Ministry of Health
Jarosław Pinkas, MD, PhD is secretary of state at the Health Ministry. He lectures at the Center of Post-Graduate Medical Education.
Wednesday, 15 June, was an important day for the Polish Internet: it took just two hours for 370,000 contributors to raise a total of 1,700,000 zlotys for a little boy suffering from pulmonary hypoplasia, to pay for heart surgery at Lucile Packard Children’s Hospital in Stanford. I mention this as an example of how the virtual world is now one with real causative power. Indeed, it is now a place where we can do great things. But unfortunately it is also one where we can destroy what has taken many years to achieve.
The virtual world is very difficult to modify. Sometimes one piece of information can bring consequences that prove impossible to control. I myself have been active on social media for quite a long time. I could not serve as deputy minister responsible for public health, if I did not know how to surf the Web or be active on Twitter, and if I made no attempts to influence opinions online. Why am I doing all these things? Because I am trying to fight for the right causes, in other words to pursue my policies, also outside the Ministry. Being a doctor, I also have a sense of mission. I work at a higher education establishment, where I teach doctors. I recently told them about the anti-vaccination movements and I said that government institutions in the United States receive great support from ordinary doctors, who get engaging in polemical debates. I asked why we had so few doctors in Poland capable of doing so. The reply was short: “Because no one is paying us to.” I hope I will never hear this opinion again, because I want to believe that the community around me surely consists of doctors true to the ideals of their profession.
Myths can spring up around any issue on the Internet. People use web portals, Twitter or Facebook, to exchange various pieces of information that seem to them to be very important and true. But the result is that the Internet has become an incredible collection of garbage, to such an extent that it is indeed often difficult to find information that is accurate. For instance, we are exposed to reports that the government wants everyone to be tagged with microchips, that vaccines cause autism and contain toxic substances such as mercury, and that natural immunity is better than vaccine-induced immunity (one example being the so-called “pox parties” fad). Of course, these claims are far from accurate. It is possible to find truthful information in this regard out there on the Internet, with many authoritative figures in Poland presenting it in an unambiguous way. In fact, we doctors should not engage in any polemical discussion at all on this topic, but rather build our position as authorities, not only in the medical domain, as prominent figures who have knowledge about the issue and should be the ones who impose the narrative. Of course, there are also government agencies that are involved in this process such as the European Centre for Disease Prevention and Control, which provides a great deal of information on the Internet.
The issue of vaccines becomes heated when something happens. When someone pulls the trigger, social media immediately go abuzz. For example, swine flu generated a great deal of interest in 2009. It later abated significantly and we can now see small peaks related to recent situations. These reflect the eruption of anti-vaccination hysteria, which generates a lot of publicity, sometimes in connection with a single case, for example “Vaccination killed my little daughter, Zuzanna. I will not get my other daughter vaccinated.” That poses a huge problem.
Poland’s largest government agency, the State Sanitary Inspection, has only 3,105 likes. How does that compare to the profiles of anti-vaccination movements? The Polish Association for Knowledge about Immunization “STOP NOP” (whatever that means) has 59,000 likes. Jerzy Zięba, the author of the book Ukryte Terapie (“Hidden Therapies”), has 91,000 likes. In my opinion, he is an extremely dangerous man, one who portrays himself as a doctor but is not one. I draw attention to him, because I believe that the faces of those who do bad things should be known to the public. The Facebook profile “O czym lekarze ci nie powiedzą” (“What Doctors Don’t Tell You”), in turn, has 22,000 likes.
Of course, the anti-vaccinationists form a movement that is completely lost yet unfortunately one that is very belligerent and uses various manipulation techniques on the Internet. For example, they create “memes,” i.e. concise visuals calculated to sway people’s awareness. The prevailing rhetoric runs along the lines of “How long can we let ourselves be treated like slaves?” or “Is there anyone who might finally talk to parents and present any arguments?” They also invoke the notion of doctors being linked to the pharmaceutical industry and therefore having a personal interest in administering vaccinations, so in other words it’s all just one big business, while in reality nature would cope with that. They present a tiny part of the truth and a gigantic number of untruths or half-truths such as “Polish patients have no freedom to decide about vaccination.” As a result of such messages, those who enter such websites meet with an onslaught of threats, of beliefs that everyone is deceiving patients. According to that rhetoric, many of us here in this room today are criminals who not only commit a crime by talking about the necessity of receiving vaccines, but also stand to personally benefit therefrom.
Another example of hysteria can be found in the notion that vaccines are untested. Many reports to this effect are completely absurd, but there are people who believe them anyway.
Unfortunately, practically no arguments can change the minds of those parents who refuse to have their children vaccinated. Andrew Wakefield (see p. 21) is publicly perceived as a guru, a prominent man whose reputation was purposefully destroyed by the medical establishment. I would like to remind you that he was stripped of his medical license in Britain, but he is nevertheless considered a martyr. Meanwhile, it has even turned out that he was working with law firms that wanted to extract money from the manufacturers of vaccines. But this narrative does not get through.
You most probably know that we intend to introduce routine pneumococcal vaccinations in Polandin 2017. So far, we have been spending 160 million zlotys on vaccines. We will now be allocating an extra 170 million to this purpose. Qualitatively, this represents completely unimaginable progress. One day, if I feel a sense of success from my time working in the Health Ministry, it will be because Minister Konstanty Radziwiłł and I took a very principled position on obtaining funding from the budget to prevent children as well as elderly people from dying from pneumococcal disease. But what does the anti-vaccinationist Dr. Jerzy Jaśkowski write about it? “Pneumococci are merely the good old pneumonia bacteria!” Apparently, one can make money off anything, especially ignorance.
Unfortunately, the Polish public institutions are not considered trustworthy, because every time we change the law, such modifications get interpreted in a way that causes anxiety. A lot of websites operate by pouring scorn on our good intentions. Meanwhile, most politicians in the world have started to support public health. The first of them was Barack Obama, who conducted an amazing media campaign in a very effective way. I will quote him in extenso: “I understand that there are families that, in some cases, are concerned about the effect of vaccinations. The science is, you know, pretty indisputable. We've looked at this again and again. There is every reason to get vaccinated, but there aren't reasons to not.” He also showed some memes. One of them was indeed fantastic. It shows a doctor examining a little boy and his parents standing next to him. The parents want to know what the rash on the boy’s back means. The doctor says, “If you connect the measles it spells out ‘My parents are idiots.’” Barack Obama was not afraid to resort to this form of message in order to stop the anti-vaccination movement.
Someone might say that things are maybe not that bad, that anti-vaccination campaigns are just a small slice of the information pie. As I said at the beginning of my talk, one small incident, one campaign, such as the donations made on 15 June, may bring something good, but one incident is also enough to destroy what has taken years to achieve in Poland.
I know that the PAS General Assembly is adopting a position statement on vaccination today [16 June 2016 – editorial note]. I will make attempts to ensure that this statement is promoted as broadly as possible by the health minister. I will promote it on my Twitter account, too. That is because the most important thing is access to accurate information, especially when health is concerned.
© Academia special issue 1 (2) 2016