The following post is the result of a classroom writing assignment by Dr. Erika Martin at the University at Albany-SUNY who required students to write a commentary on a health-related topic of interest, explaining some of the complexities of solving the problem and offering recommendations. Three commentaries have been selected for publication on JPHMP Direct this year. Here, student Mirren Galway examines the potential threats of the anti-vaccination trend.       

THE SITUATION

Vaccinations prevent between two and three million childhood deaths a year and could prevent up to two million more. First discovered in 1798, vaccines have continually improved their efficacy to prevent illness since the 18^th century. Two hundred years later, illnesses like smallpox, that at one time negatively impacted nearly all of humanity, were eradicated. Since then, society has experienced a continuous growth in life expectancy. Vaccines are seen today as one of the most successful ways to stop disease, and have proven to be an effective way to protect the health of Americans.

Despite their known effectiveness, as shown in figure one, a growing number of parents refuse to vaccinate their children, which has created a public health concern that has been labeled one of the top 10 health threats of 2019. Aversion to vaccination often stems from personal or religious beliefs or from misinformation that leads to fears.                        Anti-vaxxers Mirren Galway 

The result is what the World Health Organization (WHO) refers to as “vaccine hesitancy,” and the impacts of the latest anti-vaccination trend have resulted in dire consequences. Even though more children today receive immunizations than in past decades, new outbreaks of preventable disease are threatening the lives of children. Recently, measles, an illness once thought to be eradicated, has surged within the United States and has forced states like New York to deal with their worst breakouts in decades, as shown in figure two. As a result, “vaccine hesitancy” of parents to immunize their children has been labeled by WHO as one of the world’s biggest threats to public health.

THE PROBLEM

Myths that vaccines cause adverse side effects and other misinformation regarding immunizations is, in fact, what leads to negative health effects. In 1974, a Glasgow University professor made a claim that whooping cough vaccine resulted in permanent neurological damage in infants. This directly resulted in a drop from 80% of parents to only 30% vaccinating their children for whooping cough, inevitably leading to higher death tolls. Similar false reports have been repeated, leading to claims of vaccination causing sudden infant death, diabetes, AIDS, and more recently, autism, the concern of modern “anti-vaxxers,” as opponents of vaccination are called. Today, despite federal leadership supporting the measles, mumps and rubella (MMR) vaccination and support from activists claiming its potential to eradicate the disease, many parents display concerns surrounding the health risks of the vaccine after hearing false reports that it is linked to autism.    Anti-vaxxers Mirren Galway 

Those who believe myths surrounding vaccination tend to have common individual traits. Childhood vaccination is declared by health care professionals as a safe way to treat infectious disease, but activists and anti-vaccination websites drive movements against them. There is currently unequal access to vaccinations and educational information for communities below the poverty line and minority communities due to poor access to general medical care, but negative vaccine attitudes themselves have not been linked to socioeconomic status or educational level. Instead, a predictor of negative sentiments surrounding vaccination is a certain level of conspiratorial thinking, aversion towards perceived restrictions on individual freedom, fear of medical procedures and needles, and religious beliefs. 

[bctt tweet=”Student Mirren Galway @ualbany asks whether we are approaching the anti-vaccination trend in the most effective way in this special commentary @JPHMPDirect. #antivaxxers ” username=”@ualbany”]

Additionally, due to the ill-timed discussions of vaccination between health care providers and new parents, some are less likely to vaccinate their young children. Currently, the issue of childhood immunization is not discussed with new parents until the first week after childbirth. This is a time in new parents’ lives when information is overwhelming and their sole focus is on their child’s safety. Vaccine hesitancy is often a response of parents to act with an abundance of caution, so when they’re faced with a lot of important information at once, they may feel it’s safer to wait until later to decide whether to vaccinate. Additionally, well-child visits are often short and do not allow time for questions to be answered. Research done by the Vienna Vaccine Safety Initiative linked the short length of discussions surrounding vaccines to lowering their effectiveness in convincing parents to vaccinate. Generally, it has been found that parents want more information than they currently receive about vaccinations, often expressing worry and regret about the decisions they make. An important aspect of this communication revolves around interactions between parents and their health care providers. An effective discussion can leave parents with confidence and positive attitudes towards vaccinations, while inconsistent and negative interactions can lead to increased confusion and frustration.

POTENTIAL SOLUTIONS

In order to prevent deaths due to avoidable illness, a systematic review of the way the United States communicates information surrounding vaccinations to health care consumers is vital. First, communication should begin earlier in the process, during pregnancy while a parent is more receptive to discussion. When this conversation occurs, content discussed between parents and their health care providers should be tailored to parents’ positions on vaccination. A parent’s feelings towards vaccines can be interpreted through pre-visitation questionnaires. These opinions can range from unquestioning support of vaccination, cautious support, hesitation, late vaccination or selective vaccination, and outright refusal to vaccinate their children. By first gauging parent’s stances on vaccination, health care providers can tailor conversations that provide enough evidence-based information to help parents make sound decisions for their children’s well-being.

In tailoring a provider’s discussion about vaccination with parents, it has been found that there are two options in expressing information about vaccines to “anti-vaxxers.” The first is to attempt to dispel common myths about vaccinations. The second is to discuss the consequences of not vaccinating a child by displaying pictures of children with preventable diseases and testimonials of other parents. It has been found that the latter intervention is an effective tool in convincing parents to vaccinate while attempting to dispel misconceptions regarding vaccines.                Anti-vaxxers Mirren Galway student

Beyond this, parents should be exposed to more positive messages surrounding vaccination through the media. Communication can be used to change the narrative surrounding vaccines and plays a part in shifting away from vaccine hesitancy, as perception can affect behavior. Such interaction can take the form of campaign intervention or routine discussions with health care providers. Currently, the National Academies of Sciences, Engineering, and Medicine dispels common myths about vaccines on the organization’s website through scientific explanation  and highlights vaccine safety by transparently sharing both the beneficial effects of vaccines as well as the few side effects they may have. Correcting misinformation is an important aspect of the vaccination conversation, but it needs to be coupled with testimonials and examples of the consequences of not vaccinating. By developing community-based social media campaigns, coordinated between health care professionals and social influencers, together, these two groups can identify a message for a targeted audience and spread it within a community. This can be done by tracking patterns of discussions surrounding vaccines on various forms of social media. This would be followed with targeted campaigns involving social influencers discussing vaccination and the harms of not vaccinating children.  

CALL TO ACTION

By better tailoring community outreach programs surrounding childhood vaccination, providers can continue to advocate for the vaccination of all children to prevent mortality and eradicate preventable disease. To end fear surrounding vaccination that stems from misinformation, solutions must be aimed at shifting perspectives. This can take many forms and should specifically focus on provider and parent interactions and social media campaigns within local communities.  Anti-vaxxers Mirren Galway

Related Reading in the Journal of Public Health Management and Practice: 

• Blinding Me With Science: Complementary “Head” and “Heart” Messages Are Needed to Counter Rising Vaccine Hesitancy
• CDC Guidance for Use of a Third Dose of MMR Vaccine During Mumps Outbreaks
• Health Departments’ Experience With Mumps Outbreak Response and Use of a Third Dose of Measles, Mumps, and Rubella Vaccine
• Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County

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