Firstly, the authors, investigative journalists Shannon Brownlee and Jeanne Lenzer are at the cutting edge of showing there is a place for philanthropic and not-for-profit funding of health journalism. The Huffington Post Investigative Fund has published some of their other pieces, including this investigation raising concerns about the conduct of clinical trials. Brownlee is a senior research fellow at the New America Foundation and the author of Overtreated (2007), and  Lenzer is a frequent contributor to the British medical journal, BMJ.

As you may have seen from recent reports, Croakey is taking a keen personal interest in this funding model just at the moment.  This article, from the Columbia Journalism Review, reviewing the state of the media in the US, gives a number of examples of universities and health organisations getting involved in funding journalism.

The other reason the Atlantic article is worth reading is that you’re unlikely to have heard of many of the issues it raises before, at least if you’ve been relying on Australian media’s coverage of the influenza pandemic. So far as I’m aware, we’ve seen nothing from the local media (for-profit or otherwise) to rival the depth and incisiveness of the Brownlee/Lenzer piece. Much coverage has simply amplified the statements of government spokespeople and public health officials without critically examining the evidence underpinning them.

Meanwhile, here are two reviews of the article by local flu-watchers.

Associate Professor Heath Kelly, University of Melbourne, writes:

“This article provides a succinct account of some of the issues that impinge on our understanding of the control of both seasonal and pandemic influenza. It concentrates on the pharmacological interventions aimed at controlling influenza, the influenza vaccine and ant-viral medications. We learn that the evidence for the use of both interventions is not as good as many in the influenza community would like it to be. The facts are reported faithfully and the insight into responses to reputable researchers who have rattled the cage of public health orthodoxy makes for interesting and recommended reading.

Part of the problem with our imperfect understanding on the effectiveness of the pharmacological interventions arises from our imperfect understanding of the laboratory confirmed burden of influenza. This issue is addressed briefly on a commentary on the pandemic to be published on-line in the Medical Journal of Australia on Monday 16 November.”

***

Professor Peter Collignon, Canberra Clinical School, Australian National University

“Swine flu continues to generate both fear and controversy.  It is very important that the community has adequate information available so that we can know what were the mortalities and complications associated with this virus in various age groups and in certain risk groups (e.g. pregnant women).

We now have data available to answer some of these questions, particularly from data made available by NSW Health. These show that when the H1N1 virus spread thru the NSW population last winter 1,214 people with pandemic H1N1 influenza infection were hospitalised (17.2 per 100,000 population), 225 were admitted to intensive care (3.2 per 100,000), and 48 died (0.7 per 100,000).

Figures for the whole of Australia were similar with an overall death rate of 0.8 per 100,000.  The death rate in those under the age of 40 was 0.4 per 100,000. About three quarters of deaths were in those with associated risk factors. Thus the death rate in those under the age of 40 years and who had no known risk factors was 0.1 per 100,000 (or 1 per one million people).

We need to remember that at the beginning of this epidemic many experts and even Heath Departments were postulating that 20% or more of the population would get infected and there would be an associated case fatality rate of 1% or more. That translates to a population mortality rate of 200 per 100,000 people (or 300 times higher than what occurred).

Thankfully we did not get anywhere near that figure but it shows how we need to reassess many of our assumptions as they have proved to be wrong.

Figure such as these are important as we need these to make sensible decisions re the likely benefits versus risks from vaccines or other interventions. The Atlantic magazine article looks at these issues with regards to the efficacy and safety of influenza vaccines and also the likely benefits and pitfalls of the widespread use of drugs such as Tamiflu. It shows there are still many unanswered but fundamental questions.

We need research studies done with appropriate control arms so that we can move forward after we gain essential information that is currently lacking. The article is essential reading if you want to see the broader picture about swine flu and what actions we can take to ameliorate the problem and the likely success of these actions.”

