Colorado is joining about a dozen other states that are not requiring health insurance companies to revive canceled health plans.
No one mentioned cancellation notices. And no one expressed concerns about costs. Instead, at a sparsely attended public meeting about health insurance issues Tuesday evening, potential customers wanted to know if they could skip filling out Colorado’s complex Medicaid application.
Health exchange board members on Monday pressed for immediate improvements to Colorado’s mandatory Medicaid application, but state officials, who contend that Colorado is a “shining example” among the states, refused to promise that a full slate of short-term fixes will be completed before Dec. 15.
Colorado has no quick fix for a seemingly endless Medicaid application that health exchange board members believe is driving away customers and decreasing the number of people buying health insurance through Colorado’s new multi-million dollar health exchange.
In Choosing Wisely, physicians across the spectrum of medical specialties nationwide have created lists of procedures, tests and drug treatments that deserve second thoughts before doctors order them or patients accept them.
Fear Factor, Cost Drive Down Immunization Rates
By Mikaila Ellis Fethke Altenbern
Colorado continues to lag behind most other states on immunizing babies and toddlers and a new book asserts that parents have given in to irrational fears rather than heeding overwhelming scientific evidence that vaccines are safe.
The Colorado Health Foundation this week released its annual Health Report Card. Colorado ranked 30th in the nation for immunizations in children aged 19 to 35 months. That’s better than 2002 when Colorado ranked dead last in the country, but worse than 2008 when Colorado had improved to nearly 80 percent vaccination rates.
Only 65.2 percent of Colorado’s infants were fully vaccinated in 2009 compared to 81.1 percent of infants in Massachusetts, which had the highest rates of full immunization in the country. The goal for all states is 90 percent. According to the new report card, a combination of parental beliefs and the rising cost of vaccines accounts for the 35 percent of Colorado children who are not fully vaccinated.
“It is hard to un-scare people. Even if they realize they are wrong, it is hard to get over it,” said Seth Mnookin, whose new book focuses on fear and vaccines. The Panic Virus: A True Story of Medicine, Science, and Fear explores the fraudulent panics surrounding childhood vaccinations in the United States.
Vaccines protect not only the persons who are vaccinated, but also the community where they live. This concept known as herd immunity, protects the population from outbreaks of diseases, shielding those too young or too ill to receive vaccinations from exposure to potentially deadly diseases. The threshold for herd immunity to work is 90 to 95 percent vaccination in a population.
Once vaccination levels fall below that threshold, illnesses once eradicated from our population, can reappear and cost taxpayers millions for unnecessary hospitalizations. Measles, a disease that has killed more children in history than any other illness, has resurfaced in the U.S. while a recent outbreak of pertussis in California has killed 10 infants, and cases of Hib, which can cause bacterial meningitis, are rising.
Mnookin’s central quest is to understand why parents act on fears rather than evidence. He began his research three years ago when he realized that a large number of his friends and peers who were well-educated professionals had decided not to follow doctor-recommended vaccination schedules. After reviewing the evidence, the science and the claims, Mnookin, like many others, became convinced that there is no relationship between autism and vaccines.
In fact, earlier this year, an extensive investigation in the British Medical Journal found that the now-retracted study in the Lancet that first promoted a link between autism and vaccines was an “elaborate fraud.”
The Colorado Children’s Immunization Coalition (CCIC) has been working since 1991 to increase immunization rates among Colorado’s children. The Coalition recently kicked off an education campaign called Immunize for Good. The CCIC is providing an array of resources to parents so they can explore the latest research about vaccines and the diseases they prevent.
“The motivating factor for Immunize for Good was that we found some scientific resources were not addressing parents’ concerns and could seem preachy—validating parents’ concerns,” said Lydia McCoy, executive director for CCIC. “The fear is hard to shake.”
Mnookin found what he calls: “a paradox of vaccines.” When a disease is endemic, any potential side effects of the vaccine appear slight compared to the risks of getting a disease. The flip side is that the more effective a vaccine becomes, the more remote it seems to parents.
“This is a well-known Catch 22 for public health officials, who constantly fear that vaccines will start to feel, like vegetables or vitamins, like something one could just as easily do without,” Mnookin said.
