(September 8, 2015 at 12:07 pm)Parkers Tan Wrote:

(September 8, 2015 at 4:56 am)Aractus Wrote: I'm tell you that it's morally wrong to blame patients for the failings of healthcare delivery.

I know what you're telling me. I disagree with your view on the matter, because I know for a fact that in many cases it isn't a "failure of health-care delivery", it's people latching on to something a celebrity said on a talk-show who take up the cause themselves, reading biased literature along the way, and deliberately avoiding unbiased information. Those people do not deserve my respect, and whether or not you think I'm moral or immoral doesn't really matter to me.

You can disagree all you want, it's not "my view". It doesn't matter what the reason is, you cannot blame patients for not achieving a healthcare goal. Expecting patients to conform automatically is a form of assimilation.

Here is an example: "A deep mistrust of hospital systems means that many Aboriginal and Torres Strait Islander people continue to delay treatment." (Best & Dredericks [Ed.]. 2014. Yatdjuligin. p. 230.)

Here's another example: "Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men." (Ottawa Charter, 1986).

The way that healthcare is delivered determines its accessibility. Here's another example:

"We define non-clinical aspects related to the way individuals are treated and theenvironment in which they are treated as responsiveness1. WHO’s review of the patient satisfaction and quality care literature2 led to the identification of eight domains of responsiveness. These domains or broad areas of non-clinical care quality are relevant for all types of health care including personal and non-personal health services, as well as the population’s interaction with insurers and other administrative arms of the health system. There is empirical evidence to suggest that there is a positive association between health outcomes and responsiveness.  Notwithstanding this relationship, human rights law argues that these domains of health systems are important in their own right3." (WHO 2005).

And you can continue reading to your heart's content.

You haven't even established to me that a significant proportion of people who fail to vaccinate their children do so because they are "anti-vaccine", and you haven't even provided a coherent mechanism for determining who really is "anti-" and who isn't among people who don't vaccinate. Therefore it is illogical of you to target an extreme sub-group of this group which you haven't even established actually exists in any meaningful capacity. And even if you had, as I've pointed out to you, it's not their fault they have the "wrong view". They have been misinformed, and it is the healthcare services that have failed to communicate the message effectively to them.

Again this isn't "my view". I'm stating the conventional wisdom of the healthcare professionals. In the past there was patient-blaming, and that viewpoint is being stamped out. In many places it is not tolerated under any circumstances, and you would have your employment terminated without notice if you behaved that way. For example, if you receive a person who has overdosed on Ice is isn't your place as a nurse to judge their condition as "self-inflicted harm" or "patient stupidity" or anything else, and if you were caught behaving that way you would be fired. That kind of attitude from doctors is one of the things that can cause patients to lie to their doctors about their conditions, or delay treatment, etc.

(September 8, 2015 at 12:07 pm)Parkers Tan Wrote: Actually, it's the extremes that I'm addressing.

It doesn't matter. Patient-blaming is not tolerated in health services. You can blame organisations that spread misinformation, but you can't blame people who read that information and become persuaded by it.

(September 8, 2015 at 12:07 pm)Parkers Tan Wrote:

(September 8, 2015 at 4:56 am)Aractus Wrote: I already explained to you there is not just one reason why a person doesn't vaccinate their child. Put it this way - let's say you open a business and you sell a product that you think the public wants. And potential consumers come to you, and some of them are put off because you are mean, arrogant, forceful and disrespectful. From your point of view it's "their fault" that they don't want your service, but from their point of view you didn't earn their trust, and because of their experience they don't want to buy products from your company.

This idea that patients are to blame for not seeking and receiving the medical advice and services that they need is WRONG. It's backwards.

Except that many are, including the lady in the OP's video.

The lady in the OP's link had a mistrust in the health system because of a previous negative experience, which is exactly consistent with what I said.

The fact that she is willing now to have her child vaccinated - but not in a school - should tell you two more things. 1. That you can't just expect people to accept the service method you provide. It's perfectly reasonable that parents don't want their children receiving medical care in a school, or they want to be more involved, or they want to see their family doctor. 2. That somebody should be following up with her to arrange an alternative arrangement for her child's vaccination. Again you cannot and should not expect patients to automatically recognise what they need to do. Ideally the school should be following up with this and ensuring there is access to an alternative option - after all in some places in the world (such as the USA) you cannot access health services for free and this is a well know access barrier to low income people (I won't provide any more links in this post, but you can easily look this up on WHO or in journals).

