I'm very fortunate to live in a great part of the world, near Fremantle in Western Australia. I'm also very fortunate that there's proactive people here who are very concerned about vaccination rates—and are willing to try outreach in a number of different ways. For this interview, I talked to Dr. Katie Attwell, of "I Immunise."
Fremantle contains a number of families who practice what might be regarded as alternative parenting. It is not unusual to see a mother breastfeeding a toddler. Many parents wear their babies and use cloth nappies. These practices are in keeping with Fremantle’s reputation for being clean, green and forward thinking.
Parents within this community seek to make informed and ethical decisions regarding their children and lifestyles. However, concerns, scepticism and outright opposition to vaccines can be pervasive, and are spread through shared social networks in which they can appear the norm.
When parents elect not to immunise their children, this affects those around them who may become vulnerable to disease due to insufficient herd immunity. At risk are newborn babies too young to be immunised, and individuals whose immune systems are compromised by disease or chemotherapy.
The I Immunise campaign was formulated by a member of this community, and addresses parents who identify with natural birthing, breastfeeding and healthy living.
Kylie Sturgess: I'm here with Dr. Katie Attwell. Firstly, tell me about yourself, and why are you interested in public health?
Katie Attwell: I fell into it, actually. My background is in political science. That's what my PhD is in. That's what my main job is. I'm a politics lecturer at Murdoch University.
My passion for this really came through being a parent and finding myself amongst a community where I felt that many people were anti‑vaccination or were skeptical about vaccination. That led me to feel quite vulnerable for the well‑being of my children, particularly my newborn baby. Also, it led me to become quite passionate about the issue and to want to speak out about it.
Kylie: How did the Immunisation Alliance of Western Australia begin?
Katie: It began well before my involvement. I was actually recruited to join the organization after writing an opinion piece in the Fremantle Herald—basically castigating my community for not immunising!
The Alliance itself began in 2007, I think it was. It was the brainchild of someone who was working for the Health Department at the time, who recognised that there were similar organizations in America of communities who were in favor of immunisation and were actually working to counter the anti‑vax voices out there.
Health prodded the organization along, but the membership was always interested individuals being involved in their private capacity. Over time, the relationship between the Department of Health and the Alliance has grown more distant, in a good way, in that for us it's really important that we be an organization that stands on its own two feet and can be independent from everybody.
Obviously, our core membership and active membership has changed over that time as well. The current people who are involved and in leadership roles, they're pretty much all parents. People are many things as well as being parents. Our chair is a UWA professor. Other people involved are scientists.
A lot of people tend to have a nursing background that tend to go into other health avenues, so we've got some people from that background. We have people who are purely parents and concerned citizens. It’s quite a diverse group of people, but we're all very passionate about immunisation.
We have a number of aims. Obviously, we want to provide that voice that says vaccination is safe, effective, and a public good. We see that there are different functions that we can have as an organization, and we're still very much growing and developing. We would like to eventually be the group that people come to if they want public comment on immunisation and issues as they arise in the media.
We'd like to be able to talk about them; we'd like to be able to make ourselves known. But we're also a resource that people can come to with their questions as well.
Kylie: You mentioned anti‑vaccination voices. What are some of the issues facing Australia regarding immunisation? Are there any particular concerns to WA?
Katie: Do you mean the people that are worried about immunisation, or do you mean the people that...
Kylie: It could be either, couldn't it? It could be someone who has doubts, as you said skeptical in a sense, in terms of they're not so sure about all the facts or what's going on here. Or those who have a firm stance, say, “No, I firmly think this, and I think I have the evidence to back this up to say no to immunisation.” What's the difference? I imagine you have people who respond differently. What's it like?
Katie: Across Australia, obviously, the former organization formerly known as the Australian Vaccination Network, or the anti‑vaccination network as some of us call them, they spread a particular line. They are quite effective in doing that.
They and their ilk seem to capture a certain cohort of people who are embracing natural living. They're very health conscious. They're very skeptical about the interests represented by government, by the pharmaceutical industry, so they are doubtful that the immunisation schedule is designed to work in people's favor. That's your kind of hardcore, rusted‑on anti‑vaxers.
I don't find it particularly useful to engage with people like that. Look, given the opportunity to have a real, genuine discussion and not just a screaming match, then yes.
Kylie: Which is difficult sometimes, I know, especially with the Internet!
Katie: It is, it is! As an example, I'm running this public health campaign at the moment, which I'll talk about in a second.
I rang a yoga teacher in the Fremantle area to see whether she would be interested in displaying the posters, which are of course pro‑immunisation, but which are targeting that cohort that I was talking about—natural living and health‑conscious. I don't like to say hippies, because I don't really think of myself as a hippy, but yeah, I follow some of those practices as well!
I phoned her and said, “Would you be interested in displaying this poster?” I explained a bit more about who I was and the organization I was from.
She was like, “Oh, these posters are pro‑immunisation!”
