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Every year, the World Health Organization lists their top ten threats to world health. In 2019, the WHO yearly list included air pollution and climate change, noncommunicable diseases, influenza, antimicrobial resistance, and vaccine hesitancy (Ten health issues WHO will tackle this year).Vaccine hesitancy is defined as “a delay in acceptance or refusal of vaccines despite availability of vaccination services” (The Lancet Child & Adolescent Health). The beliefs behind vaccine opposition are that vaccines are infective, vaccination is a patriarchal, governmental invention, they are unnatural and other natural ways should be used to fight against diseases, and their danger is being undermined by health systems and government institutions (Rossen, Hurlstone, Dunlop, & Lawrence, 2019). Around 90% of countries in the world are affected by vaccine hesitancy, such as developing economies of India and China, in growing economies such as Greece, Vietnam, and Saudi Arabia, and high-income countries such as the United States (Shukla, 2019). There are many offered solutions to combat vaccine hesitancy, but the most effective solution is done with the combination of the physician level and community level. A combination of informed physicians and tailored community programs could help address the global health threat.
While the history of vaccination started began as early as 10th century B.C. in China where inoculations were first recorded, vaccination became mandatory in 1853 when England implemented an act ordering mandatory vaccination (Kate, et al., 2019). Vaccines are among the greatest public health achievements in health and medicine (Edwards & Hackell, 2016) “Anti-vaxxers”, the colloquial term for those who refuse vaccines, have been in existence since The Vaccination Act of 1853. The issue of vaccine hesitancy is nothing new, but it has become a global pandemic in recent years, with its appearance on the World Health Organization’s list of top threats worldwide. In Canada, there is about 3% of parents who refused vaccinations for their children but more than three times of parents consider themselves vaccine hesitant (Shen & Dubey, 2019). A study was conducted in 15 countries to assess responses regarding vaccine hesitancy, among them being Panama, Zimbabwe, Saudi Arabia, Yemen, Armenia, Belgium, India, Japan, Malaysia, and the Philippines. The study does not name each country specifically to their perspective but common perspectives of vaccine hesitancy in these countries were: vaccine hesitancy is linked to particular geographic groups rather than an issue for the whole country, the there is a lack of perceived benefit of vaccination, the influence of “Internet stories”, and religious groups who do not believe in the benefit of vaccines (Dubé, Gagnon, Nickels, Jeram, & Shuster, 2014). These mentioned subgroups are not uniform across the entire world, therefore appropriate intervention to combat vaccine hesitancy should be individualized to areas. The most effective solutions include a trusting and educated physician, as well as community wide programs that address specific questions and concerns (Leask, Willaby, & Kaufman, 2014).
The prevalence of vaccine hesitancy in the world shows that public acceptance of anything, even those scientifically proven over the course of many decades, isn’t automatically a given. There are multiple solutions to combat vaccine hesitancy, but the safest and most effective way include emphasizing the importance of healthcare rpvodiers, as well as implementing immunization programs that are tailored to the specific demographic. Parents reject or accept a vaccine depending on provider interaction. Physicians should be available and able to address specific questions from parents regarding vaccines, whether it be about its composition or production (Edwards & Hackell, 2016). Nurses and alternative medicine practitioners are also crucial voices in vaccine decision making as well and should also able to ask any questions that concerned parents have. There are online vaccination sources that can be utilized by health care providers in order to provide update to date data (Shen & Dubey, 2019). Physician-patient communication is a vital and relatively cost-effective way to combat vaccine hesitancy, though it is not a fool proof solution. Physicians are generally only available during doctors’ appointments and the hesitancy to vaccines could mean that people are already hesitant to go to the doctor. This is best combined with a community-based intervention.
