If vaccinations are so effective, then why are some people hesitant to use them? The World Health Organization defines vaccine hesitancy as a “delay in acceptance or refusal of vaccines despite availability of vaccination services.”(NE, 2015) Many studies of vaccine hesitancy focus on parents as their decision affects the ongoing immunization rate. Vaccine hesitant parents under immunize their children instead of not immunizing them at all.
In 2019, the World Health Organization listed “vaccine hesitancy” as one of the top ten threats to global health ("Ten Threats to Global Health in 2019,"). The reluctance or decision to not vaccinate threatens to reverse progress made in stopping vaccine preventable diseases. The W.H.O. lists that vaccine preventable diseases are up worldwide by 30% and attribute vaccine hesitancy as a significant factor.
Under immunization has led to a decrease in the percentage of herd immunity below the 95% target rate for many diseases ("Vaccination coverage goals and vaccine preventable disease reduction targets by 2025," 2017). Herd immunity is a term used to describe a condition in which enough people in the general population have been immunized against a virus to make the disease less likely to be passed on to others who are not immune("Vaccines Protect Your Community,"). The herd immunity threshold is the percentage level the general population needs to be immunized at to be able to protect from outbreaks and spreading of the disease (Rose, 2015). For example, because measles is highly contagious, approximately 95% of the population must be immune to prevent others from getting sick.
To understand the scope of vaccine hesitancy and the possible causes, the World Health Organization published a study that classified the most significant influence on vaccine hesitancy as three main categories: complacency, lack of convenience, and lack of confidence (Organization, 2014). Additional surveys may better define the causes.
Lack of confidence is easily the top category. A Canadian survey reported 70% of the parent's concern was regarding the potential side effects of vaccines. Another 38% of parents incorrectly believed that a vaccine could cause the disease it was created to prevent. Only 12% of parents were hesitant due to concern over vaccine side effects.(Greenberg J, 2017) For complacency, 28% of parents did not immunize their children because of the “lack of perceived necessity of vaccines.”
Another survey regarding the M.M.R. vaccine showed 14% of parents believed the long-disproven theory that the vaccine could cause autism while another 14% were unsure if the vaccine could be the cause. Other cited concerns include vaccine additives, long-term health problems, and overwhelming the immune system (Edwards KM, 2016). These studies and surveys are concerning as they demonstrate a large portion of the public is either misinformed or uneducated regarding essential vaccine use.
In 2010, ten children died from whooping cough in California (Kathleen Winter, 2014). In the first half of 2011, the C.D.C. recorded ten measles outbreaks ("Measles Cases and Outbreaks," 2019). The largest measles outbreak occurred in Minnesota, where of the twenty-one recorded cases, seven infants were infected because they were too young to receive the vaccine. In all of these outbreaks, many children were unvaccinated because the parents were concerned about the safety of the vaccines. The herd immunity threshold had been breached, putting people who were unable to protect themselves at risk.
The United States has seen a surge in cases of whooping cough, measles, mumps, and other vaccine-preventable diseases. For instance, in the year 2000, measles was declared eradicated. However, in 2004, thirty-seven measles cases were reported. Since 2004, there has been a relatively steady pattern of measles outbreaks. The highest number of outbreaks recorded so far was 1282 cases in 2019, with 2014 having the previous high of 667 ("Measles Cases and Outbreaks," 2019). Though some of the infections were explained by waning immunity over time, the reduction of vaccine derived protection was determined to be the leading cause of the outbreaks (Liz Meszaros, 2018).
How to best address the issue of vaccine hesitancy? The W.H.O. and several countries recommend that evidence-based education and trust should be approached by ongoing community engagement, active hesitancy prevention, regular assessments of concerns, and crisis response planning ("Addressing hesitancy," 2020). The aim is to increase knowledge and awareness about the need for vaccinations.
Misinformation regarding vaccines is a significant problem, but although 63% of parents researched information about immunization on the internet, more than half of parents consider health care providers their most trusted source for information regarding vaccinations. Parents who received information about vaccines from trusted health care providers were less likely to be vaccine-hesitant. Health care workers may provide the most significant opportunity to influence a large segment of the population by educating health care providers on how to best communicate with vaccine hesitant patients ("Survey of parents on key issues related to immunization. Final report.Ottawa, ON," 2011).
