My arm is killing me. I got my flu shot yesterday, fine, great. I am adding to the collective resistance to the flu for 2013 and 2014, go me! However at the moment, my arm hurts and I’m a little bit annoyed with my past self for allowing me to be stuck with a needle.
By contrast, one of my colleagues mentioned that her son doesn’t believe in vaccination and is going to India without getting any of the so-called “required” shots. Although I find it a little bit challenging to get behind that perspective, his perception is a useful one to consider.
The perception of interventions differs widely among different groups. For example, many younger people believe that insurance is unnecessary. Women and men have differing attitudes about what constitutes sufficient health care services. Different economic, social, and ethnic groups also demonstrate a diverse range of values and preferences — not just about health services, of course, but about trends, fashion, technology, social practices, religious beliefs, and so on.
These differences have substantial public health impact. Especially in a place like Baltimore, home of Henrietta Lacks, there is still a strong memory of the crimes of the Tuskegee syphilis study that only adds to a long history of discrimination, segregation, and well-earned mistrust of institutions. Currently, this plays out in disparities in rates of HPV vaccination among young women, influenza vaccination, and of course overall disease burden.
In my opinion, the duty to educate and promote healthy interventions falls on the institutions that have generated so much mistrust in the past — government, large hospitals, pharmaceutical companies, and the like. The successful experiences of the private sector — particularly in marketing and advertising — in spreading innovation among groups that are new to the United States might be one source of inspiration. Spreading immunization adoption among a population could follow the same model as spreading smartphone adoption — both benefit the maker of the technology (money in their pocket), the recipient (resistance to disease, greater productivity), and the group as a whole (herd immunity, better educational and economic prospects).
Regardless of the rationale behind a mother’s resistance to a vaccination program, the motivation remains consistent — protecting her child from harm. This is true here and around the world. The World Health Organization has found that vaccine adoption has less to do with medical understanding of the vaccine itself than with social norms and trust of the vaccine provider. This lesson must be taken to heart when attempting to address the 2.5 million vaccine-preventable deaths in Asia and Africa every year, and also when attempting to improve influenza and HPV vaccination numbers in Baltimore. A recent uptick in polio cases in Somalia is cause for concern, but so is the fact that the first few cases of influenza have been reported in Maryland. We can all do something about the second of these, at least, by taking steps to protect ourselves as well as encouraging our friends and families to do the same.
