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Episode 8 - Immunisation and vaccine hesitancy with Dr Linny Phuong
130 Plays1 month ago
In this episode of The Waiting Room Paediatric Infectious Diseases Physician Dr Linny Phuong joins Dr Omar Khorshid and Dr Chris Moy to discuss vaccination, childhood immunisation and vaccine hesitancy.
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Transcript
Global Rise in Disease Outbreaks
00:00:00
Speaker
With unprecedented outbreaks of measles and other infectious diseases, both here in Australia, in the US and of course all around the world, our falling rates of vaccination are very much on the agenda again.
Podcast Introduction
00:00:12
Speaker
And today we'll be covering that on The Waiting Room with me, Dr Omar Khorshid and Chris Moy. You're listening to The Waiting Room, a podcast by the Australian Medical Association with your hosts, Dr Omar Khorshid and Dr Chris Moy.
00:00:37
Speaker
Now, we are very pleased today to have a special guest, Dr. Linny Fong.
Guest Introduction: Dr. Linny Fong
00:00:41
Speaker
ah She is a pediatric infectious diseases specialist from Melbourne and is a current PhD candidate at the University of Melbourne looking into ah risk factors for pneumococcal, severe invasive pneumococcal infections.
00:00:55
Speaker
She's also the founder of the Waterwell Project, which we'll ask Linny about a little later. ah But thank you so much for joining us, ah Linny. And can we jump straight into it?
Impact of Vaccine Misinformation
00:01:06
Speaker
And give us an overview of where you think things are going at the moment here in Australia and around the world with vaccination rates, particularly in children. Yeah, absolutely. um I mean, gosh, let's start with the hard questions, Omar.
00:01:20
Speaker
I think obviously with what is going on in the world in terms of the the discourse that's going on, ah we are seeing a lot of misinformation and disinformation about vaccines and perhaps even about the natural history of diseases.
00:01:33
Speaker
um And so this is concerning for a number of reasons. Obviously, it means that unfortunately we're seeing a resurgence in some of the old infections. So things like measles and perhaps pertussis um and outbreaks are occurring more frequently as that immunisation coverage drops.
00:01:50
Speaker
um It means that unfortunately, again, because of lack of vaccinations, we're seeing people hospitalised, perhaps with ah complications of you know viral infections and then developing secondary bacterial infections. So, you know, we saw that with the flu, for example.
00:02:04
Speaker
um And also in terms of some of the invasive bacterial infections, obviously the things that are vaccine preventable, we think about pneumococcus. um And so, yeah, there's definitely a lot happening in
Parental Influence on Vaccination Rates
00:02:17
Speaker
the space.
00:02:17
Speaker
And I think we are all kind of holding on just to see what happens in in terms of vaccination rates, but also watching the conversation happen and and how that's sort of unfolding publicly. So, Leigh, you know, we're seeing this sort of resistance amongst a certain segment of population to vaccinations, particularly among adults, but is this reflecting directly into their their kids and and and and amongst children?
00:02:44
Speaker
Yeah, absolutely, because, that's you know, obviously um parents make the decisions for their children and so depending on their views, obviously that influences whether or not our children are vaccinated. And and so I think with the, as I said, with that discourse that's going on, there is so much misinformation about, you know, it's it's incredible, um you know, that vaccines are, because vaccines are so successful, obviously they are you know a victim of their own success. It means that we're not seeing those diseases that we normally would and so people are maybe legitimately or illegitimately worrying more about the potential harms of a vaccine as opposed to the conditions themselves.
00:03:28
Speaker
I think obviously the other thing is that with social media, it is so easy to pass on misinformation, disinformation and so I think it's really important as healthcare professionals that we are working towards rebuilding trust, making sure that there are reliable and reputable sources of information and and trying to combat that misinformation, but also perhaps more importantly, convincing those people in the middle, on that middle ground as to how we, you know, yeah whether to vaccinate their their kids and
Trust in Healthcare Systems Across Countries
00:04:03
Speaker
and their loved ones. So,
00:04:05
Speaker
Not sure whether I've properly answered that question, but I think there's there's a lot going on in the space. um my My daughter at the moment is in Houston, Texas. So she's in the epicentre of a lot of this discourse driven by certain ah in certain Kennedys, maybe.
00:04:21
Speaker
um ah my my My question is, is that I mean, how much of it this ah how much of this is a real problem now in terms of reflecting the the impact on vaccination rates in Australia at the moment?
00:04:32
Speaker
We're seeing echoes of of those debates, whether it's, you know, whether ah about vaccine or reproductive health, you know, we saw the paracetamol or acetaminophen thing play out in terms of autism, um even just climate and public health policies are, ah I guess, being affected here in Australia, whether directly or indirectly.