(September 8, 2015 at 6:55 pm)Aroura Wrote: Letting people make this choice as individuals is causing the herd immunity to drop into the mid 80's%, I think where I live it is now 83% immunized, WELL below what is safe for us as a group.

People need to realize that the good of the community IS for the good of their individual child.  So....that makes me not get your argument.  I immunize my child toprotect her, but also to protect the kid next door with bone marrow disease who cannot get immunized.  If people can't see that, then it needs to be forced on them.  Period.

The number you quoted is probably irrelevant. 83% of children would be immunised against all communicable diseases, however if you were to look disease by disease it would be higher - for example 87-89% or so. So the herd immunity is actually stronger than the 83% number would suggest.

Again there many reasons why the other 17% are not immunised. Access to affordable health care; mistrust in the healthcare system; fear of the healthcare system; children who missed getting immunised because of other reasons and who haven't been followed up on; etc. People relying on older more outdated information. People not realising there is a need. People who aren't offered the opportunity or who aren't followed-up on if they "miss" an opportunity. People who have never had a healthcare practitioner explain the needs to them.

That last point is essential - you cannot assume people will know about a need without it being effectively communicated to them from a healthcare practitioner. If practitioners don't take the time to explain to their clients why a service is needed then you cannot expect people to understand about it. You can't just run government TV advertising or put a bulletin in a school newspaper. A nurse or a doctor or a pharmacist or someone who is a healthcare practitioner needs to effectively communicate to the clients why there is a service that they feel their client should access.

Ask stated before, why not include that in prenatal classes?

Aractus, I'm on my phone and cannot easily deal with such a lengthy post right now. I'll get back to this thread tonight. Sorry for the delay.

(September 9, 2015 at 3:43 am)Aractus Wrote: You can disagree all you want, it's not "my view". It doesn't matter what the reason is, you cannot blame patients for not achieving a healthcare goal. Expecting patients to conform automatically is a form of assimilation.

I've been avoiding squabbling with you because I'm here to recreationally argue with theists and not brain-dead atheists, but seriously, go fuck yourself. Perhaps a victim can't be blamed for what's done to them, but they're still responsible for ALL the actions they take themselves, like for instance the action of abusing their children and putting others at risk by withholding proper medical care from their own kids. You're making a blanket statement that doctors/the medical industry are always responsible when a patient makes a fucked up decision, and seriously, you need to fuck off with that shit. It just isn't true.


My first wife and I had a horrible experience at the doctor one time over a form she needed signed for work. It was a total professional meltdown, complete with the staff violating Hippa right in the (very full) lobby concerning my ex's psychiatric history. Total clusterfuck. You know what we did? We got her a different fucking doctor. We could have forsaken medical care for ourselves and our (luckily non-existent) children forever, but we got a different doctor at a different practice. It wasn't even hard.


What you're asking me to do is look at situations where somebody is wronged by a doctor, then turns around and wrongs their own children and community afterward, and you want me to blame the doctor and not the patient for their irresponsible reaction to the situation. Fuck off. Doctors are not responsible for patients' stupid decisions.


Besides, as somebody already stated, irrational fear of vaccines is actually on the rise because of anti-vaxxer rhetoric being so prominent and so much of the public lacking critical thinking skills. What happens to your argument in communities where the number of people vaccinated dips below the acceptable norm (like it already has in some places)? Are the doctors responsible for that, too? Are they responsible for all the prominent humans who are trusted by their fans and use that position to preach a medically irresponsible message about vaccines? Where does the responsibility of medicine end and the responsibility of the public begin?

(September 9, 2015 at 9:35 am)Lemonvariable72 Wrote: Ask stated before, why not include that in prenatal classes?

Yes that's one valid idea - but remember that unless a health practitioner is the one delivering the class that people will be rightly sceptical of any health advice given from some random instructor. You need to ensure that the message is communicated in an effective way to the target clients - not just ensure that it's delivered "somehow" and assume everything will be OK. Additionally you would need to ensure people can raise their concerns and have those discussed privately with a practitioner. Even someone having an unanswered question is a barrier to the effective delivery of health services.

In Australia you would not be able to have an Anglo-Saxon instructor give the message to Ingenious parents full stop. It doesn't matter if they're the best doctor in Australia we know that Aboriginal and Torres Strait Islander people have a justified and well-established fear of "White Medicine". You would need to get an Indigenous health practitioner to deliver the message.

