Vaccination via needle

Vaccination - a researcher's insight

20 October 2016

Vaccination is a health topic that can polarise a community with extreme positions on both sides. Groups that adamantly support general vaccination and those who vehemently oppose any government mandate to make it compulsory.

In this episode of  Open for Discussion our host Dr Chris Neff speaks with Associate Professor Julie Leaskabout the people in the middle of the debate? People who may be wavering in their decision to vaccinate or not to vaccinate?

Julie talks about strategies to engage those who are undecided on vaccination.

Host: Dr Chris Neff

Guest: Associate Professor Julie Leask

Producer: Victoria Hollick

Editor: Caitlin Gibson

Associate Professor Julie Leask
Julie is a leading policy researcher who specialises in vaccine acceptance and has advised the Global Vaccine Action Plan group, which includes the World Health Organisation, UNICEF and the Gates Foundation.


(music plays)

Chris Neff: Vaccination is a health topic that can polarise a community with extreme positions on either side of the debate. Groups that adamantly support general vaccination and those that vehemently oppose any government mandate to make it compulsory. So what about the people in the middle? My guest today is Julie Leask, an Associate Professor and Social Scientist at the University of Sydney, School of Public Health. Julie has advised the World Health Organisation, UNICEF and The Gates Foundation.

Thank you for joining us on Open for Discussion. How are you today?

Julie Leask: I'm well thanks Chris. It's lovely to be here.

Chris Neff: Thank you.'ve sort of found yourself in a very interesting place within the vaccination debate because your research looks at adoption of vaccination as it's goal which is quite a controversial issue. How have you found that?

Julie Leask: Yeah it's a's an issue that raises a lot of emotion and you do sort of end up being .occasionally you know..bycatch in that discussion.


Chris Neff: Ooooooo..A bycatch reference.

Julie Leask: Ahh know I think actually that you've got an issue where people are fearful of  something and you have a lot of emotion and they react out of their fear and sometimes policies are made out of fear and speaking to outrage at either end of the spectrum. That's a really challenging space to be in particularly if you are a bit of a born diplomat, which I try to I think when you're in a public space and it's a fraught public space you have to have some strategies that work for you. Using blogs to communicate the complexities around ideas is really useful because twitter know..there's such short messages..there's so much room for misunderstanding.

Chris Neff: I think that's right and I've seen that in my research. I think there are only so many times you can know..I followed the data. Which is what I say in my research you know…I'm just following the data. It's not....

Julie Leask: But does that work? I mean do people care about the data in these fraught public discussions?

Chris Neff: I think when it comes to emotional..I think they..people want to know whether or not you're there to screw 'em. You know what I mean? what exactly do you want? And so...

Julie Leask: Can I trust you..

Chris Neff: Can I trust you? And that's why I always say you know..within any of my discussions, if the data moves, I'll move..

Julie Leask: mmm

Chris Neff: And so it makes it really..and I can't give you advice that I know will hurt you.

Julie Leask: Yeah.

Chris Neff: Like…

Julie Leask: And as you say it's not just what you say but it's how you say it and that I think is where our research is focused. It's understanding the way people think, the psychology around in this case vaccination uptake or any area where there's controversy. So it's understanding your audiences, and then thinking about how you communicate with those different audiences in a way that's respectful and true to the evidence. I love the fact that you have that commitment to being open to the data because if anything the anti-vaccine people have taught me, is that you should not fall in love with your hypothesis. If new evidence comes to light we need to try to remain open to that and that can sometimes not be easy when you research something for a long time, you start to develop ways of thinking about it that become fairly solidified.

Chris Neff: Yeah you got..

Julie Leask: I actually...I have to emphasise something here - I am a supporter of vaccination. Like any medicine .they know..side effects. Minor common side effects and rare serious side effects but overwhelmingly vaccinations have done amazing things for public health but I also believe that the way we encourage vaccination needs to be done in a reasonable, ethically sustainable and evidence based way that keeps sustainable trust for vaccination there in the agenda.

Chris Neff: So can I ask that the biggest framing that I've heard…the most powerful framing that I've heard is that there's some vaccinations that can cause autism. Is there any evidence to support that or is that just a myth?

Julie Leask: It depends how you cherrypick the evidence. I think the shorter answer is the evidence is overwhelming that vaccines do not cause autism but sometimes people will cherrypick this part of a study or this line in a table in a paper and say look here's the evidence and you know..we call that confirmation bias. Then study after study came out after Wakefield started to share his theory and really champion that the MMR caused autism and study after study...

