Got to get vaccinated

How big are the problems in developed countries, as opposed to not so developed countries, in communicating the issues around vaccination programs?

It varies enormously, country by country. Some of the biggest challenges in the wealthier countries tend to come from vaccine skeptics, who for personal reasons - sometimes religious, or just an anti-scientific perspective - are anti-vaccine. You don't see that play out quite the same way in the lesser developed countries. What you see there are issues of feasibility, or, perhaps around the example of a polio vaccine, you see politics and religion entering in there. But - whether you're in Europe, the US, or Africa or Asia - it's a question of understanding the science of vaccines and the public health value of vaccines. And it's often assumed by experts that, "It's so obvious that they have scientific and public health value," but we don't necessarily think how important it is to communicate that to the end-user of vaccines.

So there's a disparity between the scientists and the people?

Well, science delivers these great, powerful tools and we expect people to embrace them…

But a lot of people do. A lot of people blindly follow medical advice without really thinking about it.

Absolutely, we often do. But what's interesting is that when you're sick and your doctor - or the Internet - tells you that this pill or this injection can relieve you of your symptoms, you want it. But vaccines are different. A vaccine is preventing something you don't even know - that vaccine is to prevent something from ever happening. And that's a very hard concept to get across, even though scientifically they've demonstrated the efficacy of [the vaccine] in a clinical trial. If someone is healthy, they'll ask "why do I need that? I may never get that disease anyway."

You mentioned polio. We often see statistics that say polio has been eradicated, but new cases do occur. So do we have to step up the communication to make sure people understand, "Yes, it's been eradicated, however…"

Eradication is something we all long for. We always use smallpox as our example - and we want many more small poxes. If you look at the countries where polio still exists - Pakistan, India, Nigeria and Afghanistan - these are all places where you have significant political challenges, not only because of polio but for many other political reasons. And I'll draw the analogy to HIV: who is most at risk of HIV? People who are marginalized, stigmatized, criminalized. You can look at any number of diseases and very often we're talking about delivering - whether it's a vaccine or other interventions - to people at the greatest risk, who are most marginalized. So for all of the power of biomedicine, we need to understand stigma, discrimination, political instability, and poverty drive these issues - that's what makes the environments for people to be at risk. We can't assume that one technology will magically fix that. There's no vaccine for stigma, there's no vaccine for political instability. We need to understand that even with the great vaccines for polio, we have those political issues, and we need to invest a lot of time and resources into biomedicine, but in the context of something much larger, because at the end of the day, developing the products - as hard as that is - is easy compared to delivering them, particularly to the communities that need them the most.

There has been quite a lot of talk about the role of social media in communicating about vaccines. Are we dealing with an uncontrollable beast, or is it something we just have to learn to live with?

It's an incredibly powerful tool that we need to live with on the one hand, but which we need to harness on the other. [There are] the detractors, people who spread nonsense that is not evidence-based at all. With the HPV (human papilloma virus) vaccine in 2007, people said, "If we give this to young girls, they're going to be promiscuous!" It's an absurd argument. We can save people's lives if we give young girls and even young boys HPV vaccines. But really crazy myths and mythology spread like wildfire on social media, so we see that as a problem. But I think we need to turn the table. We need to say, "Social media is here. How do we harness it for good?" So just like an incorrect message can spread, we need to start making sure that really accurate, evidence-based information is spreading in just that same way.

But is that really going to happen across territories? We often talk about Africans as being totally mobile, but is broadband penetration such that we can say they are truly on the Web? Or in the Pacific, people talk about there being only one mobile in the village and it's only ever used in emergencies.

No, you're right. It's not as if everyone's on Twitter all the time. But in the rural areas, where there's only one cell phone or only one Internet spot, the person who has that - whether it's the village chief or elder - they might be the only one who has access to the Internet, but they're writing it down, or printing it, or reading it to their community. If you're sitting in Brussels, London or New York, you get the instant feed. In rural South Africa, rural Kenya or rural India, it may take hours or days rather than minutes, but it's still getting out there. So we need to understand the message as much as the messenger and the modes of that information. It's not something we can ignore. It's something we need to not only monitor, and respond to inaccuracies, but we need to really capture and mobilize for good.

Mitchell Warren is the executive director of AVAC, a New York-based advocacy group specializing in HIV prevention.