And a final pointer from Croakey:

• A new journal, World Medical & Health Policy, has just published an article arguing that there are sound reasons for NOT expecting the worst of the 1918 pandemic to recur. It says the debate about the threat posed by pandemic influenza should move beyond “facile analogies and worst-case scenarios”.

It states: “While there has been sustained attention to the myriad trends that increase our risk from emerging infectious diseases such as pandemic influenza, far less attention has been paid to countervailing forces… It is important to take the panic out of pandemic. The response to the pandemic influenza should be guided by sound science, realistic risk assessments, and good public policy.”

DEM – that’s what is left when you take the panic out of pandemic. Any thoughts on what that might stand for?

Post Script with some more links that may be of interest:

• The public health blog The Effect Measure, compares the paediatric toll of pandemic influenza and pneumonia

• The Wall Street Journal health blog analyses the swine flu toll in the US

• A bowel cancer screening program in Northern Ireland is reportedly a casualty of swine flu spending

A previous Croakey post linked to this interview, as well as to other articles related to Dr Jefferson, including a systematic review he and others published in the British Medical Journal recently.

I then asked them each to write about swine flu vaccination for the Crikey bulletin, to examine some of the issues involved. Their articles were not written as part of a debate about the merits of vaccination, although this is how they were inadvertently headlined during the Crikey production process.

I would like to put it on the public record that both authors object to their articles being headlined this way and being framed as part of a debate when they were not written for this purpose.

Their articles follow below.

Maryann Napoli, of the Center for Medical Consumers in New York writes:

“How do we know whether the H1N1 [swine flu] vaccines actually work?  How do we know they’re safe for children, pregnant women and elderly people?  These are the most basic questions consumer advocates and medical journalists usually want answered where it concerns new prescription drugs.

And yet when it comes to new vaccines, that justifiable skepticism is often suspended.  What we get instead is an uncritical version of the classic public health position: Vaccines have saved millions of lives worldwide; therefore all vaccines are good. Vaccines are a major public health triumph and any risks are far outweighed by benefits.

That was made depressingly clear three years ago in the US when Gardasil, Merck’s Human Papillomavirus vaccine, came on the market. Yes, we got a lot of excellent reporting about Merck’s appalling marketing tactics but little about the science behind this vaccination recommended to all girls, age 9 and up.

I recently asked the question about H1N1 vaccine effectiveness of the world’s leading authority on the quality of the evidence supporting influenza vaccines, Dr Tom Jefferson, a medically trained epidemiologist who has been a reviewer for the Cochrane Collaboration for many years.

His answers weren’t reassuring, and there isn’t much to say about safety because the one published study looked only at antigens 21 days after the vaccination.

As for those flu-related death stats meant to hasten flu-shot compliance, they haven’t seemed remotely trustworthy ever since a 2005 study concluded that an accurate assessment of flu-related deaths is virtually impossible because few cases are confirmed with blood tests. And the viral infection is usually cleared from the body before the appearance of complications that cause death.

Things are calm here in New York City (flu-wise, that is). The mayor says he won’t close public schools in the event of another swine flu outbreak, except as a last resort (there were at least five swine flu deaths last winter in NYC).

But perhaps the two-pig cartoon currently making the rounds is a sign of what’s going on elsewhere in the country. It shows a small pig marked, “Swine Flu” side-by-side with a giant pig marked “Swine Flu Hysteria.”

By the end of October, all we need will be a news flash about the death of one child, and people, young and old, will be lining up in droves for the vaccine.

Here’s something that might give them pause: In the wake of the 9/11 tragedy, the U.S. Congress, which is bought and paid for by PHARMA, passed a federal law that allows vaccine companies to be protected from liability if anyone gets hurt.

Authorities need only declare a public health emergency for the protection to go into effect.  Like most Americans I would probably be blissfully unaware of this law were it not for one independent vaccine safety organization, the National Vaccine Information Center.”

