This is not a piece that is pro-vaccination or anti-vaccination. I am writing this as a citizen and consumer of the health system in Canada. I have watched the messaging about the influenza vaccination both in 2009 and now in 2014. It may be time for our health officials to pause and take the time to understand why people are (and are not) getting vaccinated.
In some provinces, the rate of immunization for influenza is a dismal 20%. That means 80% of citizens are not getting vaccinated. What I wonder is: why?
It is important to understand why some people get vaccinated early in the season, why others wait until a perceived crisis, and why others don’t get vaccinated at all.
A certain percentage of people regularly get their influenza vaccinations every fall. For others, seeing headlines in the paper that announce, “Nine deaths in Alberta, 300 hospitalizations linked to the flu” is enough to send them to a clinic. There are others who have legitimate questions that need answering before they will make their decision.
It is our health officials’ responsibility to answer our questions clearly and in plain language. The public should not be made to feel stupid, lectured to, or scolded if they have questions about the vaccine. I wish that health officials would find out what information we need, and help us interpret it by providing value-neutral, concise information on websites and through phone lines. The only way to find out what information we need is to ask us, and not to make assumptions about what we need to know.
There is also a need to make the vaccinations accessible and convenient for people. Some people won’t reschedule a cancelled appointment, or drive across town in poor weather for a clinic, or stand in line for hours for a shot. From a consumer perspective, it is a good strategy to bring the vaccinations as close to the people as possible: at their community pharmacies or family physicians’ offices (assuming that they don’t run out of supply, as happened in Alberta) . Ontario is making it easy to set up a flu clinic at workplaces, and encouraging the sharing of success stories on the Ontario Ministry of Health and Long-Term Care website. Clinicians who work in the inner city are famously creative in their flu shot offerings – even going to pubs and local meeting places to offer immunizations.
There are some people who will not get immunized, no matter what information is shared with them, or how convenient the immunization clinics are. How they feel about the flu vaccine is more important than their knowledge of their risks of not getting immunized. I think many people aren’t getting vaccinated because of a lack of trust. This could be a lack of trust of health officials, the health system, or of pharmaceutical companies. Immunization involves having a foreign substance injected into our bodies. So if we distrust immunization itself, question the effectiveness of the vaccine, or are suspicious of the motives around a program of immunization, our attitude isn’t going to be altered through a billboard campaign.
The vocal anti-vaccination community adds complexity to the issue. If there is not inherent trust in health officials, then people will be influenced by dissenting opinions. This is when things get confusing for us regular folks – who should I believe?
Health organizations need to proactively build trust with their stakeholders and citizens over a long period of time, and not just assume, during a crisis, that people will suddenly demonstrate the behaviour that they are looking for.
We make decisions about our health based on a variety of factors, and taking the time to ask why we make decisions – whether or not health professionals agree with them – is the first step to understanding the needs of the people who are supposed to be served. It is simply not enough to tell people to get immunized “because we said so.”