Vaccine Hesitancy – Meaning, Factors, Solutions

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In recent years, there is a significant increase in the measles cases at the global level. This is mainly attributed to the increase in the vaccine hesitancy. This led to the World Health Organisation to declare “vaccine hesitancy” as one of the 10 deadly threats to global health in 2019. Yet, it still remains a threat to the international community given the increasing misinformation in the current Information Age.

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What is the vaccine hesitancy?

  • Vaccine hesitancy refers to the delay in acceptance or refusal of vaccines despite the availability of vaccination services.
  • It complex and context-specific and varies across time, place and vaccines.
  • It is influenced by factors like complacency, convenience and confidence.

Why has WHO included it as one of the threats to global health in 2019?

  • Globally, there was a 30% increase in measles cases in 2018.
  • Therefore, the World Health Organisation (WHO), in January 2019, had included “vaccination hesitancy” as one of the 10 threats to global health last year.
  • After the increase in the measles cases in 2018, there have been around 3,65,000 measles cases reported from 182 countries in the first 6 months of 2019.
  • The highest increase, of 900% in the first six months in 2019 compared with the same period in 2018, has been from the WHO African region, with the Democratic Republic of the Congo, Madagascar and Nigeria having the majority of these cases.
  • There has been a sharp increase in the WHO European Region, with 90,000 cases recorded in the first 6 months of 2019. This is more than the numbers recorded for the whole of 2018.
  • In recent years, there has been an unprecedented increase in the spread of infection in the European region. There were 1,74,000 cases from 49 of the 53 countries between January 2018 and June 2019.
  • By mid-November 2019, over 4,00,000 cases were reported globally.
  • Since measles surveillance is generally weak, WHO and other organisations have resorted to estimating the number of measles cases and deaths.
  • Based on the updated estimation model, there have been nearly 10 million cases and over 1,42,000 measles deaths in 2018.
  • In 2018, the Democratic Republic of the Congo, Liberia, Madagascar, Somalia and Ukraine accounted for 45% of all the reported cases.
  • The situation worsened in Congo in November with a nearly four-fold increase in cases.
  • The reasons behind the increased spread of measles in Congo are low institutional trust, misinformation, vaccine shortage and measles attacks on healthcare centres and workers.

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What is measles?

  • Measles is a highly contagious disease caused by the paramyxovirus family
  • According to the World Health Organisation, the measles cases rose 300% globally in the first three months of 2019 when compared to the same period in 2018.
  • The most measles-related deaths are due to the complications associated with the disease. The most serious of these complications include blindness, encephalitis (swelling of the brain), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections like pneumonia.
  • It is most common in children below the age of 5 and the adults above the age of 30.
  • The poorly nourished young children, especially those with vitamin A deficiency or weak immune system due to HIV/AIDS or other diseases are highly vulnerable to this disease.
  • The major cause of death among children is respiratory disease measles.
  • Immunisation through vaccines is vital, as many children do not have sufficient immunity if exposed to measles.
  • During the first few weeks after exposure to measles, the child’s immune system is weakened, making even normal cold or diarrhoea a deadly illness.

Why is there vaccination hesitancy?

Lack of awareness:

  • A 2018 report on the vaccination confidence among the EU member states found that the younger people (18-34 years) and those with less education are less likely to agree that the measles, mumps and rubella (MMR) vaccine is safe.
  • According to a March 2019 report, only 52% of the respondents from 28 EU states agree that the vaccines are effective in preventing diseases, while 33% felt that the vaccines are probably effective.
  • About 48% of the respondents believed that the vaccines cause serious side effects and 38% think vaccines actually cause the disease they are supposed to protect against.

Misinformation:

  • In India, a 2018 study found that low awareness was the main cause behind the 45% of the children missing different vaccinations in 121 Indian districts that have higher rates of unimmunised children.
  • While 24% did not get vaccinated due to apprehension about the harmful effects, 11% were reluctant to get immunised due to reasons other than the fear of adverse effects.
  • Social Media in this context is playing a crucial role in spreading vaccine disinformation.