Medical experts failed to fight fraud
Mnookin found that the controversy over autism persisted because the medical community failed to provide answers to parents. The causes for autism still are not fully understood and medical experts have provided little hope for families whose children suffer from the disease, Mnookin said.
Seth Mnookin speaks in Colorado
- Wednesday, March 9 at 2 p.m. and 5:30 p.m. , The Children’s Hospital Mt. Oxford (2nd floor)
- Thursday, March 10 at 5:30 p.m., University Memorial Center at The University of Colorado, Boulder
- Details and to RSVP: CCIC
“Communication issues played a big role in people losing faith and trust in the medical community,” he said “With specific regard to autism, as sure as we can be about anything, we should be sure that autism is not caused by MMR.”
Rather than engage in the vaccine debate by reviewing the research, Mnookin explores the roots and motivations of parents in the developed world who choose not to vaccinate their children. Focusing primarily on the U.S., Mnookin researches the occasionally turbulent relationship between concerned parents and the health care industry.
“There has been a shift in the way that people view health officials. It takes an enormous amount of schooling to become a doctor, and then someone spends 15 minutes of their day on the Internet and questions the doctor’s expertise. Hearing that day after day, doctors get impatient,” says Mnookin.
Mnookin believes fraudulent science took hold because doctors failed to fight back and the media promoted celebrities who captivated audiences with emotional claims that vaccines had caused autism in their children.
Rather than criticize parents with concerns about what they put in their children’s bodies, Mnookin acknowledges that there are a variety of fears. Mnookin, whose son was born in 2009 said, “ Sure I felt some fears. Not the same concerns. Another thing about this, it is very hard to bring a healthy kid to an appointment so that he can get a shot. You can’t tell an infant why you are doing this. I had a moment where I sort of wanted to take my kid and run for the door. Of course I didn’t.”
Mnookin validates the emotions of parents who have children with autism. He understands the isolation and anger that many feel after having seemingly perfectly healthy babies diagnosed with such a debilitating condition.
“There was resentment: Many were tired of having their lives taken over by a disease about which so little is known and so little can be done…And there was anger: Surely someone or something was to blame for the ways in which their lives had been upended.”
Mnookin hopes to give parents accurate information in an age when he believes misinformation is so prevalent.
In Colorado, some unvaccinated or partially vaccinated children are unprotected from these illnesses because their parents either decided to delay vaccination or oppose vaccinations.
Mnookin acknowledges that parents who have children with illnesses comprise a small portion of the “anti-vaccine” movement. It is the other portion of the population, the people who hear information about vaccines from various sources, and make the decision not to vaccinate who Mnookin hopes to reach.“These are parents who want good information, they want to make the right decision for their kids.”
The recommended vaccinations for children 19 to 35 months includes multiple doses of vaccines for diphtheria, tetanus, pertussis, poliovirus, hepatitis B and Haemophilus influenza type b—more commonly know as Hib—as well as one dose of a vaccine for measles and a vaccine for varicella (chicken pox). Vaccinations are recommended for a total of eight diseases that were once the leading causes of childhood death.
Advancements in immunization have dramatically reduced vaccine-preventable diseases in the U.S. Nonetheless, vaccine opponents can be convincing to parents.
The best-known anti-vaccine movement, spearheaded by organizations like Autism One and Jenny McCarthy’s Generation Rescue, claims vaccines, and the MMR vaccine in particular, cause autism. This claim received extensive media coverage after the 1998 Lancet study that purported to demonstrate the correlation between vaccination and autism. Dr. Andrew Wakefield, the author of that study, has been fully discredited. Yet the myth and the misperceptions persist.
Mnookin theorizes that much of the misinformation stems from the Internet, which Mnookin describes as the “hyper-democratization of data,” which he contends “unmoors information” from the context vital to understand it.
McCoy of the CCIC says misinformation makes it very difficult for medical experts to convince parents that their fears are unwarranted.
“It is a huge barrier for parents and for organizations trying to educate them,” McCoy said of the anti-vaccine activists. “People should be suspicious if it seems like only one or two people are behind these organizations.”
Mikaila Ellis Fethke Altenbern is an intern for Solutions.
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