Rebuilding Trust in Vaccines
00:04:52
Speaker
um I think one thing that was really interesting that I looked up was, know, When we talk about public trust in the healthcare system, um so the Australian Bureau of Statistics states that roughly 75% of Australians trust the healthcare system compared to a statistic in JAMA, which looked at um what happened after the COVID pandemic and people's trust in physicians. And it was only 40% of adults in the US trust their healthcare providers. So huge differences. So perhaps a different environment in Australia. And so i think we have...
00:05:25
Speaker
space to be able to work with um with the public and make sure that what we are communicating in terms of the science and um and the logic behind why vaccination is important. Like, I think we still have an opportunity here and I think it's important how we how we do that.
00:05:42
Speaker
um And it's, you know, all that stuff around deep listening, addressing misconceptions and fears um and ensuring that we aren't judgmental. I think that's a really key part of this.
Community Challenges and Misinformation
00:05:52
Speaker
So you you mentioned trust, Lynnie, and to me that that does seem to be right at the core of our current problems, probably starting with the pandemic, both in terms of the the mixed messaging that happened through the pandemic and and people's the general public's lack of understanding of different types of vaccines. And, you know, you you've had the COVID vaccine, but you still got COVID, so therefore it doesn't work. And when I got COVID,
00:06:16
Speaker
it wasn't bad anyway, so why would I take any risks? Similarly with the flu, you know, i had the flu vaccine and then I got the flu that year or even the next year. And and so therefore, why should I vaccinate my child against measles or mumps or rubella or whatever, where those vaccines we know are incredibly effective at the different types. So how do we rebuild that trust without having to, I guess, educate the public generally about all the details of how vaccines work and how they work in public health? Well, I think that's the thing. I think that, you know, there are factions within community and the public.
00:06:50
Speaker
There are, you know, the people who are completely anti-vax and perhaps you're never going to change their minds. But then there are the people on the fence who are getting this misinformation, disinformation and perhaps asking the right questions, but being either shut down by their healthcare providers or going to unreliable sources on social media or the internet in general.
Complexity of Healthcare Messaging
00:07:08
Speaker
So I think it's, as I said, I think it's really about making sure that information is accessible and I mean accessible in terms of, you know, not only searchable, but makes sense to the the common person, because some of the language that we use is is very confusing. And then this is where I think some of the communicators, perhaps out of the US, perhaps the Department of of Health um and Human Services, perhaps they are better communicators in some way because their messages seem so simple and they're so convincing.
00:07:40
Speaker
So when we are trying to articulate what an mRNA vaccine does, i think we can sometimes get so caught up in the science that the message gets lost.
00:07:51
Speaker
um So I think it's about being really clear in messages. I think in terms of general health promotion, I think the other aspect is that we need to make sure that we're working with communities and that not everything is a top down campaign um because again, that's where you lose people. I think COVID, the issue there was that you know we were trying to build a plan and flight at the same time.
00:08:15
Speaker
you know i worked in one of the local public health units and we were you know aiming for COVID zero at one point. And the rules were changing so constantly and people were accessing different um different means of information that people were getting mixed messages. And if they were looking at last week's bulletin versus this week's, then, you know, you were going 10 kilometres versus five kilometre radius. You know, the things were so confusing. And I think from a science perspective, you know, us as infectious diseases physicians, like we were still trying to understand what the impact would be.
00:08:47
Speaker
you know we saw what was happening in Bologna, Italy where people were dying and you know there were mass graves and we saw what was going on in the US and we had i think we were at an advantage because we were at almost you know its further down the track that we could start implementing the lockdowns and the you know um and some of those public health restrictions so that we minimised death and disease in Australia But we were still learning as healthcare
Role of GPs in Vaccination Advocacy
00:09:15
Speaker
professionals. So if you think about you know general health literacy in the community and what, you know I guess how that was perceived when we were trying to figure things out on the fly, I think of course there was going to be a lack of mistrust or ah sorry, a level of mistrust.
00:09:33
Speaker
And perhaps, yes, that has increased because of what happened during the pandemic. I must say that, you know, a friend of mine who's a master of media once said that you don't want sound like the smart aleck in the room. You actually want to, you want to tailor a message to a certain level, maybe to a a 12 year old, not not being disrespectful, but to a 12 year old and actually providing the message. But I mean, as as a GP myself and and being biased, I would say that we have a very important role in this. But, you know, could I ask from your perspective, um from in in seeing the the issue of trust being quite critical? I mean, where where do you see the role of GPs in this and and actually, in you know, trying to encourage vaccinations for our community? Yeah, so there are a lot of studies that essentially talk about um the decision making of parents and care providers in choosing to vaccinate.
00:10:26
Speaker
And it's around the fact that there is very strong evidence to show that it depends on what their care givers ah their you know healthcare providers are saying. So if their port of call is their GP or their maternal child health nurse, health nurse or it's their midwife or doula,
00:10:43
Speaker
depending on what their messaging is and what they are being told and informed, that influences their
Challenges in Australia’s Healthcare System
00:10:49
Speaker
decision making. And so when you talk about GPs, I mean, GPs are the backbone of our healthcare system.
