We are now some years into the decade of vaccines.

And by 2020, it is hoped that everyone will have access

to immunization from vaccine-preventable diseases.

And if you look at the record of childhood immunization

and the EPI, the Expanded Program of Immunization,

it's pretty good.

The figures show that over 80 percent of children

are getting their routine immunizations

against six vaccine preventable diseases.

Heidi Larson and Pauline Paterson,

you have produced a very interesting report

on the state of vaccine confidence

which highlights certain worrying trends

about public confidence in vaccines.

Heidi Larson, what are these trends?

Well, just to start with, the aspiration for 2020

is very much, as you say,

for the six basic routine vaccines.

But in most countries, those basic six

have expanded to what has become

a much bigger portfolio of vaccines,

including more complex or combined versions

of those six. The world has changed quite a bit

since those initial aspirations,

and one of the things that we've found

in our State of Vaccine Confidence report

is those metrics, while encouraging,

are very generalized at global and national levels.

And really, the issue of hesitancy and questioning

is, we see, in pockets.

Geographic pockets, population pockets.

And what's also changed in the world

since vaccines were first launched, I mean,

in the early '80s, when the whole expanded program

of immunization, EPI program, was launched

we have a radically changed world in terms of democracies,

in terms of communication,

in terms of people having embraced

what has been a very proactive human rights efforts.

So people feel, have really, I don't think we were thinking

about what it means when people embrace

those rights to know, rights to individual choice,

freedom of speech, all of that.

And combine that with the, accept

the incredibly ubiquitous tweets

and Whatsapps and Facebooks, and

that can go way beyond what have been

historically geographic social networks

to become global ones.

So we have a very different world to work in right now,

and I think that a lot of the issues around confidence,

to be honest, are not so much about some of

the basic six, although we do have some issues

with polio, but that's only because we're going to the,

polio's the only vaccine in the world

where we really are going for every last child repeatedly.

No other vaccine, they would have the same problems

if they were trying to reach 100 percent.

And so the challenges we're dealing with,

the most, most, most difficult situations in the world,

because we're trying to reach every last one,

whereas other vaccines are trying

to reach different amounts.

Measles is also complicated. I mean, it's

on the one hand, technically straightforward,

but as we've seen in the Disneyland outbreak,

and in Europe, over 30,000 cases,

that even that one is not,

I mean, in a way, we've become overconfident

in our success, and people are getting more relaxed.

Not unlike the situation with HIV,

where, you know, human people need

a bit of a crisis sometimes to get more proactive.

But at any rate, we have different types of issues

for different vaccines. You know,

with measles, we really need 90 to 95 percent

to really have the impact,

whereas other ones, we need less coverage.

And some of the places where we're seeing particular issues,

if I had to pick the top three in the past few years,

polio for sure, but again, that's partly because

it's the very last and most difficult ones.

HPV vaccine. A fantastic vaccine.

One of the highest efficacies treating, I mean preventing

serious cancers, and more than just cervical cancer.

It seems like we're just finding more and more

with oral and throat and anal,

and we're having challenges with this incredible vaccine.

It's targeting a different age group,

but that has a lot of issues.

And then the one that really concerns me

probably the most, is the flu vaccine.

We, as a global public, were really behaved badly,

as it were, in cooperating with what had the potential

to become a very fatal and widespread pandemic virus.

And we are going to get another one.

We don't know when, but if the public behaves

like it did in 2009, we're in serious trouble.

And that's a vaccine that also is not necessarily just,

well, it's, they are available for children now,

particularly the nasal vaccine.

But really, that's also partly adults that are

think that they're overconfident in their own health,

and don't realize the high risks of.

So that's a bit of a broad brush.

Okay. So I'm going to pick up on little bits of it.

I'm going to come back to you.

But before that, I'd like to move to Malik Peiris,

who is, I think, as concerned with

the problems of H1N1 vaccines and low vaccine uptake

as you are, and who has had a great deal of experience

sitting here in Hong Kong on these issues.

Malik, can I bring you in here,

and ask what your thoughts are on H1N1 vaccine,

which Heidi has described as one of the three big

sort of issues facing vaccine confidence

and the future of vaccines.

Yes. So in regard to flu vaccines, the public,

certainly in Hong Kong, seems to go

from absolutely total lack of interest at one extreme,

and then, if there is a bad flu season,

like happened earlier this year,

there is total panic,

and with people wanting the exact match vaccine

at that time.

Whereas we know that a disease like influenza

is a constant.

