Every year, the approach of the colder months and sounds of incessant coughing and sneezing signal the beginning of an important public health concern: flu season. With it comes widespread campaigns promoting the flu shot, a vaccine that contains trace amounts of weakened or dead influenza viruses. When injected into the body, antibody production is stimulated, allowing the immune system to recognize and fight off foreign antigens [1].
Although injections and their possible minor side effects, such as soreness at the injection site or low-grade fever, aren’t pleasant to have, the benefits far outweigh these inconveniences [2]. Vaccinated patients are less likely to have severe cases of the disease, and are at lower risk of dying, thanks to a primed immune system. Furthermore, rates of infectious diseases, such as measles and mumps, have been reduced dramatically over the past decades since the introduction of these vaccines. In the US, there has been a 99% decrease in the incidence of diseases for which vaccines exist [2].
While statistics demonstrate the critical importance of vaccines in public health, vaccines are being threatened by a growing wave of misinformation: the anti-vaxx movement. Supporters, known as “anti-vaxxers,” voice concerns regarding vaccine safety, government control, and bodily sanctity. Their efforts have resulted in the rise of diseases that were once virtually eliminated thanks to vaccines. A US measles outbreak in early 2019, linked back to an unvaccinated child who returned from a trip to Israel,3 involved over 1000 individual measles cases in 31 states, the highest incidence since 1992 [4].
The alarming consequences of growing anti-vaccination sentiment are not insignificant. While it may be easy to dismiss the anti-vaccination movement by labeling them as uneducated and delusional, it is crucial that we understand their perspective if we want to reverse the public health repercussions.
The anti-vaccination sentiment has existed since the development of the first vaccines. Modern-day campaigns began with a 1998 study led by Andrew Wakefield, which suggested that the measles, mumps, and rubella (MMR) vaccine could lead to developmental disorders, such as autism, in children.5 Although the study drew immediate criticism from the scientific community for its poor design and small sample size, the damage was irreversible. Wakefield’s widely publicized finding of a link between vaccination and autism incited a global fear of MMR. The resulting decline in child vaccination rates was implicated in multiple measles outbreaks throughout Europe in 1999-2000 [6].
The effects of Wakefield’s study are still felt today, two decades later. Small but powerful anti-vaccination communities continue to exist globally. Their preferred method of communication — social media — can lead to dangerous groupthink, especially with the use of sensationalist and emotional case studies. One of the most popular platforms to spread vaccine misinformation is Facebook, where one can find personal posts about children who have died from vaccinations and public pages that call for freedom from medical coercion. Despite the recent limited efforts of Facebook to crack down on misinformation, activists continue to crowdfund their campaigns on the website, promoting large anti-vaccination groups such as the Informed Consent Action Network.7 In addition to these direct efforts to rally anti-vaxxers, misleading scientific claims are also rampant on the Internet. A large amount of false information about vaccines can be easily found in the search results of Twitter, YouTube, and similar platforms. This fear mongering and misinformation causes needless avoidance of vaccination.
It can be difficult to accurately assess the demography of anti-vaxxers when many anonymously voice their opinions online. The loudest, however, seem to be moms: one study published in Vaccine analyzed the demographics of Facebook users who posted anti-vaccination comments in response to a pro-vaccination post and reported that an overwhelming majority were female and parents [8]. It is not surprising that the most vocal anti-vaccination advocates appear to be those who are most concerned about the potential risks — not for themselves, but for their children.
While the most common reasons for vaccine opposition are scientifically unsupported, anti-vax parents are adamant in their beliefs and worries. One of their biggest concerns is vaccine safety: they fear adverse side effects such as autism or brain damage, although these are unfounded. Their anxieties are fueled by sensational news headlines that capitalize on rare cases of vaccine-related illness or death. News outlets and social media platforms take advantage of widespread Internet access to capture public attention with exaggerated stories, and those about vaccination dangers are no exception. Exposure to such “news” leads parents to be more cautious when deciding their children’s vaccination schedule [9].
