Vaccination hesitancy: a generation at risk
Immunization hesitancy, which is defined by the WHO as “a delay in accepting or refusing vaccines despite the availability of immunization services,” has been reported in more than 90% of countries worldwide. In many areas, vaccination against measles, a vaccine-preventable disease that was largely eliminated following the widespread use of the measles-mumps-rubella (MMR) vaccine, has declined to below the threshold of 95% set by the WHO as that required for herd immunity. .
In the UK, for example, MMR vaccine coverage fell to 91.2%, the fourth consecutive annual decline and its lowest level since 2011-2012. In the United States, the percentage of children aged 19-35 months who received the MMR vaccine decreased slightly from 91.6% in 2011 to 91.5% in 2017, with very low coverage rates reported in some communities (for example, 60% among ultra-Orthodox Jews in New York State where a measles outbreak is ongoing). Similar trends elsewhere have led to a 30% increase in measles cases worldwide – even in countries like the United States, where measles was eradicated in 2000 – prompting the WHO to declare vaccine hesitancy as one of the ten greatest threats to global health.
Pediatricians and family physicians have a key role to play in helping parents appreciate the benefits of vaccination; physician opinion was found to be the strongest predictor of vaccine acceptance. All child health workers should promote vaccination – conflicting advice from health professionals is particularly damaging – and should have enough time with each family to do so effectively. A clear presentation of the risks that delaying or refusing vaccination could pose to the child is essential to help parents understand how critical their decision is. As Michael Gannon, President of the Australian Medical Association, has said, children “are 10,000 times more likely to suffer brain damage from measles than […] by vaccination. To support health workers, WHO has developed training modules to build the capacity to engage in difficult conversations with hesitant caregivers. Vaccine hesitancy can be difficult for pediatricians to understand, but when interacting with vaccine hesitant parents, it is important to remember that their children’s health is their primary concern.
Vaccine hesitancy cannot be addressed by paediatricians alone: governments and health policy makers also play a critical role in vaccination promotion, public education and policy implementation that reduce the public health risks associated with vaccine hesitancy. WHO/Europe has created the Adaptation guide for immunization programs which takes into account the need to adapt any intervention to take into account the various reasons why parents are reluctant to have their children vaccinated. Some countries have implemented specific penalties for these families, and school entry requirements, including specific vaccinations, have been standard public health practice for many years. France has made vaccination with 11 vaccines compulsory for children – unvaccinated children cannot be enrolled in nurseries or schools. In Australia, parents of children who are not vaccinated are denied universal child benefit.
Media platforms (including social media) have been influential in spreading vaccine hesitancy. As Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said during a US congressional hearing in February, the main problem with vaccine hesitancy is misinformation. Vaccine-hesitant parents are generally more active in seeking information online than vaccine-compliant parents, and are susceptible to unverified reports of adverse effects of vaccination and scare tactics promoted by anti-vaccination activists . Aware of this issue, Kyle Yasuda, president of the American Academy of Paediatrics, contacted the CEOs of Google, Facebook and Pinterest asking them to partner with the Academy to ensure that parents using their platforms only see credible, science-based information. . In response, Facebook announced that groups and pages that share misinformation about vaccines would be removed from its recommendation algorithm. Such partnerships are crucial to enable widespread promotion of evidence-based information explaining the benefits of vaccination.
Vaccine hesitancy threatens historic achievements in reducing the burden of infectious disease that have plagued humanity for centuries. Only a collaborative effort between pediatricians, family doctors, parents, public health officials, governments, the technology sector and civil society will dispel myths and misinformation around vaccination. If we fail, the future health of unvaccinated children and their communities will suffer greatly.
© 2019 Elsevier Ltd. All rights reserved.
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