New frontiers in vaccine hesitancy research: a border-spanning collaboration
An exciting project is taking shape at WithinReach. After nine years of extraordinary work in the vaccine hesitancy field, Vax Northwest is embarking on a new project, and we’re doing so with new partners—
a wide range of researchers from, or interested in, the midwifery community who come from both the United States and Canada.
Midwives are a very influential group of health care providers. Midwives attend 8.3% of births in the United States , but their knowledge, attitudes and beliefs about vaccines have not been robustly studied. Likewise, we know very little about the people who seek care from the midwifery community. In our attempt to engage as many leverage points as possible in building vaccine confidence, Vax Northwest has elected to focus on the midwifery community.
On January 10th, more than 20 researchers and practitioners from the fields of midwifery, naturopathy, allopathic medicine, public health, pediatrics, and anthropology, among others, came together at WithinReach to define a research agenda related to midwives (and other perinatal providers to a lesser extent). We had a rich and varied conversation that culminated in three research questions that Vax Northwest and our partners will address going forward:
- 1) What are the knowledge, attitudes, and beliefs of midwives toward vaccines? (Are they advocates of vaccines?
Do they want to be advocates of vaccines? What support is needed to become better vaccine advocates?)
2) What are the characteristics of people who seek midwifery care? (Are they more likely to be vaccine hesitant? Are they dissatisfied with ‘traditional’ medicine?)
3) What is the vaccination status of children in Washington, by the type of provider who attended their birth (midwife, physician, etc.)? Is there an association between provider type and immunization status?
“As an observer, it was a fascinating experience to listen to experts in various fields discuss current information and determine what new information is needed before deciding on specific research questions. Since the influence of the midwifery community on the decision to vaccinate children has not been studied, it will be exciting to see how these new research questions will help us better understand vaccine hesitancy” noted Cristina Cardenas, a WithinReach AmeriCorps service member, who participated in the meeting and has a special interest in immunizations.
Making policy, decisions, or interventions based off anecdotal evidence can be ineffective, or even worse, backfire. That’s why Vax Northwest has such a strong focus on creating a research foundation before we act. After several years of sharing the informative and well-received results of our previous research, we’re excited to be breaking new ground with this project and adding to the vaccine hesitancy research base. As always, we’ll do so in collaboration with the right partners with the goal of keeping all Washington families thriving and healthy.
Stay tuned for more updates!
What’s new with the HPV vaccine?
- Evidence shows that adolescents mount a particularly strong immune response to the HPV vaccine if it’s given early. After age 15, the response begins to be weaken, so 3 doses are still needed for those ages 15-26.
- Previously, we only had robust research on a 3-dose series, but new evidence evaluating 2 doses is available and indicates long-lasting protection when it’s received through age 14. Two doses will protect younger adolescents just as much as three doses will protect older adolescents.
We encourage you, immunizer or otherwise, to spread the word about this change. We know that the clinical community will hear about this change via the usual channels, but word trickles down to kids themselves less quickly, so be a part of spreading the message! And remember, the most important talking point is that HPV prevents several cancers in both men and women—a cancer-preventing vaccine is one of the greatest gifts we can give to today’s adolescents.
Vaccines for children through 18 years old are free in Washington State, including the HPV vaccine. To find a health care provider, visit ParentHelp123.org or call the Family Health Hotline at 1-800-322-2588.
HPV Prevention in High School: A Guest Blog
Paul and Claire are juniors at Nathan Hale. Paul initially got involved when his mom asked him if he would support her in a public health panel sponsored by the Group Health Foundation, which focused on HPV awareness. Paul recruited Claire for the effort too, and their remarks were so well-received that after the panel discussion they were approached by public health nurse Lauren Greenfield from Public Health–Seattle & King County about an HPV campaign to be launched at six Seattle public schools, including Nathan Hale. Their history with this brilliant project is detailed below. Enjoy! -Todd
When we both agreed to be a part of this campaign (to spread awareness about the importance of HPV vaccine at Nathan Hale and get students immunized at the teen health center), we had no idea what to expect. But despite that, we both said yes for the same reason: we realized that this campaign was a way for us to help and have a positive impact on our community. Human Papillomavirus (HPV) cancers and disease have affected the lives of many people and will continue to if nothing is done, and if immunization rates in our state remain low. People have been looking for a cure for cancer for a long time, and the thought of finding one seems impossible. But what people don’t realize is we have something even better than that. We have a way to PREVENT cancer. And it’s right at our fingertips. The HPV vaccine is of great importance because it has the ability to save thousands of lives from future cancers. And our job is to make sure that people, especially our peers, understand this.