**
Dr Tom Jefferson, of the Cochrane Collaboration’s Acute Respiratory Infections Group, writes:

“As winter turns to antipodean spring, the scientific community downunder have a duty to inform their northern counterparts about the ebbing of the current “pandemic”.

The information needs to be as accurate and as comprehensive as possible, but most of all it needs to be free of spin and shroud waving. Both of them have featured prominently in scientific and lay media coverage of the “pandemic” and have obscured reality, like a smokescreen.

Here is what we need to know:

1.    What are the estimates of the incidence and impact of influenza-like illness (ILI) in Oz/Kiwiland since early 2009?
2.    How do these compare with previous years?
3.    What is the estimated slice of ILIs and complications caused by influenza A&B and influenza A/H1N1 since early 2009?
4.    What is the estimate of the co-circulation of other agents?
5.    Can you give us full details of deaths coded as caused by H1N1 including, setting, comorbidites and coinfections?
6.    Can you do the same for all serious cases who survived?
7.    Do you have evidence from seroprevalence surveys of when H1N1 first appeared dowunder?
8.    What does your pharmacosurveillance tell you about harms from the use of antivirals?
9.    Are still serious about mass vaccinating now the epidemic is past?
10.   If so, why?

I know it is a lot to ask for, but we need the information to break the smokescreen and in any case if your public health is as good as we hear it is, you will be able to get the information relatively quickly and in an unbiased manner.”

In Crikey today, a leading US consumer advocate as well as an international expert on influenza vaccines from the Cochrane Collaboration raise several questions for Australian health authorities, while former Federal Health Minister Dr Michael Wooldridge argues strongly in support of the vaccination program.

Meanwhile, a regular Croakey contributor, Dr Trevor Kerr, has been watching the media coverage of the campaign, and believes it’s been too uncritical.

He writes:

“Geoffrey Barker’s essay for the latest Griffith REVIEW on the death of Australian journalism (’The crumbling estate’) concludes:

Free, independent, muck-raking journalism is more important than ever in a world dominated by political, bureaucratic and corporate authoritarians supported by armies of flim-flam communications advisers whose mission is to conceal and mislead, and who are delighted to see readers distracted with a fast-food diet of sex, sport and celebrity scandal.

On page three, Barker reflected on an episode of intensive marketing for a pharmaceutical product. “Recent disclosures about the intrusive role of PR flacks in a court case over the withdrawn anti-arthritis drug Vioxx offers alarming evidence of how far they are prepared to go to intimidate reporters. It is hardly surprising that young journalists are tempted to get among the big bucks rather than to struggle thanklessly to develop independent reportage, for it is easier and more congenial to be a massager of messages than a raker of muck.”

We could see reasons for Barker’s denunciations in the item for last night’s (Sept 29th) 7.30 Report on the H1N1 influenza vaccine. The academy (University of Melbourne’s Terry Nolan), government (Health Minister Nicola Roxon) and commerce (CSL’s Rachel David) were lined up to refute rational objections to the vaccination policy (Canberra Hospital’s Peter Collignon). Nolan even trotted out the coup de grace “We could wait and we could allow people to die”.

It would be helpful in this debate if interviewers asked medical experts and researchers to declare their conflicts of interests and associations with pharmaceutical companies. That tactic, however, despite seeming to be in the wider public interest, does not always meet with approval.

Peter Sandman, risk analyst, in his latest update on H1N1 vaccination, comments “Worst case: The seasonal vaccine turns out not only unnecessary this year, or not only ineffective against the most virulent seasonal flu strain – but actually dangerous, by increasing vaccinees’ susceptibility to pandemic H1N1. This could cause a fiasco (like the 1976 swine flu vaccination campaign) that shadows all influenza vaccination for a generation or more. And, most important, it could kill people.”