It's with us every year.

It kills about one in a thousand elderly people here

just in Hong Kong alone.

So how we communicate this

so that people understand the benefits,

which is quite often not seen,

because much of the morbidity and mortality

that is caused by a flu is perceived as due to pneumonia,

bacterial infections, and other things.

So it gets masked by many other things.

So I think the challenge, really,

is to convince the general public,

and also, frankly, to convince some

of the healthcare workers as well,

who also don't seem to appreciate the disease burden

of influenza, and the fact that it's preventable.

Interesting point that you've made.

The fact that you need to convince healthcare workers

as well, which seems to mean that, or imply,

that a lack of knowledge is not what is at issue here.

Because even in the case of measles,

I think you would have found that there are many

educated, middle-class parents who seem

to be suspicious of the measles vaccine.

So knowledge is, I mean, we would have assumed that

you know, the problem people don't uptake is low

is because of a lack of knowledge.

But here we seem to have evidence showing that

it is not the lack of knowledge.

And so, I'd like to turn to both of you

to see what do you think is driving this?

So with the influenza vaccine,

the Joint Committee of Vaccines and Immunization

recommended vaccinating children in the UK in 2012,

as children are the carriers of the influenza virus,

in order to reduce transmission.

And so some parents have been not accepting

the vaccine for their children,

and at the Vaccine Confidence Project,

we've been interviewing these parents.

And the reasons for not vaccinating are

a lack of perceived need of the vaccine,

if their child is healthy and has never had flu,

or concerns about side effects from the vaccine,

or concerns about lack of effectiveness.

Especially with flu, if the strains

aren't predicted correctly,

then the vaccine may be less effective.

To be honest, I mean,

each of these, these are fairly factual concerns, right?

But despite this, people should take the flu vaccine.

So, and you had also mentioned the idea

of communication, the gap of, you know,

a gap in communication.

So what do you think is the best way

to start talking to people about this,

about things like, even if the vaccine is not perfect,

even if it's not perfectly, you know, 100 percent safe,

which no vaccine is, it's still worth doing this.

How do you sort of begin this process?

Or is this the way forward?

Well, I think one thing is that we,

it became very clear to me,

and I think to a number of us,

just trying to change my volume here.

One of the things that became very clear to us

around H1N1, and in general with flu,

people really have no idea how flu vaccine

is made or works.

I mean, when people say, oh,

I had that last year.

It didn't work for me.

I mean, I don't think there's,

we need better general understanding.

I don't mean to contradict myself

that it's not just about knowledge,

but I think some of the perceptions and beliefs

are in fact related to just some fantastic

or fantasy-like ideas about what these vaccines do.

If you look at some of the things on YouTube,

and some of the cartoons, it's,

they actually, to be honest,

don't look much different from the 1800s.

It's where you had graphic images of vaccine monsters.

And really, the fact that it's actually triggering

your natural immune system,

and not pumping in a lot of chemicals.

The fact that the flu vaccine

is a highly sophisticated process

of sampling current strains around the world every year,

and making it very current.

The H1N1, one of the big anxieties

was that it was made too quickly,

and that, you know, every year, vaccines are made

remarkably quickly, considering

it's a one-year cycle and turnaround.

And I think some general information about that

would be good.

I would love to start a campaign,

which I think would alleviate a third

of the concerns in the world,

that vaccines, you know, are natural.

You know, the natural way, or something.

Because there's this, I don't want to say obsession,

because I believe in a lot of the natural approaches.

But not at the exclusion, or instead of,

proven medical interventions.

So I think some general knowledge.

I also think we have a real, I'm just talking right now

about things that we in the public health community can do,

because there are some things

that need engagement outside of immunization.

I worked for a long time in AIDS,

and one of the advantages,

although it wasn't an advantage for the patients,

but one of the triggers for so much reaching

outside of the public health community

is when there was no treatment.

There was no, even no diagnostic in the beginning,

that it meant that everybody from all kinds

of different sectors got engaged.

I think we're really missing that broader engagement

in immunization. It's highly regulated,

highly government-owned, highly,

which is all important. But I think from a,

polio's gone a bit farther, partly because

it's easier to administrate.

But because of the nature of the movement.

But I think if we get more engagement

from different types of groups,

it could help, and also a better understanding

of how these vaccines work,

in a very lay language.

Because I think there is information out there,

but it's lost in translation, as they say.

Panel discussion: The State of Vaccine Confidence

Epidemics

Conheça os instrutores