When we started the campaign, there was no plan to work off of, no template or outline of what we were supposed to do. We were basically winging it. At our first meeting with our advisor, she asked us, “What are your ideas? What do you guys want to do?” This was one of the best features of the opportunity; it was up to us to come up with ideas on how to run a successful campaign, and it was our ideas that mattered the most. This campaign taught us many important skills, including leadership organizational skills. Running into many obstacles, we’ve learned to be persistent in our goals. The biggest challenge, though, was always juggling this on top of schoolwork, sports, and other activities we do outside of school—especially since it was just the two of us.
As for the future of the campaign, we have high hopes and many plans. We plan to continue running the campaign at Nathan Hale, and this year hope to create an HPV Awareness Club at our school. The club will not only educate people on the topic, but also the group can help with certain projects throughout the year that are part of the campaign. We also hope to get speaking time at an assembly this year, and maybe do a schoolwide HPV awareness week. And of course, our goal every year is that more and more people at our school get vaccinated. Finally, as a more widespread goal, we hope students at other schools around the state take on the challenge that we have and raise awareness about HPV, and the vaccine that prevents certain HPV cancers and disease, at their schools.
It’s wonderful to see young people getting involved and speaking up for the health of their peers. Many thanks to Paul and Claire for their great work!
Get ready for the first annual Washington State Immunization Summit
The immunization team at WithinReach is using its well-honed event planning skills on a new endeavor. On April 26, 2017, we will host the first ever (and hopefully annual) Washington State Immunization Summit at the SeaTac Conference Center. Guided by best practices nationally, we have decided to offer an annual summit for immunization stakeholders from any sector across the state. Continuing education credits may be available (see website for details).
So why are we doing this? Immunization is complicated; it is both a precise science and a complex social phenomenon, and the strategies needed to be successful evolve constantly. Washington leads the country in the immunization field in many ways (our hesitancy research, our cutting-edge HPV work, etc.), and this is yet another way that we want to support our state in taking the lead. In creating this summit, our goal is to offer responsive, cutting-edge immunization education to our partners. There is plenty of immunization education out there, but the content is usually pre-defined by the creators. In this case, we have been surveying our constituents about what they want and need from us. Three specific areas of interest emerged at the top of the list:
- Vaccine hesitancy
- The use of data and information systems to improve rates
- Reaching underserved populations
While the agenda is still coming together, we are thrilled to feature our colleague Dr. Doug Opel of Seattle Children’s Hospital, who will deliver a talk on the intersection of ethics and vaccine hesitancy. If you’ve ever seen Dr. Opel live or read his work, you know how powerful he is as an educator. Also, Dr. Clarissa Hsu of the Group Health Research Institute will share preliminary results from a study Vax Northwest has commissioned that examines the attitudes and beliefs of families in Washington who are delaying or skipping vaccines. The Washington State Department of Health – Office of Immunization and Child Profile will lead an excellent session on the use of data and information systems to bring up rates. And an as-yet-undetermined session will focus on reaching underserved groups.
WithinReach is thrilled to offer this learning opportunity, and we are committed to making this part of our ongoing suite of services offered to Washington immunization professionals.
Interested? Good news! You can learn more and register today. Please spread the word widely.
Partnering to prevent HPV
Using the extensive immunization network of WithinReach, our cutting-edge work surrounding HPV promotion, and our depth of knowledge in vaccine hesitancy issues, WithinReach staff review all funded proposals with an eye towards:
- Connecting grantees to existing resources that will further their projects
- Eliminating duplication of efforts
- Creating partnerships between organizations with aligned goals
- Encouraging organizations to attend our HPV Task Force or other immunization committees in the state
When WithinReach launched the HPV Task Force in 2015, we learned that many organizations were developing HPV initiatives, but there had been little communication between organizations, largely because there was no venue to do so and because HPV vaccination brings together organizations from seemingly disparate fields: immunization, cancer prevention, sexual health, and adolescent medicine to name a few. Having the HPV Task Force–and now the assurance that these organizations are collaborating–will make Washington a leader in HPV vaccination.