Chris Neff: but that..that was repudiated.

Julie Leask: was saying again and again, we can't find any link here. We take this seriously, we've looked into it, we can't find a link. It didn't matter what the evidence was saying because it had caught fire in the public imagination and the UK media were onto it and so we saw this sort of..escalation of this scare story that had no strong evidence for it, the systematic reviews kept saying look..we can't find any link and yet the tragedy is that many parents unnecessarily worried about vaccines or unnecessarily beat themselves up if their kids had autism because they thought the vaccine had caused it.

Chris Neff: Like you were just noting that research is the foundation for the autism myth. What happened with Wakefield?

Julie Leask: So..he published this paper, along with a bunch of other colleagues in The Lancet in 1998. The paper itself didn't provide any evidence that the MMR vaccine caused autism, he just raised it as a hypothesis in the discussion of the paper. But what he did was a press conference after that he said know I think there's a real issue here and he recommended that instead of giving the combined vaccine, parents get the vaccine separately so give M measles vaccine, then M mumps vaccine and then a rubella vaccine instead of all combined into the one needle. And there was no evidence behind this major public health recommendation and in fact the original study was of only a small number of children, it was a case series study. It was kinda the bottom of the pyramid in terms of quality of evidence but that sort of took off. But then after many years it was found that he had conducted his research unethically, he was deregistered as a doctor and he lost his medical licence and then eventually the paper itself was retracted by The Lancet so huge sort of fall from grace for Wakefield.

Chris Neff: And this is the research that most people think of or at least this is what most people cite as the solid evidence.

Julie Leask: sort got embedded in folk knowledge and it's still there. If you survey parents, about 15 percent of them still wonder if there's a link but most of our Australian parents are fortunately not acting on that belief and avoiding the MMR vaccine.

Chris Neff: There… I was looking at the opinion of all of the presidential candidates in the United States about vaccination and three of the four of them…so Donald Trp cited autism and said that's why people shouldn't get vaccinated, and the only one of the major parties to say vaccination is good and helpful and part of the public health strategy was Hillary it seems like it's quite a powerful force.

Julie Leask: seems to be in the US with these politicians and that pattern is really concerning because if you want to wreck a vaccine program, the best thing you can do is lose political commitment to it cause we need our politicians, our leaders to be funding them, resourcing them, supporting them but in Australia fortunately we have very strong support for vaccination from both sides of government. Fortunately there is not any kind of ideological or political gradient upon which vaccines are accepted in Australia.

Chris Neff: So does the financial…cause that's a really good point. In Australia, has the financial incentive of the no jab no pay, ahh…example increased vaccination among families?

Julie Leask: So this one's a really interesting one. You might have heard in the media that no jab, no pay appears to be working. We have seen a tiny uptick in vaccination rates. There are..they are.. they're a bit jumpy anyway, vaccination rates. They do go up and down but I think it's important to caution people against saying that simply taking away welfare payments will cause your vaccination rates to increase and removing that conscientious objection exemption will be the answer to all our problems because it's not, and it only targets one part of the problem. Because… they're applying the penalty more frequently, they've extended it up to age 19, it used to be just a penalty that applied at ages one, two and five and now it's every year until the child turns 19 and so it's causing a lot of parents who are just not up to date to get caught up anyway. You know…these are the families who are...suffering a lack of access to health care, who may not be aware that they're missing a vaccine, that might have been born overseas and they're here and they need to catch up with our schedule. So all of those things together, are working on different areas of our vaccination programme. And to that extent I think the marginal gains with that ramping up and the highly punitive nature had a lot of downsides to it. You know..I remember when it was announced thinking...kind of like Beyonce you know…if you like it then you should've put the figures on it.


Chris Neff: mmm mm

Julie Leask: We wanted to know how many parents this would affect if you took away these exemptions. How many…what proportion of the wealthier families would not be affected where there is more vaccine refusal because these are means..means tested payments so…

Chris Neff: I thought I was gonna have the Beyonce reference today and…

(music plays)

Julie Leask:…we just need Taylor Swift now…

Chris Neff: Exactly…I'm going to bring in something…I'm going to figure something out…

You're listening to Open for Discussion, a University of Sydney podcast that looks at research through a personal and critical lens. I'm your host, Chris Neff.