(September 9, 2015 at 3:43 am)Aractus Wrote: You can disagree all you want, it's not "my view". It doesn't matter what the reason is, you cannot blame patients for not achieving a healthcare goal. Expecting patients to conform automatically is a form of assimilation.

Here is an example: "A deep mistrust of hospital systems means that many Aboriginal and Torres Strait Islander people continue to delay treatment." (Best & Dredericks [Ed.]. 2014. Yatdjuligin. p. 230.)

Here's another example: "Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to women and men." (Ottawa Charter, 1986).

The way that healthcare is delivered determines its accessibility. Here's another example:

"We define non-clinical aspects related to the way individuals are treated and theenvironment in which they are treated as responsiveness1. WHO’s review of the patient satisfaction and quality care literature2 led to the identification of eight domains of responsiveness. These domains or broad areas of non-clinical care quality are relevant for all types of health care including personal and non-personal health services, as well as the population’s interaction with insurers and other administrative arms of the health system. There is empirical evidence to suggest that there is a positive association between health outcomes and responsiveness.  Notwithstanding this relationship, human rights law argues that these domains of health systems are important in their own right3." (WHO 2005).

And you can continue reading to your heart's content.

And yet the anti-vaxxers here have this for your perusal:

http://www.vaclib.org/basic/basicfct.htm
https://en.wikipedia.org/wiki/Stephanie_....27s_death
http://naturematters.info/




... and so on. I could link you to scores more sites demonstrating a positive antipathy to the medical establishment, in many cases (as in Messenger's child's death, linked above) driven by personal pain. Now, if you think they will respond to outreach from the medical community, I'd suggest you lack insight into a significant proportion of the antivaxxer community here in America. Your comments may well be pertinent for Australia; I don't know, and because I don't live there, I'm not really interested.

(September 9, 2015 at 3:43 am)Aractus Wrote: You haven't even established to me that a significant proportion of people who fail to vaccinate their children do so because they are "anti-vaccine", and you haven't even provided a coherent mechanism for determining who really is "anti-" and who isn't among people who don't vaccinate.

The latter first: it's very easy to tell the difference in motive between someone who says, "I didn't vaccinate my child because I can't afford the cost" versus "I didn't vaccinate my child because vaccines are filled with poisons which cause autism."

Now, I don't have exact numbers as to how many people who haven't vaccinated their kids have decided upon inaction based on their pseudoscience, but here in America, their media presence is large, featuring Jenny McCarthy, Joe Scarborough, and Rob Schneider, amongst others, and as the websites linked above (and the many more that I frankly don't have the time to hunt up simply so you won't read them) demonstrate, there is a sizable proportion of people who are expounding this claptrap that, as you yourself have noted already, has been discarded as unsupported claims. Those people are the antivaxxers to whom I refer -- the term "anti" should have been your clue, because a parent too poor to vaccinate their child is not necessarily against the procedure, obviously. This is why I am specifically using the terms I have, and your continual muddying of the waters by insinuating that I am railing at all parents for holding these dopey views is irritating, yet you insist on not reading what terms I'm using.

(September 9, 2015 at 3:43 am)Aractus Wrote: Therefore it is illogical of you to target an extreme sub-group of this group which you haven't even established actually exists in any meaningful capacity. And even if you had, as I've pointed out to you, it's not their fault they have the "wrong view". They have been misinformed, and it is the healthcare services that have failed to communicate the message effectively to them.

You clearly are ignorant of matters here in America. I suggest you read more about the movement, loud as it is here, before you take me to task for anything further. This subgroup needs to be shown wrong, because they are harming others by their obdurate ignorance. This is not to say that all unvaccinated children have irrational parents. As you can see from the sites above and elsewhere, they are not interested in what the medical community has to say because they do not trust it -- and that is because of things like the death of a child to a genetic disease that the medical community couldn't prevent. That sort of irrationality cannot be reached by an outreach program in most cases. You may as well be an atheist in a religious forum, for all the good your outreach will do.

(September 9, 2015 at 3:43 am)Aractus Wrote: Again this isn't "my view". I'm stating the conventional wisdom of the healthcare professionals. In the past there was patient-blaming, and that viewpoint is being stamped out. In many places it is not tolerated under any circumstances, and you would have your employment terminated without notice if you behaved that way. For example, if you receive a person who has overdosed on Ice is isn't your place as a nurse to judge their condition as "self-inflicted harm" or "patient stupidity" or anything else, and if you were caught behaving that way you would be fired. That kind of attitude from doctors is one of the things that can cause patients to lie to their doctors about their conditions, or delay treatment, etc.