Here’s an example of an early success: Planned Parenthood wanted to pioneer an electronic signature process to easily obtain permission from parents to give their children the HPV vaccine. WithinReach has long known that Public Health – Seattle & King County successfully uses a service called DocuSign for this very purpose. By putting the two organizations in contact, Planned Parenthood was able to mobilize quickly and follow an existing blueprint to make this service available. Another success? All GHF grant-funded organizations are routinely meeting as a group outside of the HPV Task Force because they have found informal conversations about sharing resources and ideas helpful and productive.
And if you need a reminder of why the HPV vaccine is important, here are the pertinent details: All cases of cervical cancer, and a large percentage of other genital and anal cancers/warts and oropharyngeal (mouth and throat) cancers are caused by the HPV. The latest HPV vaccine protects girls from 90% of the strains that cause cervical cancer. Cervical cancer takes the lives of over 4,000 American women annually, and inflicts untold sickness and suffering on many more. The vaccine can virtually eliminate morbidity and mortality from cervical cancer.
WithinReach has been working with community partners for over 25 years to not just address health issues facing our community, but to actually create lasting change. Partnerships like this one with the Group Health Foundation are essential to that goal.
International visitors at WithinReach
- An Immunity Community parent advocate meeting in Bellingham
- An opportunity to learn from our colleagues about vaccine hesitancy research projects at the Group Health Research Institute
- A visit to the Washington State Department of Health
- A major event at PATH highlighting the resonances between the vaccine hesitancy work happening locally and globally
- A tour of the school-based health center at Nathan Hale High School
- A learning opportunity at, and tour of, Seattle Children’s Hospital
We’ve learned so much already. South Africa faces many challenges that parallel what we see in the United States, specifically focused on trust in the health system and the impact of cultural norms on vaccination. I think we all feel a sense of awe about the challenges faced in Afghanistan, where hesitancy often emerges from violent propaganda and edicts of rogue groups like the Taliban, which threaten the lives and livelihoods of immunizers at times. Nonetheless, our conversations have focused on new and creative strategies, like activating social networks, creating projects focused on specific ethnic groups, engaging performance opportunities like songs, etc. in addressing vaccine hesitancy.
Many thanks to all of the people who have come together to make this week a success!
Immunization Program: 2015 Reflections & 2016 Opportunities
- We welcomed Jessica Broz, Immunization Coordinator, to our team. Jessica has been a wonderful addition, supporting all of the work we do with skill and a thoughtful approach.
- The Pink Book Conference, which the Immunization Team hosted in September, was a sold-out event that brought together 450+ colleagues from around the state to learn, network, and strengthen relationships.
- The Immunity Community, our program that engages parents as immunization-positive advocates in the spaces where their children spend time, expanded into a truly statewide program, with active communities in Spokane, Thurston, Snohomish, Kitsap, and Whatcom Counties.
- We developed an HPV educational webinar for healthcare providers. This webinar shares the latest communication science around vaccines and encourages a strong HPV vaccine recommendation and has been taken by over 700 healthcare providers.
- WithinReach began hosting the HPV Task Force, a collective of partners statewide that are convening to collaborate on promoting HPV vaccine uptake and series completion.
And in 2016, we look forward to:
- The continued expansion of the Immunity Community.
- Re-energizing the Vax Northwest work with healthcare providers, hopefully developing a new research project focused on provider-parent communication.
- Learning more about what drives parent decision-making about vaccines in Washington State, and where we might best intervene through focus groups across the state.
- Extending the stellar work of our Spokane Regional Health District partners to provide mobile immunization clinics and other tools to improve immunization record-keeping statewide.
- Restructuring the Immunization Action Coalition of Washington’s committees to better align with needs in the state.
- Connecting with current and new partners to promote HPV vaccine uptake.
To the exceptional Immunization Team at WithinReach, thank you for being so proactive and skilled in producing work of an outstanding caliber. To all of our partners with whom we collaborate on these successes, thank you for your great work independently and with us!
Wishing everyone a healthy and happy New Year!
Protecting newborns from whooping cough: a new protocol at WithinReach
A few weeks ago, WithinReach’s Immunization and Healthy Connections Teams collaborated to roll out a new conversation pathway with callers to the Family Health Hotline, where our friendly and informed staff helps callers understand and apply for a variety of food, health, and child development resources in Washington State. We are proud of the fact that all pregnant callers, or all callers who are in a household with a pregnant person, are now being advised of the recommendation that all pregnant women get a booster of the Tdap vaccine in every pregnancy. The Tdap booster ensures continued immunity from three diseases: tetanus diphtheria, and pertussis. We are particularly concerned about pertussis, commonly known as whooping cough, in Washington for several reasons:
- We are seeing a surge in new cases right now.