Well, at least the New York Times is willing to publish divergent views. In the context of Nicola Roxon urging pregnant women to be among the first to be vaccinated against H1N1, NYT ran ‘Don’t Blame Flu Shots for All Ills, Officials Say’ and ‘Pregnancy Is No Time to Refuse a Flu Shot’ in the last few days. There’s more to be said about this unseemly rush to expose the unborn to the unproven.

There are reports today (eg, NPR) that CDC will be reporting in its Morbidity and Mortality Weekly Report that significant numbers of people dying after H1N1 infection had pneumococcal pneumonia.

Will this provide fuel for another roll-out campaign to be spearheaded by Nicola, Terry and Rachel? If so, CSL shareholders will be most pleased.

Finally, the proponents for universal vaccination could help themselves by watching the file shots used in last night’s 7.30 Report. For about the fourth occasion on the H1N1 vaccine, the ABC has used video of that vaccinator with appalling long, false fingernails.

That is clearly not world’s best practice and at a time when prudent and careful context ought to be tempering the haste.”

Trevor Kerr is a retired medical microbiologist, now working part-time for a community health service

The interview, conducted by Maryann Napoli from the Center for Medical Consumers in New York, raises many questions about the merits of our mass vaccination program for H1N1.

You can also read more about Jefferson’s views and work in this article from the European magazine, Der Spiegel, in this 2005 news release issued by the University of Oxford, at this Cochrane Collaboration site, and in this recent blog by a Scottish GP, Margaret McCartney, at the Financial Times website.

He is also lead author of this systematic review published a few days ago in the British Medical Journal, examining the use of physical interventions (eg handwashing, masks etc) to interrupt or reduce the spread of respiratory viruses, such as influenza.

It seems like the issues around influenza vaccination generally – and swine flu vaccination in particular – may not be quite as clear cut as they’re often made out to be.

Carol Bennett, executive director of the Consumers Health Forum, is encouraging the public to discuss the pros and cons of vaccination with their health provider, rather than relying on media coverage to inform their decisions.

Here is what she has to say:

“While I do not claim to be an expert on the H1N1 vaccine and the specific risks associated with the vaccination, I think we will need to rely on individual health service providers to be aware of, and inform, consumers about the risks rather than expecting consumers to rely on a broad media discussion of potential risk factors.

I know that the risks of any vaccination vary considerably according to individual characteristics – a preschool child has different risks to a teenager who has different risks to an obese middle aged nurse or an older businessman with pre existing asthma and diabetes.

Knowing there are some risks does not inform individuals about how the risk relates to them personally.

I am not one to support health consumers being treated as mugs, but I am confident most health consumers would prefer to discuss their specific circumstances with their health service provider rather than base their risk assessment on generalised advice provided by media summaries of a Health Minister’s statement about potential side effects.

My reading of the media is that the Health Minister has been transparent in both the advice she has received (including potential risk factors) and the policy that she is adopting.”

Below is a document that the Medical Indemnity Protection Society has sent members, making it clear that they will be covered only if they obtain informed consent from patients. This means discussing the potential benefits and risks of vaccination versus no vaccination.

It is interesting to contrast what the Government is telling the public with what doctors are expected to tell their patients. Quite a contrast.

Now, don’t get me wrong. I am not opposed to vaccination per se, and I am certainly not seeking to inflame anti-vaccination campaigns generally.

What I do want, however, is for those in positions of authority to be upfront and honest with the public – in the way that the health professionals charged with delivering the vaccination program are expected to be.

I’ve been thinking about what Minister Roxon could feasibly say when asked about the pros and cons of vaccination and issues such as the infection control concerns around multidose vials.

Of course she doesn’t want to say anything that will lead to alarmist tabloid headlines. But that doesn’t mean she can’t acknowledge that there are legitimate concerns, and to explain how these are being addressed.

Apart from anything, this discussion might help members of the public play a more active role in their care. I was struck by a comment on the earlier Croakey post, where a reader asked: “Is there anything ‘mug consumers’ of swine flu vaccination can do to minimise their risk of contamination with multidose vials?”