00:10:55
Speaker
um I think the difficulty in having just that GP approach is that obviously GPs are becoming harder and harder to access in communities and weve we've talked about this a lot.
00:11:07
Speaker
um And so it's really, you know, what are those opportunistic times where a parent would present with their child where there is that opportunity to talk about vaccination?
00:11:18
Speaker
I think that's the difficulty in this. But, you know, I absolutely think that GPs need to be. um helping sort of push the messages. It's just around that availability and that, you know, um accessibility in some ways.
00:11:32
Speaker
um But yeah, immunisation appointments obviously are important, but not all patients will or families will book in with their GP to get immunisations. It's, you know, sometimes around the councils, sometimes around, um yeah, schools, including, um yeah, I think that there's there's definitely some work to be done.
00:11:53
Speaker
around that. Yeah, the AMO is often talking about um a vision for primary care with the GP at the centre, but actually utilising the skills of practice nurses and pharmacists, you're an ex-pharmacist yourself.
00:12:07
Speaker
yeah um And and it's ah it's a great vision that we can see really clearly, but unfortunately, Government seems to be moving in the other direction with fragmenting our system. And yes, for instance, with um with childhood vaccinations being done in in pharmacies, that improves accessibility. It's much easier to get an appointment.
00:12:25
Speaker
I've taken my son for his flu back to the pharmacy myself within the last six months. Easy to access. I've got to get it on a Sunday when I wanted it. But we are missing that opportunity for holistic care and to build that trust, I guess, which um which for certain patients is absolutely critical. Yeah, no, agree. I think, I mean, the other thing I would say is that um obviously GPs are also important just because they have that trusted relationship and they are able to see families through from, you know, from, um you know, we talk from cradle to grave. And I feel like the other you know The other issue in terms of the advocacy side of things is obviously, <unk> took I know the AMA is a really big advocate in terms of Medicare billing and and ensuring that GPs are correctly remunerated in terms of the time that they spend with families. So if you know a ah patient is there for that one problem, then gosh, you've got a waiting room full of people. How are you going to fit in that conversation about that
00:13:18
Speaker
vaccine-hesitant family to get them to get that flu vaccine or their overdue childhood
Culturally Sensitive Health Education: The Waterwell Project
00:13:24
Speaker
immunisation. I think that's a real big challenge. um So it has to be a system approach.
00:13:31
Speaker
but ma I'm going to totally ignore your comment about getting a vaccination from a pharmacist, but I'll move on to the next question, which is, Lynnie, tell us about the Waterworld project and the importance of culturally sensitive health education.
00:13:44
Speaker
The Waterworld Project is a health promotion organisation that I started 14 years ago as an intern doctor. ah Let's just say that I was a little bit naive um and didn't really really understand what I was getting in myself in for.
00:13:59
Speaker
um We essentially deliver interactive health education to communities from migrant, refugee and asylum seeker background. um And so really that discussion point around culturally sensitive health education is so important because as I said, like we saw it in COVID, we saw that people were accessing information in Australia from their home countries, from, you know, TikToks, from WeChats, from really um ah unreliable sources. There was a lot of misinformation, disinformation.
00:14:31
Speaker
There were a lot of, um you know, we saw the disparities play out in terms of increased hospitalisations and deaths in culturally and linguistically diverse populations as a result of this. And this was, you know, it was really kind of a a magnifier COVID in terms of what was going on in some of these communities.
00:14:50
Speaker
So for me, and the reason why Waterwell is so important is because we feel that by providing practical and and interactive health education where communities literally just, um I guess, gather around a dialogue with healthcare professionals.
00:15:09
Speaker
They are able to ask us the questions and dispel those myths and really kind of be on the ground with you know, with doctors and find out whatever they, you know, whatever they need to. So it's really filling in those knowledge gaps.
00:15:23
Speaker
And I think from a healthcare provider perspective, like we are sitting in community in their space and we are listening to some of the stories and those myths and some of the stigmas as well around some of these conditions that we are, you know, trying to to manage in hospitals.
00:15:41
Speaker
So I think, um you know, I think that culturally sensitive health education goes two ways. I think it's about us as healthcare professionals being open to that dialogue and and listening, but it's also around communicating in a way that is understandable, whether it's working with interpreters, using visual props, um having these interactive
Dr. Fong’s Research on Pneumococcal Disease
00:16:00
Speaker
discussions.
00:16:00
Speaker
Fantastic, Lenny. Well done. I understand it's ah an award-winning program and it sounds like it deserves to be supported and and grown. And we certainly saw in the pandemic that the problems associated with are not delivering messages in culturally sensitive ways.