Social interactions are just as important to addressing vaccine hesitancy as provider interactions. Vaccine hesitancy or rejection is often specified to clusters in communities with alternative or religious views. Solutions and programs should be specifically tailored to these specific clusters. These community-based interventions are used to “build try and increase community participation in populations that are difficult to reach with mass media or standard health services” (Leask, Willaby, & Kaufman, 2014). In 2011, the European Technical Advisory Group of Experts on Immunization pushed for a program, called Tailoring Immunization Programmes (TIP) in order to develop strategies to promote infant and child vaccination to increase immunizations and decreasing the risk of diseases in that region. TIP has been applied to Bulgaria, Sweden, and the United Kingdom. When a serious measles outbreak occurred in Bulgaria between 2009 and 2011 resulting in 24 deaths and almost 25,000 cases, TIP was utilized to develop three strategic solutions to address hesitancy. These strategies were to strengthen the role of health mediators and support medical practitioners, promote trustworthy information and sources regarding child vaccination, and improve relations between medical practitioner and parent/guardian (Butler & Macdonald, 2015). If TIP were implemented on a global level, it must be developed specifically to regions; training, supplies, and lessons should all be individualized. The World Health Organization already supports the implementation of TIP globally but its specifics have not been developed. This solution combines the utilization of community participation and physician/patient relationships.
Vaccine hesitancy is not a modern problem, but its prevalence in the 21st century has had modern causes. Webpages and social media have been a source of false information and travels quicker than in previous generations. This questionable information is being shared between families and friends, with personal beliefs and lack of knowledge affecting the trust of vaccines in a negative way. The social media age has had a significant affect on the lack of confidence in vaccines, one of the reasons why people choose not to vaccinate. In middle-to-lower-income countries also have the issue of the inconvenience in accessing vaccines. In order to combat the many issues causing vaccine hesitancy, solutions must be specific to the area where vaccine hesitancy is being addressed. There is no cookie cutter way to solve this global issue, especially because of the various economies and societies where vaccine hesitancy needs to be addressed. Vaccine hesitancy is threatening to reverse the historical scientific achievements spanning centuries in reducing the spread of diseases, as well as eradicating sicknesses that were once prevalent. The collaborative solutions between highlighting the importance of provider and patient as well as community-based interventions would hopefully keep the scientific advancements of vaccination going. Failing to do so would continue to greatly affect the future health of children, immunocompromised people, and even simply healthy adults.
References
- Butler, R., & Macdonald, N. E. (2015). Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine, 33(34), 4176–4179. doi: 10.1016/j.vaccine.2015.04.038
- Dubé, E., Gagnon, D., Nickels, E., Jeram, S., & Schuster, M. (2014). Mapping vaccine hesitancy—Country-specific characteristics of a global phenomenon. Vaccine, 32(49), 6649–6654. doi: 10.1016/j.vaccine.2014.09.039
- Edwards, K. M., & Hackell, J. M. (2016, September 1). Countering Vaccine Hesitancy. Retrieved from https://pediatrics.aappublications.org/content/early/2016/08/25/peds.2016-2146.
- Kate, Ozkurt, I., Evan, Than, B., Dobson, P., Pendse, M. B., … Brookings Institution. (2019, September 11). The anti-vaccination movement. Retrieved from https://measlesrubellainitiative.org/anti-vaccination-movement/.
- Leask, J., Willaby, H. W., & Kaufman, J. (2014). The big picture in addressing vaccine hesitancy. Human Vaccines & Immunotherapeutics, 10(9), 2600–2602. doi: 10.4161/hv.29725
- Rossen, I., Hurlstone, M., Dunlop, P., & Lawrence, C. (2019). Accepters, fence sitters, or rejecters: Moral profiles of vaccination attitudes. Social Science & Medicine, 224, 23–27. https://doi.org/10.1016/j.socscimed.2019.01.038
- Shen, S. C., & Dubey, V. (2019, March). Addressing vaccine hesitancy: Clinical guidance for primary care physicians working with parents. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515949/.
- Shukla, M. (2019, March 12). The Global Threat of Vaccine Hesitancy. Retrieved from https://yaleglobal.yale.edu/content/global-threat-vaccine-hesitancy.
- Ten health issues WHO will tackle this year. (n.d.). Retrieved from https://www.who.int/emergencies/ten-threats-to-global-health-in-2019.
- The Lancet Child & Adolescent Health. (2019). Vaccine hesitancy: a generation at risk. The Lancet Child & Adolescent Health, 3(5), 281. doi: 10.1016/s2352-4642(19)30092-6
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