That is an entirely different subject and quite irrelevant to the point that antivaxxers are deliberately ignoring the science of vaccinations. If you as a doctor tell a patient that they stand a chance of dying of overdose if they don't stop shooting smack, and that patient goes on ahead shooting smack, whose fault is it? The doctor has spoken in plain simple English; the patient has ignored him in plain simple English.

People who deliberately ignore the information about vaccinations aren't reachable.

(September 9, 2015 at 3:43 am)Aractus Wrote: It doesn't matter. Patient-blaming is not tolerated in health services. You can blame organisations that spread misinformation, but you can't blame people who read that information and become persuaded by it.

I don't work in the health services. What that means is that my opinion doesn't have the same deleterious consequences you are wringing your hands over, and that means that I'm not really worried if Jenny McCarthy gets butthurt over my opinion.

Or you, for that matter.

(September 9, 2015 at 3:43 am)Aractus Wrote: The lady in the OP's link had a mistrust in the health system because of a previous negative experience, which is exactly consistent with what I said.

Her "negative experience" was simply a feeling that her doctor was treating drug use with drug prescriptions. Now, that could have been the doctor's fault, it could have been hers, but automatically assuming that it's the doctor's fault has no basis in evidence.

Quote:It started with a drug-induced psychotic breakdown. She grew up in something of a broken home, with an absent father, an addict mother, and a violent stepfather — an environment where drugs were easy to come by and hard to ignore. At 17, she smoked something weird and felt herself quite literally losing it. Hallucinations. Panic attacks. Nausea and heart palpitations. After a grueling week of recovering from the episode, she did the normal thing and took herself to a doctor.

She got out with a prescription and an unshakable feeling that this doctor, and his clinic, and the government that paid for his services, did not care at all about her concerns, her needs, and her fears. That she was a problem that could be solved with a couple of pills. That the fear she had felt for her sanity was not respected, not even considered. That the solution to her drug problem was more drugs.

She was the drug-using child of an abusive home environment, and she felt alienated? And somehow the doctor must connect to someone who is alienated, despite the fact that he isn't a psychologist?

This does not demonstrate your point.

(September 9, 2015 at 3:43 am)Aractus Wrote: The fact that she is willing now to have her child vaccinated - but not in a school - should tell you two more things. 1. That you can't just expect people to accept the service method you provide. It's perfectly reasonable that parents don't want their children receiving medical care in a school, or they want to be more involved, or they want to see their family doctor.

Which is nothing I ever touched upon, so why you're highlighting this is a mystery to me.

(September 9, 2015 at 3:43 am)Aractus Wrote: 2. That somebody should be following up with her to arrange an alternative arrangement for her child's vaccination. Again you cannot and should not expect patients to automatically recognise what they need to do. Ideally the school should be following up with this and ensuring there is access to an alternative option - after all in some places in the world (such as the USA) you cannot access health services for free and this is a well know access barrier to low income people (I won't provide any more links in this post, but you can easily look this up on WHO or in journals).

Actually, in America, poor parents can receive vaccinations for their children, free of charge. You assume knowledge that you don't have in your possession, and this is one reason why we seem to be talking past each other.

I notice that you still haven't answered my point about that 5% uninoculated providing a substantial reservoir to allow for microbial evolution. At this point, I don't honestly expect an answer from you on it, so I'm going to leave this conversation, with this being my last post. You have a nice day, now.

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: And yet the anti-vaxxers here have this for your perusal:

http://www.vaclib.org/basic/basicfct.htm
https://en.wikipedia.org/wiki/Stephanie_....27s_death
http://naturematters.info/


... and so on. I could link you to scores more sites demonstrating a positive antipathy to the medical establishment, in many cases (as in Messenger's child's death, linked above) driven by personal pain. Now, if you think they will respond to outreach from the medical community, I'd suggest you lack insight into a significant proportion of the antivaxxer community here in America. Your comments may well be pertinent for Australia; I don't know, and because I don't live there, I'm not really interested.