Another large reason for anti-vaxxers’ hesitancy is a mistrust of medical information. Many parents believe that their doctors are not fully disclosing the risks of vaccination, indicating low trust levels. Additionally, parents find their doctor difficult to talk to and indicate that conversations are one-sided in swaying them to vaccinate their child.10 In one study, vaccine-hesitant parents explained that they felt that their health providers were dismissive of their concerns and there was limited opportunity to have an open dialogue about vaccines [11].
While the aforementioned reasons do not encompass all of anti-vaxxers' beliefs, they are indicative of one thing: a need for medical professionals to communicate more effectively with their patients. In a world where few patients have access to peer-reviewed scientific literature, most turn to google and social media for information. It's easy to be emotionally swayed by shocking headlines, and even more easy to produce irrational fear in parents who hold the enormous responsibility of their children's wellbeing. Likewise, it is also the responsibility of doctors to foster a trusting relationship with their patients and provide an unbiased account of the risks and benefits [9]. In order to limit the spread of misinformation, it is important for health care providers to address parental anxieties about vaccine safety by taking the necessary time to reassure their patients.
There are genuine, albeit misinformed, reasons behind the anti-vaxx movement. It's counterproductive to attack vaccine naysayers for being ignorant when they often are only trying to protect their loved ones in the way they believe best. What needs to change is how we communicate with the vaccine-hesitant; If healthcare providers and other informed individuals made a greater effort to understand anti-vaxx reasoning instead of making immediate judgements, a candid discussion could occur. If we are to restore public trust in vaccines and reverse the comeback of easily-preventable diseases, we must seek understanding rather than conflict.
References:
CDC. How Influenza (Flu) Vaccines Are Made. (2018, September 24). Retrieved from https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm.
(n.d.). Retrieved from Vaccines: Vac-Gen/Side Effects: https://www.cdc.gov/vaccines/vac-gen/side-effects.htm
Goldschmidt, D. (2019, May 13). More than 800 cases of measles in US, with NY outbreak continuing to lead. Retrieved from CNN: https://www.cnn.com/2019/05/13/health/measles-update-cdc-800-cases/index.html
CDC. Measles Cases and Outbreaks. (2019, October 11). Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html.
Rao T. S., & Andrade C. (2011) The MMR vaccine and autism: Sensation, refutation, retraction, and fraud. Editorial. Indian J Psychiatry, 53, 95–6. doi: 10.4103/0019-5545.82529
Pepsy M.B. (2007) Science and serendipity. Clin Med (Lond), 7(6), 562-78. doi: 10.7861/clinmedicine.7-6-562
Zadrozny, B. (2019, October 11). Anti-vaccination groups still crowdfunding on Facebook despite crackdown. Retrieved from https://www.nbcnews.com/tech/internet/anti-vaccination-groups-still-crowdfunding-facebook-despite-crackdown-n1064981.
Hoffman, B. L., Felter, E. M., Chu, K.-H., Shensa, A., Hermann, C., Wolynn, T., … Primack, B. A. (2019). It’s not all about autism: The emerging landscape of anti-vaccination sentiment on Facebook. Vaccine, 37(16), 2216–2223. doi: 10.1016/j.vaccine.2019.03.003
McKee, C., & Bohannon, K. (2016). Exploring the Reasons Behind Parental Refusal of Vaccines. JPPT, 21(2), 104–109. doi:10.5863/1551-6776-21.2.104
Harmsen, I. A., Mollema, L., Ruiter, R. A., Paulussen, T. G., Melker, H. E. D., & Kok, G. (2013). Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health, 13(1). doi: 10.1186/1471-2458-13-1183
Helps, C., Leask, J., Barclay, L., & Carter, S. (2019). Understanding non-vaccinating parents’ views to inform and improve clinical encounters: a qualitative study in an Australian community. BMJ Open, 9(5). doi: 10.1136/bmjopen-2018-026299
Deer, B. (2011). How the vaccine crisis was meant to make money. BMJ, 342, c5258–c5258. doi: 10.1136/bmj.c5258