It’s not such a silly question. Ensuring consumers are informed about potential risks is well acknowledged within the broader safety and quality field of being one way to minimise the risk of adverse events or to ensure they are effectively managed if they do arise.

If the Government insists on treating the general public like mugs who are incapable of engaging with these issues in a sensible way, it is missing an opportunity. And so are the health professionals who would prefer all these debates stay firmly behind closed doors.

Anyway, enough ranting from me. Here is the advice from the Medical Indemnity Protection Society to doctors:

SWINE FLU VACCINATION – MEMBER INFORMATION
The Australian Government plans to distribute the swine flu (H1N1) vaccine in the near future. This information from MIPS clarifies the indemnity issues surrounding this vaccination program for members and their employees.

Indemnity for members
MIPS will indemnify its members for administering the H1N1 vaccine however, members are required to:
•    provide patients with adequate informed consent including a succinct summary of the current information needed to make an informed decision about H1N1 vaccination.  This should include information about the risks of the vaccine, the general risks of an injection and risks of electing not to have the vaccine;
•    follow the current draft RACGP Guidelines for the use of multi-dose vials (MDV’s) available at http://www.racgp.org.au/h1n1/33545; and
•    meet MIPS general requirements of appropriate qualifications, training and experience.

Informed consent
Members need to appropriately advise patients of the risks of H1N1 and the risks of having or not having a H1N1 vaccination based on their individual circumstances so that patients can make an informed decision (and therefore provide informed consent to undergo vaccination).
For example this should include:
•    information regarding risks associated with H1N1 compared with seasonal flu;
•    information comparing risks from catching H1N1 compared with risks associated with vaccination;
•    advising that the vaccine is currently undergoing clinical trials; and
•    that it is currently not clear whether one or two doses will be required to achieve immunity.

Although presumed, it is not yet confirmed that the risks of H1N1 are in general much higher than normal seasonal flu and/or the extent that the risks of H1N1 are more serious and/or more likely than the risks associated with vaccination.

According to the Australian Government there have been no concerns raised from early vaccination trial data, however it is possible concerns might be subsequently identified.  Members should also set patient expectations that a second vaccination dose may be required and ensure appropriate recall systems are in place to achieve that.

Ultimately, it is the patient after having been appropriately informed, that must make a decision as to whether they wish to proceed with vaccination or not.

Information material
The Australian Government has advised it will provide health professionals and patients with Pandemic H1N1 Influenza Vaccine Information material and also a “consent” form. These should be used.  Refer www.healthemergency.gov.au.  As for any health service the patient’s medical record must also reflect advice given and the patient decision.

Multi-dose vials
For adults the H1N1 vaccine will be presented in multi-dose vials. Practitioners and patients need to be aware of the steps taken to remove potential risks associated with use of multi-dose vials particularly in relation to vertical transmission of blood borne diseases. Strict adherence to the RACGP Draft “Guidelines for the use of multi-dose vials” is required by MIPS because it will remove that risk and thereby provide confidence to patients when making a decision about H1N1 vaccination.

Other matters
The normal issues associated with seasonal influenza vaccines for e.g. egg allergies/potential issues with preservative, risk of bruising, infection, sterile abscess, nerve damage etc. remain for consideration in respect of H1N1 vaccination.

In addition, strict attention to maintaining the cold chain (especially in view of the huge volume of vaccine and potential vaccinations) provides a greater challenge than for other vaccination programmes.

Indemnity for members, those under members direct supervision and practice staff
For those members whose practices are considering arranging for employed staff such as practice nurses to administer the vaccine, in addition to compliance with the above requirements (e.g. for advice and use of multi-dose vials) it is important to remember under the individual MIPS Insurance medical indemnity policy a MIPS member is covered for vicarious liability claims that arise from the provision of healthcare by others under the member’s direction in accordance with clause 12.1.7 of the member’s medical indemnity policy. The relevance of the clause is the requirement for the member’s appropriate and adequate direct supervision and also for the supervised individual to act within practice protocols. The MIPS Insurance Policy can respond if the member’s practice staff seeks indemnity from the member on the basis that the claim against them is as a result of the member’s actions or inactions but only if all requirements are met.