So can you tell us...about some of the vaccination success stories because there's a lot of politics and there's a lot of myths as we've said…

Julie Leask: Well…ahh…great question because I get really excited about this. The vaccines eradicated smallpox. In 1980 It was declared eradicated. This was a terrible, terrifying disease that killed 30 percent of people who were infected. Polio is next on the agenda. We are...I mean it's hoped that polio will be eradicated from the whole planet within the next few years. And polio you know…for some of the older listeners will remember the iron lungs and the terrifying epidemics, the kids in callipers and you know…just terrifying, awful disease that vaccines made such an impact on. But more recently things like Haemophilus Influenzae B, which is a bit of a big word but it's now a vaccine preventable disease and this was kind of meningitis which...could make kids really sick, it terrified paediatricians and so the vaccine was introduced in ‘93 and the rates for that plummeted. And now, paediatricians just don't see it much anymore at all. Occasionally you hear about it among kids who…who aren't vaccinated...and that's really tragic. That's one of the tragedies when people either can't get to or won't have vaccines.

Chris Neff: And what's the vaccination rate? Is it…is it different for every disease? Like within any..I know they talk about it in schools, like in a classroom if it's not 90 percent or 93 percent then people can catch things. How does that work?

Julie Leask: Well..ahh this is the concept of herd immunity. Which..we..we're kind of trying to get rid of because it's such an impersonal concept.

Chris Neff: Sorry..sorry Julie.

Julie Leask: (laughs) No I said it. You didn't…

Chris Neff: Yeah.

Julie Leask: So..It's a genuine concept. It's important. If vaccination rates are high enough..that disease can't get a foothold because even if one person's infected most people around them are immune so it can't sort of jump from one person to the other...and that is a conceptually a really important thing. We do need high vaccination rates and you see these kind of what we call herd affects. You see kids being vaccinated against ahh..rotavirus, a diarrhoeal disease for example that you see less diarrhoea…presentations in emergency departments among adults for example so you…you do see these sort of…knock on other age groups who haven't received the vaccine because there's just less disease circulating.

Chris Neff: And isn't one of the issues that…you know…parents who've got kids who've got compromising immune systems from something else, whether it's leukaemia or maybe you've got childhood cancer know and they want the kid to go to school but then they walk into the classroom, and if the classroom isn't highly immunised then it can put that student with leukaemia at a really high risk of getting something else.

Julie Leask: Right. So there's a real sense of , you know it's a…it's a…a social good well as an individual good and I think that's one of the reasons why attracts so much anger when people don't vaccinate because there's a sense of people breaking that social contract and putting others at risk. It's kind of the same...response you get when people are speeding .. or you know drinking driving and so forth. And it's an interesting thing about communicable diseases. You know the decisions that we make about communicable disease prevention, whether it be vaccination, hand washing and so forth, affect not just ourselves but others.

Chris Neff: This...this may be a...I don't have children moment..

Julie Leask: (laughs)

Chris Neff:...of the broadcast but I do think that if you were to go out to a dinner party and say to anybody what are the five successes from vaccination, folks wouldn't know. But if you..but if you asked know…do you think…you know there are any problems with it, you might hear…you might hear some answers and so I just think it's interesting seems like there's a welfare and/or socio-economic, potentially racial component to the way in which people would have access to resources or…you know if you're rural, it's gonna be harder to get vaccinated. Is that fair?

Julie Leask: Yeah, that is a real genuine concern that came up about such ..a ramped up, almost punitive know you imagine the single Mum, country town, recent separation, three kids, doctor who doesn't bulk bill. You know..she's gonna have some problems with getting her kids vaccinated on time. Even if she wants to. And that is happening…in public health we think about the greater good for the greater number and so…I think it's just so important for us to know are all of those risks and the downsides, worth the benefits in terms of the improved uptake? And that's why we keep asking, is the government going to evaluate this policy? It's really important they do so that other countries that may be looking to Australia for similar policies can know whether it really is effective and what part of it is working so they can cherrypick those bits.

Chris Neff: And has the government committed to doing an evaluation of the policies?

Julie Leask: I understand from just last week..that there is an evaluation.

Chris Neff: break..breaking news..