The Philippines and Samoa:

  • The two nations serve as a textbook case of the sudden increase in vaccine hesitancy.
  • Mass immunisation using the newly approved dengue vaccine was initiated in the Philippines before the manufacturer reported the risk associated with the vaccine. This led to the public mistrust in vaccines. This subsequently resulted in the low vaccine coverage, leading to the outbreaks of measles and polio.
  • In Samoa, an error in preparing the MMR injection led to the death of two infants.
  • Fear-mongering led to the fall in the vaccine uptake, leading to the measles outbreak.

Religious beliefs and fake news:

  • In many European countries and the US, the vaccine hesitancy has been on religious grounds.
  • The numerous anti-vaccination campaigns spreading fake news about vaccine safety are also preventing the people from getting the immunisation.

India:

  • Vaccine hesitancy is a concern for India.
  • For example, there was a five times low uptake of oral polio vaccine in the early 2000s among the poor Muslim communities in Uttar Pradesh due to the fear and misconception that the polio vaccine was ineffective and caused illness and infertility.
  • Similarly, in 2016, Muslim communities in two districts in north Kerala reported low uptake of diphtheria vaccine. One of the reasons behind this is propaganda that the vaccine may contain microbes, chemicals and animal-derived products which are forbidden by the Islamic Law.
  • Tamil Nadu and Karnataka, which have traditionally seen high vaccine acceptance, witnessed low uptake in the measles-rubella vaccine when it was introduced in 2017 due to the fear of adverse effects that had spread through social media.
  • The December 2018 found that nearly a quarter of parents did not vaccinate their children out of a fear of adverse events in 121 high priority districts chosen the Health Ministry for intensified immunisation drive to increase the vaccination coverage.

What are the benefits of vaccines?

  • According to the World Health Organisation, vaccination prevents 2-3 million deaths annually.
  • Vaccination protects the children from preventable diseases which can lead to amputation, paralysis of limbs, hearing loss, convulsion and even death.
  • A 2017 study that analysed the flu seasons between 2010 and 2014 found that vaccination reduced deaths by 65% among healthy children.
  • Immunisation through vaccines can prevent hospitalisation, reduce the expenditure related to hospitalisation and can prevent and reduce severe illnesses.

What can be the way forward?

Making vaccination mandatory:

  • Several countries had made immunisation mandatory. If not taken, those not immunised will not be eligible for certain benefits.
  • This has proven to be an efficient way to deal with the fear of vaccination.
  • For instance, France has made vaccination with 11 vaccines mandatory for children. If the children are not vaccinated, they cannot be enrolled in the nurseries or schools.
  • In Australia, the parents of the unvaccinated children are denied the Universal Family Allowance Welfare payments.

Winning the public’s trust:

  • Vaccine manufacturers must provide honest information about the side effects as well as the benefits of the vaccines so that the public are given factual information.
  • The vaccine-related FAQs can also be used to address the issue.

Internet for good:

  • Google, Facebook and other related platforms should make sure that the users only have access to credible, science-backed information about vaccines.

Prominent persons:

  • Prominent people must be careful while addressing this issue.
  • Giving out false information to the public can only worsen the vaccine hesitancy situation.
  • They must use their influence to spread awareness about the advantages of vaccination.

Medical Community:

  • The paediatricians and family doctors must help spread awareness among the parents about the necessity of vaccination.
  • It is found that the physicians’ advice has increased vaccine acceptance among the public.

Conclusion:

Vaccine hesitancy is a threat that is causing adverse effects on the achievements made in addressing the burden of preventable diseases. Collaboration amongst the governments, parents, doctors, health institutes, civil society, celebrities etc., can help curb the increasing misinformation related to vaccination and protect the new generation.

Test yourself:

What is the vaccine hesitancy? Critically analyse why it is prevalent in recent years. (250 words)

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