All that "Nature Matters" and Wikipedia links prove is what I already told you - which is that most so-called "anti-" people have a mistrust or fear of healthcare based on past negative experience. The only way to get through to people who have mistrust in the healthcare system is to rebuild it. All you achieve by yelling, labelling, and patient-blaming is to drive these patients further away from receiving the medical services that they need.

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: The latter first: it's very easy to tell the difference in motive between someone who says, "I didn't vaccinate my child because I can't afford the cost" versus "I didn't vaccinate my child because vaccines are filled with poisons which cause autism."

Now, I don't have exact numbers as to how many people who haven't vaccinated their kids have decided upon inaction based on their pseudoscience, but here in America, their media presence is large, featuring Jenny McCarthy, Joe Scarborough, and Rob Schneider, amongst others, and as the websites linked above (and the many more that I frankly don't have the time to hunt up simply so you won't read them) demonstrate, there is a sizable proportion of people who are expounding this claptrap that, as you yourself have noted already, has been discarded as unsupported claims.  Those people are the antivaxxers to whom I refer -- the term "anti" should have been your clue, because a parent too poor to vaccinate their child is not necessarily against the procedure, obviously.  This is why I am specifically using the terms I have, and your continual muddying of the waters by insinuating that I am railing at all parents for holding these dopey views is irritating, yet you insist on not reading what terms I'm using.

You just lost all credibility with me by misquoting the Wakefield et al. 1998 (ret.) paper - which I already talked about earlier. There is an established positive link between Autism and autoimmune disease. In the future it may even be possible to prevent the onset of Autism in at-risk patients, if there is indeed a cause-and-effect relationship (something that has not yet been fully established). The MMR vaccine has since been vetted by 15 years of researching following Wakefield et al. (ret.).

The fact that you don't even know this, despite the fact that I already told you much earlier in the thread, shows wilful ignorance on your behalf.

You keep on saying "these are the 'ant-' people I'm talking about" - but you already labelled the lady discussed in the OP link an 'anti-'. So you're being inconsistent. You have your own biases that you refuse to move on from.

The fact that these websites are able to persuade people and that the healthcare system is not re-persuading them of the need for a healthcare service is not an indication that health practitioners "can't".

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: You clearly are ignorant of matters here in America.  I suggest you read more about the movement, loud as it is here, before you take me to task for anything further. This subgroup needs to be shown wrong, because they are harming others by their obdurate ignorance. This is not to say that all unvaccinated children have irrational parents. As you can see from the sites above and elsewhere, they are not interested in what the medical community has to say because they do not trust it -- and that is because of things like the death of a child to a genetic disease that the medical community couldn't prevent. That sort of irrationality cannot be reached by an outreach program in most cases.  You may as well be an atheist in a religious forum, for all the good your outreach will do.

You have once again lost all credibility with me by suggesting people either do or should make healthcare decisions based on "rationality".

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: That is an entirely different subject and quite irrelevant to the point that antivaxxers are deliberately ignoring the science of vaccinations. If you as a doctor tell a patient that they stand a chance of dying of overdose if they don't stop shooting smack, and that patient goes on ahead shooting smack, whose fault is it? The doctor has spoken in plain simple English; the patient has ignored him in plain simple English.

People who deliberately ignore the information about vaccinations aren't reachable.

Once again you've used that term without defining its parameters. Once again you loose credibility by suggesting that people should be aware of science before making healthcare choices (if that was the case the vaccination rate would go way down, not up).

Furthermore I've already clearly explained that patients who "ignore" information can be reached and I can give you plenty of literature that demonstrates that. I suggest you look on WHO.INT as it has plenty material which demonstrates this. All your contributing is your own biased uninformed conclusions based on the worst type of evidence there is - anecdotal.

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: Her "negative experience" was simply a feeling that her doctor was treating drug use with drug prescriptions. Now, that could have been the doctor's fault, it could have been hers, but automatically assuming that it's the doctor's fault has no basis in evidence.

It doesn't matter. A negative experience with a patient accessing one health service creates a barrier which can prevent them from accessing other health services. I already provided literature on this, and I can provide plenty more, and you can easily find as much as you need on WHO.INT. I didn't assume it was anyone's fault - she had a negative experience which is an indication that the healthcare service is inadequate or otherwise failed in its delivery - that's what I said, yes? I didn't put any personal blame on any one practitioner. You fix these problems by addressing the system and reforming it in a direction the provides an environment where patients feel safe, and that they are receiving the service and level of care and respect that they expect.