- Whooping cough makes babies very, very sick, and some die.
- Most babies who get whooping cough get it from a person in their household, particularly a parent.
- If the booster is given to the mother in the third trimester, some immunity will be conferred to the baby, offering some protection if the baby is exposed to an infected person.
- Babies cannot begin the vaccination series until they are 8 weeks old.
The above-listed reasons, combined with the fact that our Healthy Connections Team interfaces with more than 250,000 families per year, makes this the ideal venue to protect families from this disease. This recommendation is new, so many people may not have heard about it. To learn about the recommendations for pregnant women, read more from the Centers for Disease Control and Prevention.
Lastly, antibodies for pertussis wane over time, so it’s critical that everyone (regardless of if you are in contact with a pregnant woman) consult their doctor about a booster. In particular, adolescents are scheduled to get their booster dose of Tdap in the 11-12 age range. But outside of these groups, please make sure you’re up-to-date with your Tdap vaccine, especially if you did not get a booster as a teen or pre-teen. With waning immunity, risk increases, and the best thing you can do to protect a newborn is to ensure that you’re providing a disease-free cocoon around that child.
Creating a Healthy Washington: The Pink Book Training
I have a strong belief that anyone who works in the field of public health is an everyday hero. These professionals work “behind the scenes” to keep us all safe and healthy every day, but their work largely goes unnoticed if they’re doing their jobs well. Immunization falls into this category; by getting kids immunized on-time, diseases that used to plague our community have nearly vanished.
But the job isn’t easy and it requires tremendous technical expertise. Vaccines need to be stored, timed, and dosed appropriately, and providers need to know of contraindications, among myriad other factors. It’s important that we consistently provide immunization champions and providers with the opportunity to stay abreast of immunization best practices as well as the science of vaccines, which includes the fields of immunology and virology.
This is why WithinReach is thrilled to be hosting The Epidemiology and Prevention of Vaccine-Preventable Diseases Course, colloquially known as The Pink Book Course (because of the pink book that contains all of the information from the course) September 15-17, 2015 at the Hotel Murano in Tacoma, WA. We are proud to offer this opportunity to health care providers in Washington State and beyond. Faculty from the Centers for Disease Control’s National Center for Immunization and Respiratory Diseases will present a live, two-day comprehensive review of immunization principles, as well as vaccine-preventable diseases and the recommended vaccines to prevent them. We’ve planned some great pre-course workshops as well, on topics from vaccine hesitancy to using our state’s immunization registry.
Perhaps most importantly, the course will bring together our colleagues, giving them the chance to learn and network. The course also offers 14 continuing education credits for just $250, making it an exceptional value. To learn more about the course, or to register, please visit the course website. Opportunities for comprehensive, inexpensive, and immunization-specific education are rare; we’re happy that we can organize this opportunity for our peers and we encourage you to spread the word. Reserve early to save your seat!
Giving Kids a Shot@Life in Washington, D.C.
Tags: Bill & Melinda Gates Foundation Capitol Hill immunization advocacy. Measles Pneumonia polio Representative Dave Reichert Representative Derek Kilmer Representative Jim McDermott rotavirus Senator Patty Murray Shot@Life United Nations United Nations Foundation vaccines Vax Northwest Washington D.C.
From Magic Mountain to Measles – Get Vaccinated to Stay Safe!
Our Immunization Team will always advocate strongly for complete, on-time vaccination to protect health. We also recognize that all parents, even those who don’t immunize, do so out of an interest for the health of their children. As such, we’ll continue to foster dialogue about why immunization should be a community priority, especially featuring the voices of parents who choose to immunize, like those enrolled in our Immunity Community program. Many thanks to those parents who are working hard to ensure that children in Washington are protected from disease!
Concerned About Ebola?
(1) The Harris Poll; Pritish Tosh, M.D., infectious diseases physician and researcher, Mayo Clinic, Rochester, Minn.
(2) “Flu Vaccination Coverage, United States, 2013-2014 Influenza Season.” Centers for Disease Control. http://www.cdc.gov/flu/fluvaxview/coverage-1314estimates.htm