Two decades on from the publication of Andrew Wakefield’s refuted paper linking autism in childhood with the MMR vaccine, the spread of fake news online has contributed to vaccine hesitancy now being one of the top ten threats to health, globally.11
Referred to as the ‘delay in acceptance or refusal of vaccines despite availability of vaccine services’ by WHO,12 vaccine hesitancy is being credited for the demise in coverage for all routine childhood immunisations in the UK.13
The proportion of children receiving their first dose of MMR now stands at just 90.1% – well below the 95% required for herd immunity. As a result, the UK has now lost its measles-free status.14
While the majority of parents do vaccinate their children, recent measles outbreaks show what can happen when even a small proportion of the population put their own individually held beliefs, while often well intentioned, ahead of recommended public health measures. In Europe, measles cases have snowballed since 2016, as shown above. Worryingly, it has also been revealed that a measles infection can deplete a child’s immunity against additional viruses and bacteria.15 Much deliberation has been given to potential interventions aimed at stemming the tide of vaccine hesitancy. However, will these policy changes be effective in addressing the underlying determinants that cause a lack of confidence in vaccines?
The current Health Secretary, Matt Hancock, said he was considering “all options” to improve vaccination coverage in England, and that there is a “very strong argument for movement to compulsory vaccination”.16 Mandatory vaccination policies ahead of kindergarten admission are widespread across the US, with varying exemption criteria in place, ranging from medical to religious reasons. In states where this criteria is most difficult to attain, rates of vaccine-preventable diseases are lower.17 A model exploring the effects of the ‘no jab, no play’ policy demonstrates that compulsory vaccination strategies can remarkably increase coverage and decrease infection rates in high-income countries.18
Four interventions, aimed at shaping behaviour rather than changing minds, have been found to encourage uptake of vaccines.19
- Making vaccination the default option, requiring parents to opt out rather than in.
- Using reminders via email, text or phone to prompt when the need for vaccination occurs.
- Encouraging parents to make a concrete plan for getting vaccinated.
- Making vaccination a requirement, e.g. for school admission or employment.
It can be argued that mandatory vaccination touches on all four of these techniques. Making it a requirement of school admission automatically makes vaccination the default, and provides parents with a concrete logistical plan for when to vaccinate. Reminders can then be sent through the already established communication channel of the admissions process.
However, these interventions rely on parents being in favour of vaccinations in the first place; which we know is not the case, at least not universally. For this reason, many senior medical professionals do not support making vaccinations mandatory.
Vaccination is perhaps a victim of its own success. In eradicating or making easily treatable so many infectious diseases that were once so prevalent, parents nowadays can be forgiven for underestimating the risk and consequences of disease. Vaccine hesitancy is greater in higher-income countries,20 because here our disease burden has now shifted so heavily to non-communicable diseases. Cancer, which affects one in two people,21 we see as a dangerous threat which commands our humility. Whereas diseases which historically impacted swathes of the population such as tuberculosis and polio seem in contrast, like relics from the past – toothless in the face of modern medicine.
However, hesitancy around vaccination is not just a western phenomenon. In order to counteract it on a global scale the medical community must improve its communication strategies. It has become obvious that just stating the dangers to the masses doesn’t address the individual fears of the few. We must become better at understanding their point of view and become better at communicating to reluctant ears.
By adopting a more emotional and persuasive rhetoric like that of the anti-vaccination community, healthcare providers could provide a compelling argument in favour of vaccines.
As with the most effective marketing campaigns, a clear message, a compelling narrative, and an overriding emotional sentiment may go a long way to convincing parents that your child may be in danger.