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    The

  • The

    PARENT

  • PARENT

    TRAP PART 2

  • TRAP PART 2

    The dangerous

  • The dangerous

    epidemic of

  • epidemic of

    immunisation

  • immunisation

    refusal

  • refusal

     

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THE VACCINE REFUSAL CAPITAL

Welcome to Takaka, white sand and vaccine refusal capital of New Zealand.

Spot a six-year-old in the hippy holiday spot and there’s almost a 50/50 chance they won’t have had their recommended disease jabs.

New data shows that, in 2018, 44 per cent of Takaka five-year-olds were not fully immunised. Not because they couldn’t make it to the doctor, but because their parents made a conscious choice to decline the vaccinations.

With a national average of about six per cent of parents rejecting scheduled jabs, that makes the Golden Bay town of 1300 New Zealand’s hottest vaccine refusal hotspot. In the middle of a national measles outbreak, it also puts enormous pressure on health workers, knowing they must immediately contain any suspected cases or risk the disease’s rapid spread.

We are on a knife edge on a daily basis,

Nelson Marlborough District Health Board associate director of nursing
Jill Clendon

Hoping that nothing comes into our community and, if it does, that we are able to get on top of it very, very quickly.

The vaccine decline data - obtained by Stuff under the Official Information Act - shows parents are most likely to refuse vaccines in communities around Tasman, Coromandel, Bay of Plenty, Northland and some parts of Waikato.

The numbers reinforce the idea that anti-vaccination hotspots are often concentrated in alternative lifestyle communities who try to live “natural” lives. While suburbs with high vaccine refusal rates tend to have higher than average proportions of Europeans, hotspots are far from universally white.

REFUSALS IN EVERY GROUP

Overall, the characteristics of vaccine refusal hotspots vary nationwide. High concentrations of vaccine refusers in Northland and higher rates among lower income communities suggest the profile of those rejecting vaccination is not clear-cut.

Declining is due to a mixture of reasons. It is not straightforward or linear but a complex mixture of issues.

Immunisation Advisory Centre director,
Nikki Turner says the data picture fits her expectations.

So it’s no surprise that you see decliners scattered around localities and income groups.

Clendon classifies vaccine refusers into “decliners” and “delayers”. The decliners are often alternative lifestylers who flock to Golden Bay and Motueka and are ideologically opposed to immunisation. While the health board wants every child to be immunised, they have limited resources and investing time in those populations is a lot of work for little gain, she says. Staunch refusers rarely change their mind, unless someone close to them suffers a vaccine-preventable disease. They can also be aggressive to staff.

However, health workers do make progress with “delayers”, Clendon says. Those are more likely to be Māori or Pacific children who have trouble accessing family doctors, who choose to delay a jab because a child was unwell on the day, or who are fence-sitters whose concerns can be talked through one-on-one.

THE VIRUS OF SOCIAL MEDIA MISINFORMATION

Experts also point to the growing role of online sharing in spreading immunisation misinformation.

Back in Takaka, the vaccination battle is fought in social-media-sized salvos. Immunisation-related posts on the Golden Bay Community Facebook page trigger hundreds of comments.

A mother who believes her son has been injured by vaccination writes anti-vaxx updates on her Facebook page on an almost daily basis. Others post pictures of healthy unvaccinated children, as evidence jabs are redundant. An unvaccinated child just won their school cross-country, a vaccine-refusing parent shares. Vaccination supporters counter with childhood experiences of polio outbreaks, or the fact their husband has suffered a lifetime of deafness in one ear from catching measles as a child.

Insults fly. No-one changes anyone’s mind.

In the 25 years Clendon has worked in the field, she says the biggest change has been the burgeoning social media misinformation network.

It is difficult. People often don’t know which way to go and what is the truth and what’s not the truth.

Auckland University immunisation researcher Helen Petousis-Harris says the pockets of high vaccine refusal in Northland could be evidence of the insidious way social media multiplies myths faster and further than the traditional pamphlet or letter to the editor.

The anecdotal evidence is that they have quite a problem with misinformation up there.

Read the story of the Northland town where the parents of one in seven kids declined one or more jabs

Read more

The measles crisis in Samoa - which has killed 57 children under the age of 15, including 26 babies less than one year old - shows the power of fear and viral misinformation. World Health Organisation immunisation director Kate O’Brien blamed Samoa’s dramatic immunisation fall, from 84 per cent of pre-schoolers in 2015 to 31 per cent in 2018, on fear resulting from the death of two babies due to incorrect vaccine preparation and an anti-vaxx social media campaign.

INNOCULATION FOR MISINFORMATION

Petousis-Harris says health workers in areas with low vaccination rates could also be recording children as having declined vaccines, rather than acknowledging they had not been able to reach those families. However, she says the data lacks sufficient detail to draw clear conclusions.

Turner believes the apparently higher refusal rate among lower-income communities points to poverty, dispossession and lack of trust. While higher income hotspots often have entrenched anti-vaccination views for lifestyle reasons, those in poorer areas might be worried about vaccines, but if they were not enrolled with a family doctor, or constantly moving around, GPs or practice nurses never got a chance to answer those concerns.

To reduce vaccine refusal rates, Petousis-Harris says health groups need to work with vaccine rejectors, both online and in person, to debunk misinformation and respectfully listen to - and answer - their concerns.

Health authorities also need to step up information campaigns to show the real impact of vaccine-preventable diseases and pre-arm parents against common myths.

You also need to inoculate them against this misinformation. Get in first and give people good information. It’s important they understand so they can recognise misinformation when they see it. That requires you to be proactive. We are always being reactive. That’s not the best position to be in.

Turner says health authorities need to give more support to outreach services in the poorest areas.

We need tailored approaches to the local communities that have high rates of decline - go and talk to them, get feedback, help generate local solutions.
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Reporter

Nikki Macdonald

Data Editor

Andy Fyers

Design&
Development

Sungmi Kim

PROJECT EDITOR

John Hartevelt