In a study titled “Addressing vaccine hesitancy” published by the University of Toronto, Canada, they provide a multi-tiered approach to talking with vaccine hesitant patients/parents:
Works Cited
Addressing hesitancy. (2020). Retrieved from https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/
Anti-vaxxer. (2009). Retrieved from https://www.merriam-webster.com/dictionary/anti-vaxxer
Cynthia G. Whitney, a. o. (2014). Benefits from Immunization during the Vaccines for Children Program Era — United States, 1994-2013, MMWR. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm
Edwards KM, H. J. (2016). Committee on Practice and Ambulatory Medicine Countering vaccine hesitancy. Committee on Infectious Diseases, 138(3);e20162146(Pediatrics).
Greenberg J, D. E., Driedger M. . (2017). Vaccine hesitancy: in search of the risk communication comfort zone. PLoS, ecurrents(9).
Kathleen Winter, M., and others. (2014). Pertussis Epidemic — California, 2014. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a2.htm
Liz Meszaros, M. (2018). Deadly disease resurgence: Outbreaks linked to waning vaccine protection. Retrieved from https://www.mdlinx.com/internal-medicine/article/2851
Maron, D. F. (2017, December 2017). Fact or Fiction?: Vaccines Are Dangerous. Scientific American, 61-63.
Measles Cases and Outbreaks. (2019). Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
NE, M. (2015). SAGE Working Group on Vaccine Hesitancy Vaccine hesitancy: definition, scope and determinants. Vaccine. 33(34):4161–4.
Organization, W. H. (2014). Report of the SAGE Working Group on Vaccine Hesitancy. In: Strategic Advisory Group of Experts on Immunization.
Rose, J. (2015). The Simple Math of Herd Immunity. Retrieved from https://thoughtscapism.com/2015/04/20/the-simple-math-of-herd-immunity/
Survey of parents on key issues related to immunization. Final report.Ottawa, ON. (2011). EKOS Research Associates Inc Retrieved from www.ekospolitics.com/articles/0719.pdf
Ten Threats to Global Health in 2019. Retrieved from https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
Vaccination coverage goals and vaccine preventable disease reduction targets by 2025. (2017). Public Health Agency of Canada Retrieved from www.canada.ca/en/public-health/services/immunization-vaccine-priorities/national-immunization-strategy/vaccination-coverage-goals-vaccine-preventable-diseases-reduction-targets-2025.html?wbdisable=true#1.1.2
Vaccines Protect Your Community. Retrieved from https://www.vaccines.gov/basics/work/protection
In 2019, the World Health Organization listed “vaccine hesitancy” as one of the top ten threats to global health ("Ten Threats to Global Health in 2019,"). The reluctance or decision to not vaccinate threatens to reverse progress made in stopping vaccine preventable diseases. The W.H.O. lists that vaccine preventable diseases are up worldwide by 30% and attribute vaccine hesitancy as a significant factor.
Under immunization has led to a decrease in the percentage of herd immunity below the 95% target rate for many diseases ("Vaccination coverage goals and vaccine preventable disease reduction targets by 2025," 2017). Herd immunity is a term used to describe a condition in which enough people in the general population have been immunized against a virus to make the disease less likely to be passed on to others who are not immune("Vaccines Protect Your Community,"). The herd immunity threshold is the percentage level the general population needs to be immunized at to be able to protect from outbreaks and spreading of the disease (Rose, 2015). For example, because measles is highly contagious, approximately 95% of the population must be immune to prevent others from getting sick.
To understand the scope of vaccine hesitancy and the possible causes, the World Health Organization published a study that classified the most significant influence on vaccine hesitancy as three main categories: complacency, lack of convenience, and lack of confidence (Organization, 2014). Additional surveys may better define the causes.
Lack of confidence is easily the top category. A Canadian survey reported 70% of the parent's concern was regarding the potential side effects of vaccines. Another 38% of parents incorrectly believed that a vaccine could cause the disease it was created to prevent. Only 12% of parents were hesitant due to concern over vaccine side effects.(Greenberg J, 2017) For complacency, 28% of parents did not immunize their children because of the “lack of perceived necessity of vaccines.”
Another survey regarding the M.M.R. vaccine showed 14% of parents believed the long-disproven theory that the vaccine could cause autism while another 14% were unsure if the vaccine could be the cause. Other cited concerns include vaccine additives, long-term health problems, and overwhelming the immune system (Edwards KM, 2016). These studies and surveys are concerning as they demonstrate a large portion of the public is either misinformed or uneducated regarding essential vaccine use.