00:16:17
Speaker
While we're talking about you, can you take us through in ah in a simple way that an orthopaedic surgeon can understand what you're doing with your PhD on neumocardial infections in children? Oh, that's so, yeah. sorry um So, my PhD is, so I'm looking at high risk factors in terms of pneumococcal disease. so looking at the um you know the invasive side of things.
00:16:38
Speaker
And I think um to give you an idea of why I picked this topic, initially I just thought it would be interesting. But what we found was um one of the initial studies was looking at the the prevalence of immune deficiency in kids who are presenting with invasive pneumococcal disease.
00:16:58
Speaker
So initially, and I think, you know, some of the anecdotes out there is that if a child has pneumococcal disease and perhaps it's not a vaccine type, then perhaps it's because, you know, it wasn't covered by the vaccine and so they were going to get it anyway.
00:17:12
Speaker
But what we found was of those children who had invasive pneumococcal disease, whether it was bloodstream infection, bone and joint infection, sepsis, complicated pneumonia, one in eight of those children essentially had an underlying immune deficiency.
00:17:29
Speaker
So things like common variable immunodeficiency that requires you know regular immunoglobulin infusions, um complement disorders, um various different things. So that discovery kind of, I think, changed everything and changed why I embarked on a PhD.
00:17:45
Speaker
So for me, it was, um you know, we have implemented some practice changing guidelines around Australia, which is amazing, which means that these children are screened after presenting with pneumococcal disease.
00:17:56
Speaker
um It means that we are able to change that trajectory so that they are seen by immunologists earlier on. Potentially we can prevent future infections, but also improve quality of life, prevent, you know, deaths.
Addressing Vaccine Hesitancy
00:18:08
Speaker
um But then the next part of my PhD was looking at the health economic component. So if we are to screen these children and we detect them early with an immune deficiency, does that save money to the individual but also the wider healthcare system?
00:18:23
Speaker
And I think that that's probably the skill that I'm working on in terms of... building my PhD and um I think it's really important for doctors and policymakers and, you know, people who are trying to advocate for change to understand how the government works in terms of their decision making and understanding the dollar value of health.
00:18:43
Speaker
and Liddy, just ah as as we finish up and let you get back to your seeing your patients, um do do you have any final sort of words to our colleagues about the the main messages that they should be telling their patients about childhood immunisation? oh Yeah, I had to think about this and I think um not um not a main message, but something more around something to think about. I think...
00:19:08
Speaker
The big misconception is that when parents are vaccine hesitant or when when they have doubts about vaccination, people often attribute to that to the fact that they don't care or they don't they just don't want to vaccinate their kid just because.
00:19:24
Speaker
And I would actually argue that the reason why parents don't vaccinate their kids is because they do care, that they are trying to advocate for their kids because they think that that they, in their head, think that that's the best course of action for them, that they think that the vaccine is going to be harmful or or they think that um You know, they truly think that perhaps real wild type measles is a good thing.
00:19:48
Speaker
So I think my lesson in that is that healthcare care professionals, I think we we just need to approach these conversations with a bit more curiosity rather than confronting these these parents and putting them offside.
00:20:02
Speaker
um I have a lot of conversations with vaccine hesitant parents. And I think for me, it's really around distilling, like, like what are their beliefs and ah why do they why do they not want to vaccinate? Because often we hear funny things, you know, we have parents who will only give their kids BCG vaccine, but they don't want anything else on the schedule.
00:20:23
Speaker
Or, you know, it's and so... Yeah, I think it's a really interesting conversation and i think we just need to be yeah a bit more curious. and Thank you so much, Sonny. This is obviously ah really important topic and with ah global events, you know, the the US cuts to to foreign aid, the ah growing hesitancy, unfortunately, we we appear to be, if if you I guess if you you could also add antimicrobial resistance into that. We may be entering an era of infectious diseases,
00:20:52
Speaker
yeah like we saw maybe um you know prior to the antibiotic year and prior to vaccines. So it's it's an ah an area that the medical profession has to stay involved in and
AMA’s Role in Healthcare Advocacy
00:21:01
Speaker
advocating. The AMA, of course, has always been a strong advocate for immunisation and,
00:21:07
Speaker
course, we have a position statement and any listeners who'd like to have a read of that can find that on the AMA's website. um But it's fantastic that we have people out there in the community, doctors out there fighting the fight and advocating for their patients, not not just with those strong messages vaccines are safe and effective, but actually with the the listening hat on, which you clearly have and perhaps more of us need to need to learn those skills. So thank you so much for joining us. It's been a pleasure to meet you and have you on the show.
00:21:37
Speaker
And um goodbye to you all, goodbye the listeners, and we'll see you next time. Thanks for listening to The Waiting Room.
00:21:45
Speaker
Learn more about the AMA, including how to become a member, ama.com.au.