Julie Leask: (laughs) ahh..there is no detail yet on who...who is evaluating it know what the parameters of that evaluation are and it's clear that regulation helps raise vaccination rates. So having some rules but having firm but fair rules is important so at the margins where you know you''ve brought in all these incentives, you've brought in incentives for health professionals, you've got education, you've got ...access readily available, you're supporting health professionals, doing all the upstream stuff and there's still a group who aren't vaccinating, in those situations, it's like tobacco control, you need to find out what the needs are of those communities and those groups and provide really targeted programs. So my research is focused on the families who struggle to accept vaccination because we kind of have a lot of the answers for the families who are struggling to access vaccination. We know what they need. There's a huge gap in the understanding of how we can work with parents who struggle to accept vaccination. I'm not talking here so much about the really entrenched non-vaccinators who you know…won't have any vaccines and never will. I'm talking about parents who may be willing to reconsider their decision or are just hesitant. And with some good guidance and support, will vaccinate despite their concerns.

Chris Neff: So tell me a bit more about your research on the anti-vaccination movement.

Julie Leask: Well it was really interesting when I started looking at this movement because I had a bit of experience with it as a child. So it felt very natural for me to be trying to understand this phenomenon more. So… goes back to my grandmother who in 1941 turned to natural health which was a way of thinking about health, it was against medical intervention and very much about focusing on a good diet, ...fresh air, ...good water, avoiding chemicals and treating diseases naturally and she was also against fluoride of the drinking water and vaccination. So she raised her four children, including my mother, to not vaccinate. So when my mother had, you know by this stage three boys, I wasn't born yet...she hadn't vaccinated any of them and my brother had hit his head. She'd taken him to the doctor and the doctor said he needs to have a tetanus vaccine...and Mum said well he's not vaccinated and he was…the good doctor was aghast.  And Mum went away that night, discussed it with Dad and decided that she would get them all caught up with their vaccines. This was in the...I think the there weren't that many vaccines and she did. And then she owned up to her mother, my grandmother and my grandmother said to her, this is the worst day of my life. Such was the sentiment against vaccination.

Chris Neff: Wow.

Julie Leask: So this was like something that was like I was really familiar with when I started to study it and it was why it's easier for me to try to understand this phenomenon although I still remain very supportive of vaccination.

Chris Neff: Well I'll make a confession as well then. My grandmother was a Christian scientist and not a scientologist…which not that there is anything wrong with that but just a…a Christian scientist. So…so didn't believe in going to doctors or hospitals and if there was something wrong with you, you would just open the bible and you'd read from the bible and pray and you know…I remember…I think my father got bitten by a dog and never went to the hospital. Never got the tetanus shot.

Julie Leask: You know I've got a similar story. My grandfather's father, was also committed to Christian science and he got stomach cancer. My grandfather remembered him pacing the backyard in agony, having had no treatment, no pain relief and dying early. And that affected him greatly...but you know you say ‘I'm a vaccinating person’. I mean that reminds me of one of the big gaps in our vaccination rates in Australia which is that while we are very focused on children, our adult vaccination rates are pretty bad. So often people think about vaccinations just being for the kids and actually vaccination is for us as adults as well.

Chris Neff: And especially when you get older like…for the elderly.

Julie Leask: Well not even when you get older. Like in adolescents…they should have the HPV vaccine..

Chris Neff: mmm hmmm

Julie Leask: ..that will prevent a range of genital cancers and some oral cancers. Through to the older adults who need the flu vaccine, the pneumococcal vaccine and now the shingles vaccine.

Chris Neff: I've had shingles.

Julie Leask: Have you?


Chris Neff: I have. It's very unpleasant.

Julie Leask: You've had 2 vaccine preventable diseases.

Chris Neff: Yes I have.

Julie Leask: Wow.

Chris Neff: I'm a perfect host really for this discussion today on ah...vaccination.

Julie Leask: I'm glad you're still here.

Chris Neff: I'm glad I'm still here too.

(music plays)

Thank you so much, Associate Professor, Julie Leask. Thank you so much.

Julie Leask: Pleasure.

Chris Neff: You can subscribe to this podcast on ITunes or Soundcloud. You can find me on Twitter @christopherneff.

Additional resources

Keen to know more about Associate Professor Leask's work

Julie has advised numerous international governments and agencies on immunisation uptake, communication and social research priorities. This includes the Global Vaccine Action Plan, WHO Europe, the European Centers for Disease Control and Prevention, the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, and the New Zealand government. She has also advised governments and professional organisations in Australia.

Related articles