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: She was the drug-using child of an abusive home environment, and she felt alienated? And somehow the doctor must connect to someone who is alienated, despite the fact that he isn't a psychologist?

This does not demonstrate  your point.

That isn't what I said. Read what I said. You could have a pharmacist, or a nurse clinic, or a community health worker follow up with a patient who is alienated. I've provided plenty of avenues that can be pursued - you haven't any ideas about one.

(September 9, 2015 at 12:41 pm)Parkers Tan Wrote: Actually, in America, poor parents can receive vaccinations for their children, free of charge. You assume knowledge that you don't have in your possession, and this is one reason why we seem to be talking past each other.

I notice that you still haven't answered my point about that 5% uninoculated providing a substantial reservoir to allow for microbial evolution. At this point, I don't honestly expect an answer from you on it, so I'm going to leave this conversation, with this being my last post. You have a nice day, now.

You don't seem to be listening to what I'm saying. I am not specifically talking just about vaccines. If you provide a tiered health service model where poor patients have lower access to healthcare that they feel is important for their health then there is a positive association between them also not accessing the health services that you have made available. You cannot say "oh we're giving the poor people this so they should access it".

As to your last point - it's irrelevant. We're discussing a health service, not the "what if's" to do with what happens if someone choose not to participate in a particular service. The fact that you can't move past that tells me you're incapable of critical thought in this area - all you're doing is parroting the patient-blaming viewpoint.

(September 9, 2015 at 3:57 am)Aractus Wrote:

(September 8, 2015 at 6:55 pm)Aroura Wrote: Letting people make this choice as individuals is causing the herd immunity to drop into the mid 80's%, I think where I live it is now 83% immunized, WELL below what is safe for us as a group.

People need to realize that the good of the community IS for the good of their individual child.  So....that makes me not get your argument.  I immunize my child toprotect her, but also to protect the kid next door with bone marrow disease who cannot get immunized.  If people can't see that, then it needs to be forced on them.  Period.

The number you quoted is probably irrelevant. 83% of children would be immunised against all communicable diseases, however if you were to look disease by disease it would be higher - for example 87-89% or so. So the herd immunity is actually stronger than the 83% number would suggest.

Again there many reasons why the other 17% are not immunised. Access to affordable health care; mistrust in the healthcare system; fear of the healthcare system; children who missed getting immunised because of other reasons and who haven't been followed up on; etc. People relying on older more outdated information. People not realising there is a need. People who aren't offered the opportunity or who aren't followed-up on if they "miss" an opportunity. People who have never had a healthcare practitioner explain the needs to them.

That last point is essential - you cannot assume people will know about a need without it being effectively communicated to them from a healthcare practitioner. If practitioners don't take the time to explain to their clients why a service is needed then you cannot expect people to understand about it. You can't just run government TV advertising or put a bulletin in a school newspaper. A nurse or a doctor or a pharmacist or someone who is a healthcare practitioner needs to effectively communicate to the clients why there is a service that they feel their client should access.

Actually, I know a lot of people who refuse to immunize.  I live in Oregon.  A lot of people here think it is "unnatural" and prefer homoeopathy or naturopathy. I suppose that is distrust for organized medicine, but Oregon has very good public health care for the poor (I know, I've been homeless here and I was still able to get basic healthcare).

And our last point in response to my last point I guess is THE point.  It's all about education. I mean, a doctor can explain all day, but if the person has a distrust built in from society, then they aren't going to get anywhere. (Oh Portland, I love thee, but thou art full of unwashed hippies who will never listen to a "real" doctor!)  
I don't mean, getting a HS diploma or going to college, just general education about the necessity and safety of vaccines.  I wish there was more of that, but I wouldn't know how to even go about it.

I have noticed a growing tendency for pediatricians to actually refuse to take patients who's parents refuse to vaccinate (without a good medical reason), in order to protect their little patients who cannot vaccinate for legitimate medical reason.
It's a really hot topic where I live, and becoming more and more divisive.  I don't blame the doctors or the patients so much as I do celebrity morons who keep promoting the lies, like Jenny McCarthy.

Also, if state laws allow people to opt out of vaccinations without even giving a good reason ~Cough again OREGON~, then really, it's kind of the states fault.

Oh hey, look!  Oregon changed their laws just this very year to force people to be educated before opting out of vaccinations, and it is making a HUGE difference!

Yay, go education!!