Immunization

Citation

(2013), "Immunization", Health Education, Vol. 113 No. 3. https://doi.org/10.1108/he.2013.142113caa.001

Immunization

Article Type: Internet review From: Health Education, Volume 113, Issue 3.

What is the greatest advance in medical history; is it anesthetics, germ theory, antiseptics, heart surgery? Arguably, in terms of the amount of disease prevention, and the associated suffering for victims and their relatives, simple immunization, must be somewhere at the top. Obviously the concept of immunization is very simple and people were aware of it long before the idea of inoculation became common. Indeed as long ago as 429 BC, the Greek historian Thucydides observed that those who survived the smallpox plague in Athens did not become re-infected with the disease. By 900 AD the Chinese had developed a system that comes very close to inoculation. They would take the scabs from smallpox victims, dry and powder the scab, and then inhale the powder through the nostrils. This technique was known as variolation. In the eighteenth century, in Europe, smallpox was the most infectious of the deadly diseases. Of those people who contracted the disease, 20 percent would die. Variolation itself sometimes killed people but most would suffer only a mild illness and would subsequently remain immune to the disease. Edward Jenner pioneered what we now call vaccination and although he was able to demonstrate its efficacy there still remained violent opposition in some quarters. People felt that it contravened civil liberties and was possibly blasphemous. After all not everyone who contracted smallpox died and those who did must have been chosen by God for some reason. This is reminiscent of the Taliban's opposition to vaccination in parts of Pakistan even now.

In the 1920s vaccination became more widely available with diphtheria, whooping cough, tuberculosis, and tetanus all being targeted. By the 1950s polio vaccination began and more recently vaccination against cervical cancer has become possible. Despite these successes many people are reluctant to take up vaccination particularly where they believe a risk, no matter how small, might be involved. The recent problems with the MMR vaccination are a good example of this.

In this review we look at web sites aimed at promoting the benefits of vaccination and consider the role that the internet can play in this.

NHS Vaccinations Guide

www.nhs.uk/Planners/vaccinations/Pages/Aboutvaccinationhub.aspx

The UK's National Health Service web sites have come on leaps and bounds since the early days and this is another example of a well designed, user friendly web site that fully exploits the technology. For most lay people what they want to know about vaccinations is what is required and when, are there any risks or side effects and perhaps a little general information on what vaccinations do and how they are developed. All this information is provided by this web site. Starting with the vaccination schedule, a very comprehensive list is provided starting at two months and going up to 65 years and older. In total, 15 vaccinations are listed and for each one a link is provided to more information. This information includes details of the vaccination, who should have it and equally important who should not (usually for allergic reasons). The section on benefits and risks provides a really good explanation as to why the benefits nearly always outweigh the risks. Vaccinations do carry risks, this is admitted, but these risks are lower than the chances of contracting the disease and the serious consequences of this are thoroughly discussed. For some people any risk is too much and so careful balance between risks and benefits has to be explained and this web site does this well.

Resources available from this site include an interactive vaccination wall planner and after keying in the name, sex, and date of birth of the person concerned, a wall planner specific to that person is produced that can then be downloaded and printed. The video resources provided are excellent and one particularly harrowing clip tells the story of a young girl who contracted measles because she was not vaccinated and the terrible consequences are described by the child's mother. This is almost too painful to watch but if it makes even one person have their child vaccinated then it is worthwhile. This is a very good web site that provides all the information on vaccination a user might want.

Center for Disease Control and Prevention

www.cdc.gov/vaccines/

The Center for Disease Control and Prevention is a USA government organization responsible for “promoting quality of life through the prevention and control of diseases.” Initial impressions of this web site are that it is probably trying to do too much for too many. The home page is cluttered and untidy with different types of design in different areas of the page. Nevertheless, given the myriad of content available, when users delve into the web site they will almost certainly find what they are looking for.

As with the NHS site one of the first things users will find are schedules of vaccinations. However, unlike the UK site that tailors the schedule to suit the user, this site provides different schedules for different age groups. The charts provided are free and can be downloaded by users for printing. However, it should be pointed out that their content is quite detailed and complex and it looks like they would be more suitable for health professionals rather than lay people.

An excellent feature of this web site is the section labelled “specific groups” that provides information for providers (i.e. health professionals), parents, travellers, and program managers. Of most interest to lay people will be the parents and travellers sections. Both are highly interactive and provide a wealth of information. Parents can key in details of their child and work out what vaccinations will be required at what age, as well as finding out more about the particular disease concerned. Travellers are presented with an interactive world map and by clicking on a particular country, relevant vaccination information is provided.

Other resources available from this web site include leaflets, podcasts, textbooks and manuals as well as flyers, videos and lots more. These materials are on the whole very good and easily accessible. The main problem is that materials that are more suitable to health professionals are all mixed up with those designed for lay people so it can be quite a trawl trying to find exactly what you want, and it is also very easy to get side tracked!

Overall, content is great, but the web site needs better organization.

Department of Health, Province of Kwazulu-Natal

www.kznhealth.gov.za/vaccinations.pdf

The web site of the department of health in Kwazulu-Natal in South Africa provides a range of health-related information for both health professionals and lay users. The link above is to a resource that can be downloaded in the form of a pdf leaflet and it provides basic information on vaccinations, why they are important, as well as a schedule based on the age of the person to be vaccinated, although unlike other schedules we have looked at, this one stops after 12 years. The information presented in the leaflet covers most of the diseases we would expect and for each a brief description of the disease followed by a section on symptoms is provided. At the end of each section there is a paragraph explaining why vaccination against this particular disease is important.

The web site itself has a very comprehensive set of links to its main content, though rather surprisingly, there are no links to “vaccinations” or “inoculations,” and at the time of access, the search facility was not working either.

Although the web site does try to provide information for both professionals and lay people it should be acknowledged that health education professionals will probably find this site of more use than lay users.

ImmYounity

www.vaccines.com/why-vaccinate.cfm

ImmYounity is a North American organization whose sole aim is to provide scientifically based information about vaccines. It describes itself as being “written by moms for moms” and it is unashamedly aimed at persuading parents to have their children vaccinated. To this end it provides a whole host of information in different formats, some of which are more persuasive than others. Probability is used quite a lot, for example the web site claims that a child in 100 more times more likely to be struck by lightning than have a severe allergic reaction to a vaccine. Unfortunately many people are not good at interpreting probabilities and may respond to the above by saying that “if I do not have my child vaccinated then there is absolutely no chance of an allergic reaction.” This may seem like better odds. What might be more persuasive is information from the Center for Disease Control showing that vaccination is probably the most important health act in history, after the provision of safe drinking water.

“Isn’t polio a thing of the past in developed countries?” The web site asks. Ironically, one of the success stories in the history of vaccination, i.e. the eradication of polio from developed countries, is also a source of danger. To prevent parents from becoming complacent the web sites warns that although polio may have been eradicated to a large extent, reinfection of North America (or any other developed country) is only a plane ride away. Arguably, this type of argument is far more persuasive than those based on probabilities.

This web site does not provide much in the way of interactivity and there are no free downloads or leaflets available, but what it does do is provide the right amount of information at the correct level, aimed at a particular audience (parents), and it does this really well. Unlike many other web sites that provide the vaccination information, schedules, and so on, up front with only an implied persuasive content, this web site does the reverse. The persuasion element comes first and dominates the web site. The more detailed educational/informative section takes something of a back seat. But is works and it works well.