MIPS Members’ Practice staff and the practice entity are also indemnified in accordance with the terms and conditions of the MIPS Member Practice Entity Policy. (A practice entity is defined as a practice in which a member has a financial interest and the majority of shares are owned by medical practitioners working in the practice). In general terms this policy provides cover for health care errors made by practice nurses, receptionists and other administrative staff who act independently and which may financially implicate the practice and/or the member.

It is important to remember that MIPS requirements (as listed above including consent and use of RACGP guidance for the use of multi-dose vials) will be a pre-requisite in relation to indemnity for any H1N1 vaccination matters that arise.

Asked about infection control concerns surrounding the use of multidose vials(as outlined in this Crikey story recently), Minister Roxon said these are “very minimal”.

Does she realise what dangerous territory she’s entering here?

Our national infection control guidelines (you can read them here) state that the use of multidose vials is a “high risk” procedure (p49).

The guidelines cite the Australian Drug Evaluation Committee’s advice that “injectable products packaged in multidose vials should not be used except where products such as insulin are intended solely for the exclusive use of an individual patient”.

The guidelines also state: “When single-dose vials or ampoules are not available, the risk of cross-contamination is high if injectable products are used on multiple patients.” They recommend several measures for controlling this risk.

If the Government and its advisors have decided the potential benefits of a mass vaccination program outweigh the costs, including potential harms, then fair enough. Not everyone agrees with them, but that’s their call.

It’s another matter entirely to mislead the public in an effort to sell their program.

This will come back to bite them on the bum, pardon the language, if history is any guide. You don’t have to look too far back to find an example of the perils of health ministers spruiking pharmaceuticals.

Below follows is an extract from Ten Questions You Must Ask Your Doctor, which I wrote with another health journalist Ray Moynihan. This particular section comes from a chapter urging readers to be more alert to the possibility of side effects from medications and notes that these are often downplayed.

“In June 2000, the then Australian Minister for Health, Dr Michael Wooldridge, issued a most extraordinary media statement. In it, he announced that the first of a new class of arthritis drugs called COX 2 inhibitors would be funded by the Australian Government. He said the drug, celecoxib (sold under the brand name Celebrex), was significantly safer than older types of drugs used to treat arthritis and called it a ‘major breakthrough in arthritis therapy’.

It was highly unusual that a Health Minister would feel the need to single out any one drug for such an enthusiastic plug. It was even more remarkable considering that a careful reading of the scientific literature would have shown there were already rumblings of concern about the safety of COX 2 inhibitors. Over the next few years, these rumblings turned into a roar of alarm and an international scandal damaging public trust in drug regulatory agencies, medical journals and drug companies alike.

We now know that tens of thousands of people around the world paid a very high price – suffering heart attacks and strokes – for following advice to take drugs that they had been assured, wrongly as it turned out, were safer than older types of arthritis drugs.

Taxpayers and patients also paid a very high price for the overly enthusiastic promotion of these drugs, which reaped huge profits for their manufacturers. While safety concerns surround many of the COX 2 inhibitors, including the one so warmly endorsed by Dr Wooldridge, the most alarming case is that of rofecoxib, which was sold under the brand name Vioxx by the drug giant Merck.

The history of rofecoxib reveals how so many different groups failed to protect the public’s safety…”

I am not suggesting that swine flu vaccination will turn into this scale of disaster. I sincerely hope not.

But the point is that there are enough lessons from recent history for Health Ministers to be extremely cautious about how they pitch pharmaceuticals and other health interventions to the public.

