parents to have their children immunized.

The DMCB likes the idea but wishes the authors had pointed out that in the context of value-based insurance, this is hardly a radical idea. 

2. Make it really difficult to attend school without proof of vaccination.  Getting an exemption should demonstrate that the parents are serious and not shuffling by on lax enforcement.

The DMCB grew up in New York City and recalls being immunized against polio in the school's cafeteria.  Is it time to bring this back as a first-line strategy?

3. Confront the anti-vaccine community with counter-education campaigns that rely on more than facts and figures.  Anecdotes and trusted public figures should also be used.

Whither social media?  And, at a traditional marketing level, the DMCB thinks that maybe it's time to partner with the pharma companies that do such a good job of convincing TV viewers to take lipid-lowering agents and anti-depressants.  Nothing against the colleagues in public health, but they're not known for their marketing savvy.

4. Physicians need to step up one patient at a time and, while they're at it, make sure they're up to date with their shots.

The DMCB did a literature search on "shared decision making" and "vaccination" and found no useful information.  Given the success of aids and engagement strategies that enable truly informed decision-making, the DMCB thinks its time for the population health management community to step up and offer their services.

(One last thought: Newt's been lampooned for his moon-base wackiness, but as the DMCB understands it, his recommendation is really based on an X-Prize approach, which he contrasts with the discontinued Shuttle program.  The DMCB wonders if such an approach couldn't work in those areas of the country with critically low childhood vaccination rates: a 5 figure prize to any outfit that can move it to 90%.  Why not?)

Image from Wikipedia

1 comment:

Branden W. Comfort said...

Jaan, I really like this article and I thank you for bringing this issue up for discussion. I agree with the majority of what you have said with the exception of how to confront the anti-vaccine community. I really doubt that they will respond to facts and figures. I think the emphasis should be placed on running a campaign focused on anecdotal evidence for why vaccines are important. This is the exact strategy that the anti-vaccine community has implemented by highlighting children with autism or other terrible health problems. Many other successful campaigns have ran on this same strategy. The pro-vaccine community needs to wage similar campaigns highlighting one child with measles, mumps, rubella, pertussis, tetanus, polio, etc. Then back up that anecdote with a few facts. Unfortunately, most will not respond to just facts, so we have to make it personal somehow.

Thanks again for the great post.