I said, “Yes.” The reason I was slightly hopeful is that my yoga teacher is pro‑immunisation. It was actually through talking with her that I got the idea for this campaign. I was delighted to know there were people out there that shared my values and my lifestyle interests as well.
Kylie: Stereotypes don't stack up all the time.
Katie: Yeah, indeed. But this yoga teacher who I talked to on the phone then proceeded to say, “Oh, no. I wouldn't want to display the poster. I don't think that at all. I don't agree with immunisation at all.” Then she said to me, “Have you looked into it?”
I said, “Yes, yes, I have.” I just thought, “Oh, God. What kind of conversation can I even have with this person?”
The trouble is that most of the anti‑immunisation case is built on junk science. It's built on a house of cards. That's not to say that pharmaceutical companies are squeaky‑clean. That's not to say that there are not problems. That's not to say that vaccines don't come with a risk. Of course they do.
It's just that I, the Immunisation Alliance, and indeed the majority of the population believes that that risk is worth taking, because the alternative is so much worse. The alternative is death and destruction on a large scale. People become very complacent when they're not faced with that.
If many people were obliged to travel to other parts of the world where immunisation is not practiced and not funded by government, they would probably feel rather vulnerable about whether their homeopathic vaccines would protect them or whether their hand‑washing and breastfeeding would really keep their children safe.
Kylie: You're taking proactive steps—things such as posters, reaching out to groups that might not normally be open to the discussion, and perhaps trying to catch some attention for the group and for the messages. How do you deal with misconceptions without alienating or insulting people?
Katie: That's a good question. This particular campaign that I'm talking with you about tonight is called the “I Immunise” campaign. That's one of only three particular projects that the alliance is running.
Kylie: One of three? That's huge. That's massive. Wow.
Katie: It's the one that's my job to run, so it's the one that I'm utterly consumed by. I'll just briefly tell you that we have a couple of others, because that will give you an idea of the scope of what we do.
We're running an Aboriginal‑indigenous project, which has its own project officer, as well. Her job is to consult with community and people here in the metro area in Perth, and develop a resource that's going to assist local Aboriginal people with accessing immunisations.
The rates for Aboriginal people in WA and in Perth are lower than the national average. Obviously, there's a completely different set of barriers that is preventing them from accessing immunisation. The job of that particular project is to suss out what some of those barriers are and come up with a resource that's going to help people get access.
Access can be informed by many factors. Obviously, it's not our job to design and deliver the system, the schedule. Our job is to say if there's anything that can be done to help people get into wherever those places are, that prompts that to be something in the forefront of their minds. That's where we want to come in with that.
A second project is a book project. One of our members has a background in commercial writing. She's written a children's book, using the correct technical terms. Her big thing was, she didn't want to dumb it down. We're getting illustrations done, and we're getting a certain amount produced, which will go out as a pilot to schools in WA.
I'm not exactly sure on the delivery data of that, but it's not in the next two or three months. It will be a little while away. That's another project.
Then there's my project, which is “I Immunise.” My project, as I mentioned earlier, really grew out of my politicisation around vaccines. It grew out of my feeling of alienation and frustration with my community.
I had a home birth with my second child. I wasn't a massively long‑term breast feeder, but longer than most. I used cloth nappies with my second child and wore both of my children. With my second child in particular, because I had him at home, I became not more radical—that's not the right word—but less mainstream I suppose.
With my first child, I used disposable nappies and a dummy. I obviously still breastfed and still wore her, but I wanted too…
Kylie: Try a different approach.
Katie: Yes, but what I was aware of was that I was shifted away from the mainstream by my peers and that I was exposed to new practices that I was attracted to and had been attracted to but had not yet been game to try out. Sitting with it there and having a new friend explain how cloth nappies work, how you wash them, how you look after them.
I'm not the kind of person who actually likes to read a lot of stuff, especially on the computer. If I want to learn something, I like to learn by talking. My peers in my community taught me how to do things like that. Baby wearers can be really frightening—I don't mean the people, I mean the structures, the garments, can be quite frightening!
There were wonderful people, just friends, or friends of friends, who could help me learn all those things. I became very aware, as I was shifted away from the mainstream, how much I valued what my peers taught me, and how there would be certain experts on certain things. Maybe in some ways I enjoyed becoming the cloth nappy expert after that to new friends having babies.
I learned that we are herd animals. Even those of us who are not in the mainstream, we are herd animals, too. What frightened me about my new herd was, when the topic of immunisation came up, I was pretty much the only voice in the room in favor. That really frightened me, and I became quite emotional.
The question I was asking myself was, “Aren't we supposed to be ethical? Aren't we supposed to be concerned about the world around us? Aren't we supposed to be concerned about the well‑being of other people?” I know parents and parents of young babies; you're incredibly focused on your own infant and your own family. That is the most important thing in the world to you.
But you're not using cloth nappies because your baby is going to be so much better off. You're using cloth nappies because you don't want a pile of nappies in a landfill somewhere with your name on them. You're actually connecting and thinking about the world around you, the world you're leaving behind.
