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Ms Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
Between public skepticism on vaccinations and provisions of the American Health Care Act, some representing physicians are voicing concern.
While years of education from the medical community and policymakers seemed to dampen the anti-vaccination movement that helped lead to a resurgence in vaccine-preventable diseases, President Donald J. Trump may be reawakening concerns in doubters.
General public opinion doesn’t seem to match this movement, according to a recent study from the Pew Research Center that finds most Americans are not on board with anti-vaccination or vaccine-hesitant sentiments.
Still, physician groups are concerned and are already working to advocate for patient safety.
R. Shawn Martin, senior vice president, of advocacy, practice advancement and policy at the American Academy of Family Physicians (AAFP), said there hasn’t been any formal action from the administration or Congress about vaccine safety yet but the physician organization is keeping a close eye on any developments.
“We’re monitoring a number of these freedom of expression or exemption bills churning in the state legislatures right now, so I think the battleground is really in the states for the first four or five months of the year and it then it will move to the federal [level],” Martin told Medical Economics.
Physicians should address, not ignore, inquiries
Martin says the AAFP supports the public questioning vaccines and doesn’t try to bat down myths, but rather to drive education about vaccines.
“I think it’s important our members be equipped to have meaningful conversations with patients,” Martin said. “You never want to say ‘just do this.’” Patients want to feel informed.”
But the AAFP isn’t without concerns about the president’s comments and the rekindling of anti-vaccination fears.
In recent years, Trump has made his concerns known about the safety and timing of vaccines, and he continued to voice his concerns on the campaign trail, giving weight to the cries of the anti-vaccination movement.
A meeting in January with known anti-vaccine enthusiast Robert F. Kennedy Jr. for a supposed post on a proposed vaccine safety committee was later met with denial from Trump on the appointment, but didn’t stop Kennedy from using the momentum to attempt to stir up vaccine fears. Kennedy held a press conference in mid-February in his role as chair of the World Mercury Project, calling for further study and removal of thimerosal from vaccines-despite the fact that the preservative has never been used or is no longer used in U.S. vaccines for at least the last decade.
Since the election, there are reports of anti-vaccination groups reigniting efforts, with a march already planned for later this month in Washington.
AAFP joined with a number of other healthcare organizations in sending a letter to Trump in February declaring support of vaccines.
“We have two concerns. One is just this fostering of anti-science sentiment that’s taking place in the country. It’s not owned by the Trump administration. There’s a whole movement,” Martin said. “The way I frame it is, it’s a dangerous trend when we have large portions of our population and elected leaders casting a skeptical eye on proven science.”
The other concern, he said, is the fear practitioners are facing over the public health outbreaks that could result and what that means to individuals and communities.
“There’s a growing concern that there’s going to be a public health outbreak and that the states and this administration are ill-equipped to handle it,” Martin said. “We’re doing a lot of education and paying very close attention.”
Fear of history repeating itself
Like Martin, Margot Savoy, MD, MPH, FAAFP, medical director of family medicine centers at Christiana Care, a council member for the Delaware Academy of Medicine and AAFP’s liaison to the Advisory Council on Immunization Practices (ACIP), is also concerned about the overall fear being stoked about vaccine safety and misinformation that might be spread.
“I think vaccines are pretty straightforward. The difficulty is that most people haven’t lived through a time when we had most of these vaccine-preventable diseases. We’re not just talking about does it bother you to get a shot or not. In the physician’s mind, they are thinking you could have died by getting this disease,” Savoy said. “For some reason that’s a really difficult thing for people in average society to understand. You’re stoking fear in folks who don’t fully understand the implications. It’s very difficult to undo fear.”
Savoy said she hopes leaders will look to evidence-based research when crafting new policies.
“I’m honestly very disappointed that our administration isn’t seeming to look at the information that is widely available and reinventing things that are already proven to be false,” she said, adding that calls to look into vaccine safety implies that it hasn’t been done already. “It feels unfair to say to put a committee in place. It implies there’s nothing there, when in reality you’re disregarding what’s already there.”
GOP healthcare reform plan causing concern
The association is also keeping a watchful eye-but has not yet outright opposed-the proposed American Health Care Act presented this month.
The bill has fundamental problems related to tax subsidies that disproportionately affect lower income Americans, and it also goes after Medicaid expansion, Martin said. While the bill doesn’t directly touch preventive care, it does eliminate funding for certain wellness-related funding and promotes high-deductible plans that have been shown to create a disconnect between patients and healthcare providers. Emerging evidence shows that patients faced with high deductibles make choices that negatively impact their health-including foregoing vaccines like the pneumococcal vaccine.
“There’s nothing in this bill that makes prevention better,” Martin said.
Savoy, who is on the front lines of patient care and vaccine safety, is also concerned that wellness and preventive medicine cuts will limit patients’ access to services.
“These things that don’t seem directly related to vaccines could have a wide impact,” Savoy told Medical Economics. “One of the challenges of prevention is that you don’t necessarily recover the cost of vaccines up-front.”
Practitioners in her system are already seeing patients afraid of losing care, she said.
“We consider preventive medicine to be necessary, not just nice to have. Whenever people start going after basic insurance coverage, it makes us concerned,” she said. “It’s the folks who can least afford it that have to choose between vaccines or dinner. A lot of people really benefitted from the changes from the [Affordable Care Act]. Now they are concerned about being able to pay for care.”