Why Immunization Rates Will Fall – We Aren’t Listening

Why is it that illnesses that could be prevented by vaccination are on the rise despite scientific evidence they save lives? Recent articles noted measles exposure to people riding the Bay Area Rapid Transit (BART) public transportation system as well as more cases of whooping cough due to refusal to vaccinate and in some cases getting “non-medical” personal exemptions. The suggestion that vaccines could cause autism has been debunked. So why is this happening? Will more cases of preventable illnesses make the news?

If we look at the research from Frank Luntz, the answer is yes.

Frank Luntz would hardly be the right person to ask. Luntz is known for his work, particularly in politics, for polling and interpreting what the American public wants to hear. Luntz has a knack for advising Republican candidates, corporations, and speaking on Fox News and CBS. Though he is a professor at the University of Pennsylvania, he isn’t in health policy. He isn’t a doctor.

What he is, however, is the best person to gauge the pulse of the American public. This perspective of what is happening in America should have doctors concerned. This is why vaccination rates will continue to fall.

As the Atlantic article, the Agony of Frank Luntz, notes:

• [Luntz] not sure what to do. He’s still going through the motions—giving speeches, going on television, conducting focus groups, and advising companies and politicians on how best to convey their message…
• “I spend more time with voters than anybody else,” Luntz says. “I do more focus groups than anybody else. I do more dial sessions than anybody else. I don’t know shit about anything, with the exception of what the American people think.”
• It was what Luntz heard from the American people that scared him. They were contentious and argumentative. They didn’t listen to each other as they once had. They weren’t interested in hearing other points of view. They were divided one against the other, black vs. white, men vs. women, young vs. old, rich vs. poor. “They want to impose their opinions rather than express them,” is the way he describes what he saw. “And they’re picking up their leads from here in Washington.” Haven’t political disagreements always been contentious, I ask? “Not like this,” he says. “Not like this.”

Would America be better served if we were listening? What might that look like?

• “I don’t like this. I don’t like this,” he says, meaning D.C., the schmoozing, the negativity, the division. At football games, “People are happy, families are barbecuing outside, people are playing pitch and toss. A little too much beer, but you can’t have everything. They’re just happy and they’re celebrating with each other and it’s such a mix of people.” The first week of football season, he went to four [NFL] games in eight days: Sunday night, Monday night, Thursday night, and then Sunday again.

Why does this matter?

Increasingly we are seeing doctors kick patients out of their practice because patients (often parents deciding for their children) don’t agree with getting vaccinated.  I do understand the reasoning. Is it the right thing to do?

If doctors are increasingly adding to the polarization, how are we going to build long-term relationships that engender trust?

• Can’t we respectfully disagree and tell patients that as we continue to care for patients?
• Can’t we continue to gently remind patients at every encounter to get vaccinated even when they said no the first one hundred times?
• Can we stop writing immunization exemptions in record numbers for non-medical reasons?

Surveys demonstrate that doctors are still among the most respected individuals that the public looks to. Sometimes doing simple and difficult things like saying no to exemptions, reminding patients that we care and will continue to remind them about immunizations even if yesterday and today they say no because tomorrow is another opportunity to say yes, builds trust and relationships.

Because organizations and politicians who don’t hear what Frank Luntz has to say often pay a price.

What the public is telling him is that America even more polarizing around many issues. We can assume that vaccinations will be one of these issues. Fewer patients wanting vaccinations will be a reality.

As doctors we not only need to continue to educate in person, via professional societies and social media, but also ensure that we do not contribute to this polarization and continue to learn and listen. If we do not, there is no chance that the rise of preventable illnesses will stop.

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