In 2010, ten children died from whooping cough in California (Kathleen Winter, 2014). In the first half of 2011, the C.D.C. recorded ten measles outbreaks ("Measles Cases and Outbreaks," 2019). The largest measles outbreak occurred in Minnesota, where of the twenty-one recorded cases, seven infants were infected because they were too young to receive the vaccine. In all of these outbreaks, many children were unvaccinated because the parents were concerned about the safety of the vaccines. The herd immunity threshold had been breached, putting people who were unable to protect themselves at risk.
The United States has seen a surge in cases of whooping cough, measles, mumps, and other vaccine-preventable diseases. For instance, in the year 2000, measles was declared eradicated. However, in 2004, thirty-seven measles cases were reported. Since 2004, there has been a relatively steady pattern of measles outbreaks. The highest number of outbreaks recorded so far was 1282 cases in 2019, with 2014 having the previous high of 667 ("Measles Cases and Outbreaks," 2019). Though some of the infections were explained by waning immunity over time, the reduction of vaccine derived protection was determined to be the leading cause of the outbreaks (Liz Meszaros, 2018).
How to best address the issue of vaccine hesitancy? The W.H.O. and several countries recommend that evidence-based education and trust should be approached by ongoing community engagement, active hesitancy prevention, regular assessments of concerns, and crisis response planning ("Addressing hesitancy," 2020). The aim is to increase knowledge and awareness about the need for vaccinations.
Misinformation regarding vaccines is a significant problem, but although 63% of parents researched information about immunization on the internet, more than half of parents consider health care providers their most trusted source for information regarding vaccinations. Parents who received information about vaccines from trusted health care providers were less likely to be vaccine-hesitant. Health care workers may provide the most significant opportunity to influence a large segment of the population by educating health care providers on how to best communicate with vaccine hesitant patients ("Survey of parents on key issues related to immunization. Final report.Ottawa, ON," 2011).
In a study titled “Addressing vaccine hesitancy” published by the University of Toronto, Canada, they provide a multi-tiered approach to talking with vaccine hesitant patients/parents:
- “Start the conversation on vaccination using a presumptive approach.
- If parents are still unsure, continue the conversation on vaccination, address concerns, and make a strong recommendation.
- Describe the benefits of vaccines.
- Describe the side effects.”
Works Cited
Addressing hesitancy. (2020). Retrieved from https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/
Anti-vaxxer. (2009). Retrieved from https://www.merriam-webster.com/dictionary/anti-vaxxer
Cynthia G. Whitney, a. o. (2014). Benefits from Immunization during the Vaccines for Children Program Era — United States, 1994-2013, MMWR. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm
Edwards KM, H. J. (2016). Committee on Practice and Ambulatory Medicine Countering vaccine hesitancy. Committee on Infectious Diseases, 138(3);e20162146(Pediatrics).
Greenberg J, D. E., Driedger M. . (2017). Vaccine hesitancy: in search of the risk communication comfort zone. PLoS, ecurrents(9).
Kathleen Winter, M., and others. (2014). Pertussis Epidemic — California, 2014. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a2.htm
Liz Meszaros, M. (2018). Deadly disease resurgence: Outbreaks linked to waning vaccine protection. Retrieved from https://www.mdlinx.com/internal-medicine/article/2851
Maron, D. F. (2017, December 2017). Fact or Fiction?: Vaccines Are Dangerous. Scientific American, 61-63.
Measles Cases and Outbreaks. (2019). Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
NE, M. (2015). SAGE Working Group on Vaccine Hesitancy Vaccine hesitancy: definition, scope and determinants. Vaccine. 33(34):4161–4.
Organization, W. H. (2014). Report of the SAGE Working Group on Vaccine Hesitancy. In: Strategic Advisory Group of Experts on Immunization.
Rose, J. (2015). The Simple Math of Herd Immunity. Retrieved from https://thoughtscapism.com/2015/04/20/the-simple-math-of-herd-immunity/
Survey of parents on key issues related to immunization. Final report.Ottawa, ON. (2011). EKOS Research Associates Inc Retrieved from www.ekospolitics.com/articles/0719.pdf
Ten Threats to Global Health in 2019. Retrieved from https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
Vaccination coverage goals and vaccine preventable disease reduction targets by 2025. (2017). Public Health Agency of Canada Retrieved from www.canada.ca/en/public-health/services/immunization-vaccine-priorities/national-immunization-strategy/vaccination-coverage-goals-vaccine-preventable-diseases-reduction-targets-2025.html?wbdisable=true#1.1.2
Vaccines Protect Your Community. Retrieved from https://www.vaccines.gov/basics/work/protection