We need to be able to have an open and frank discussion about the costs and potential harms of any interventions – including vaccines – as well as their potential benefits.

• a lot of people must be working pretty hard and wondering how on earth they’re going to pull it all off

• we will be hearing and reading plenty of reports emphasising the potential benefits of vaccination and maximising concern about the impact of swine flu.

In one sense, this is what happens whenever there is a roll out of a new health program or intervention; the advocates talk it up. But this time, they will no doubt be even more determined to do this, given the questions that are being asked about the merits of the campaign and its timing.

In light of this second point, you might be interested in this piece calling for a “common sense” response to swine flu, recently published by Healthy Skepticism, a group which is not known for being overly enthusiastic about medical marketing.

It is by Juan Gérvas, a rural GP in Spain, and a Visiting Professor, Primary Care, International Department, National School of Public Health (Madrid), Spain. He is also Honorary Professor, Public Health, School of Medicine, Autonomous University (Madrid).

Check out this example – the US Department of Health and Human Services has launched a competition for a public service announcement on swine flu prevention. It’s a clever way of getting people to engage with public health messages.

I quite liked the rapping doc and the bagman – but top billing has to go, in my view anyway, to chainsaw man.

Click here to view the embedded video.

What do you think?

Would Australian health departments ever let us have so much fun? Somehow I just can’t imagine our politically constrained bureaucrats letting rip like this.

Mind you, they will need to come up with some innovative strategies if they’re to have any hope of getting much uptake of the H1N1 vaccination program…

She wrote an interesting article in Crikey today about the image problem of swine flu vaccination and the need for “full transparency from the authorities” to ensure public confidence.  The public will need to know the data the Government is using to assess the vaccine presented in comparison with data comparing the risks of swine flu in Australia, and that systems for reporting adverse events following immunisation are in place, she wrote.

Those who saw the whooping cough story on the 7.30 Report may be interested in her analysis of related issues.

She writes:

“Vaccination is mostly a technically rational practice but the decision to vaccinate is not usually made with a rational approach to the facts. Trust, desire for protection, good mothering all play a role. Fear is also a powerful motivator. In vaccine promotion terms, Toni McCaffery’s willingness to go public is a blessing. Parents who will do this crop up every few years. In the meantime, vaccination advocates struggle in fighting emotional anti-vaccine stories with doctors delivering dry (in comparison) verbal reassurances.

Often parents who go against vaccination do so with what they believe is lots of evidence (often from Jenny McCarthy’s “University of Google”) They also have entrenched belief systems. This 2% will be almost impossible to win over.

A few media reports lately have suggested we are having a drop in rates. This is a blow-up. There is no sign of this from national rates which remain stable at about 94% for two year olds. I am not aware of a fall in the northern rivers rates. It’s always been poor with about two thirds fully vaccinated.

The current approach to the anti-vaccinationism movement is missing the mark.

Health professionals often seem to think you can just feed vaccine dissenters the facts, educate them and this will correct wayward thinking.

This demonstrates a poor understanding of the anxieties and wider social shifts at the heart of vaccine debates. These include mistrust driven by poorly handled health scares (CJD in the UK), a thirst for discrete causes of idiopathic ills (eg, autism), increasing tendency to question medicine, middle-class “intensive parenting”, and the appeal of natural health practices.

Tactics like The Skeptics’ which seek to demonise antivaccination polarise the issue taking away any room for grey in a complex issue (vaccines are great but not perfect).

They also give the AVN a media profile which would potentially attract fence-sitting new paid-up members who otherwise would not have contacted the once nearly bankrupted AVN.

One has to wonder whether appeals to availing oneself of the truth and facts will work with GenY parents who were raised to value the fundamental truth of the personal narrative. We need to consider new models of addressing vaccine scepticism. This first requires better understanding of the current landscape.

The best strategies will be evidence-based, tailored to parents’ needs and contemporary. They will be resource intensive and require consultation and listening, not lecturing.”