This is what the opinion piece was about that I wrote and was published in theFremantle Herald. It was saying I don't really understand why immunisation is actually something that people are avoiding and staying away from, when to me it's entirely in keeping with being an ethical person, living an ethical life, and living by one's values.
I especially felt that because I felt that people were hiding inside the herd. They were hiding inside the herd of the “boring mainstream people” who don't think about anything, and just buy their Huggies and use their dummies.
Kylie: Go along with the status quo and don't think about being green.
Katie: I actually felt that was pretty low to free-ride off people, who one believed (simultaneously) to be superior to. I felt there was something a bit off about that. That was what drove my particular passion. I had this idea forming in my mind for a long time, and I shared it with the Immunisation Alliance, when I'd been involved for around a year.
I remember being at a planning meeting and drawing a poster. It was just a terrible line drawing on a whiteboard of my yoga teacher. It just talked about her and said that she was a yoga teacher, that she home‑birthed, and then it said that she immunised.
Although she didn't end up being in the campaign, that's what the campaign now is. It features six individuals, one of whom is me. I advertised through social media for these people. Several of them I knew anyway.
We, as a cohort, share what we do. On these posters, we talk about what we do. We all do different things. To the extent that we identify as alternative, we do that in different ways, but we definitely are appealing to a certain identity or a certain lifestyle of person. We're saying, “We do all this stuff that you do and that you value, and we immunise our children. We value that, too, and this is why.”
The “This is why...” component will be found on our website. The posters just list what we do and say that we immunise. Then you go to the website and you find out why.
Kylie: It's a multifaceted approach that you've got here. Not only are you caring about indigenous health, you're looking at the perspective of children; but then you've also got that personal touch, as well. Looking at what connects us rather than having the idea of the faceless scientist saying, “Put jabs into yourself. I know what's best for you!”
Katie: That's really important. I remember watching a documentary that was really an anti‑vax documentary, which was American. I can't remember its name, but I believe it was available free on the Internet and may still be.
It purported to be representing both sides, but the reason I was so clear that it wasn't was that the anti side was represented in these terrible personal stories that were not, I should add, always verified by scientists.
Yes, vaccine injuries do occur. Of course, they're horrible stories for anybody to see and hear. But not everyone in it was vaccine‑injured in the way that would be recognized, understood, and verified. The only people talking the pro side were these talking heads—scientists and doctors.
The Alliance and this campaign are so incredibly important because the pro side of vaccines has a human face. It's mostly really banal. It's, “Look! Look at my two healthy children!” What a non‑story! But it's the most important story because they're safe, they're protected, and they're protecting everybody else.
For me it's really, really important that the community claims this space. That's why even though things like “No jab, no play,” and the campaigns that are taken up by often your more populist media. Even though they can have quite a snipey tone or a supposed anti‑elite tone, and even though they can be divisive, ultimately I'm not sure that they are effective, and I suspect they're possibly not effective.
Despite all of that, I nevertheless can't help but warm to them because to me it's the herd speaking up. It's the herd saying we do have to look after each other.
Kylie: We care…
Katie: Yeah, we care and we have a responsibility. That is a human story, and I really connect to that.
Kylie: What's up next for the Immunisation Alliance of Western Australia?
Katie: Well, it's going to be a big year for us because all our campaigns will be rolling out in 2014.
Kylie: Wow! It's going to be a busy year!
Katie: Yeah, it is. We've been through a lot of ups and downs as an organization. We have staff now, but for a long time we didn't. A lot of hard work is done by volunteers. The leadership and management of our organization is all done by people not just who are volunteers but who have huge day jobs—hugely important and stressful day jobs.
Our future is, hopefully, continuing to grow. We are always looking for new members in the community. We meet once a month in Cockburn Central, which is on the train line. We meet in the evening. People who want to get involved don't necessarily have to be able to commit to come to those meetings, although it would be awesome if they did. Seriously, when I got involved I was a mum of two, I was doing my PhD, I was also teaching at university.
Kylie: Were you super woman as well? Oh my god!
Katie: No, I really wasn't! They kept saying, “Just come to a meeting, just come.”
I was like, “Look, I really can't. I really can't put my hand up and do anything else,”
Then finally I thought, “You know what, I'm never going to be less busy. I'm never going to have more time.” I used to go to one two‑hour meeting a month.
I didn't do anything outside of that time. I barely looked at the emails. I just went along. For those two hours a month, I learned. I talked to people. I listened as we sit around and talk at the table. This is what we try to do with our new members as well.
I'm not an expert in vaccines or anything, but we try and share the knowledge that we have. Literally, for me it was such a small investment of my time. It's grown into something personally so satisfying and so awesome for me. Many great opportunities have come to me having been involved.
I would urge any of your readers who are in Western Australia and who are passionate about this issue to consider coming along to one of our meetings and seeing what we do. It could be that small a commitment. We make a lot of important decisions around that table. You wonder how much you could possibly do in two hours a month, but because we now have staff who can do the doing of our work, then being part of that brain trust is a really great opportunity.