This article was originally published in our Spring 2019 print issue.
Vaccine hesitancy, the reluctance to be vaccinated, has garnered a lot of press in recent years due to multiple measles outbreaks in the United States (CDC). Traditional news outlets portray vaccine hesitancy as a black and white issue, but it is more nuanced than it seems. According to Dr. Art Reingold, division head of epidemiology at the UC Berkeley School of Public Health, “Dividing the world into those who are pro-vaccine and anti-vaccine is overly simplistic. In reality, there are vast ranges of people in the middle who will take some vaccines but not others, or take vaccines despite skepticism. It is important to keep in mind that most parents are just looking out for the health of their children.” To fully understand this issue, the supporting reasons for vaccine hesitancy must be explored.
In middle-income countries, the perceived and often false risks of vaccines have been cited as the primary reason for vaccine hesitancy, rather than the barriers of religious beliefs or lack of awareness (Fosters). There are many common misconceptions that are spread around in the vaccine-hesitant community. One of the most common falsehoods is that vaccines — particularly the measles, mumps, and rubella (MMR) vaccine — have a plethora of side effects and can even cause other illnesses such as autism. Reingold states, “The  study that claimed an association between the MMR vaccine and autism could never prove an association; that’s not the way it was set up. The study was eventually proved to be fraudulent and has since been redacted.” More recent studies have repeatedly shown that there is no link between the MMR vaccine and autism spectrum disorder (CDC).
However, vaccines are not completely free of risks. According to Reingold, “Anyone who says that a vaccine is 100% risk-free is not being truthful. In reality, there can be negative consequences, but the risks that these side effects pose are vastly lower than the risk of the diseases themselves.” While there may be a few side effects of vaccines such as a mild fever or sore arms, these both temporary and negligible. More serious side effects happen so rarely that there is not enough data to assess the links between the side effects and the vaccines, states the World Health Organization (WHO). Multiple studies also show that simultaneous vaccination with multiple vaccines has absolutely no harmful effect on a child’s immune system.
Some simply argue that vaccines are not effective to begin with, and that those who contract diseases have already been vaccinated. It is true that it is possible to contract a disease even if one has been vaccinated, as no vaccine can be 100% effective. However, most vaccines are effective 85 to 98% of the time (WHO). Secondly, the number of people who are vaccinated vastly outnumbers the number of people who are not vaccinated, and many statistics used by anti-vaxxers exploit this fact. Some people who are vaccinated may end up contracting the disease, but this does not prove in any way that vaccines are not effective. Vaccines still protect most people and have been proven to work in almost all cases.
Reingold argues that because most parents and doctors have not encountered first-hand the diseases vaccines prevent against, they do not fully understand the implications. “Many people see illnesses like measles as benign, and not a problem for them, as they do not live in areas of the world where the effects are visible. This is partially true, as the risk of contracting measles in most areas of the United States is relatively low, but it is not zero.” Even though the prevalence of these preventable diseases in the U.S. is low, they certainly still exist; it is possible to infect those who cannot be vaccinated due to severe allergies or other health issues. Those who are unable to be vaccinated often rely on herd immunity, which protects vulnerable individuals only when a high enough proportion of the population is immune to a disease, generally due to vaccination (PubMed). The loss of herd immunity in certain areas would be devastating for many. Although vaccination has seriously reduced the prevalence of these diseases in developed nations, there are many places in the world where these diseases are still epidemic (WHO). Travellers can pose a serious threat to these areas if they are unvaccinated.
The rise in number of vaccine-hesitant individuals impacts the world as a whole. The World Health Organization reported vaccine hesitancy to be one of the top 10 public health hazards in 2019, among the likes of Ebola and cancer (WHO). Although Reingold agrees that vaccine hesitancy is an issue, he says, “It is not exactly a crisis in the United States. There are pockets of space where vaccine-hesitancy is unusually high, but for the most part, vaccination rates are good. However, we still do not want these vaccine preventable diseases to come back.” Worldwide cases of measles have increased by about 50% in the last year. Additionally, 90% of those who come into contact with a person infected with measles will catch the disease unless they have been vaccinated. The number of unprotected people in some areas of the United States is high enough to cause the rapid spread of threats.
What can be done to curb the threat of vaccine hesitancy? Although many stress the importance of education, Reingold is skeptical. “Often the boomerang effect is observed, when we attempt to persuade those who are vaccine-hesitant of our side of the issue, they often come out of the conversation even more critical of vaccines than before,” he says. Another approach is to tackle social media platforms that allow the spread of false information. However, censoring content online could face legal backlash and is difficult to regulate (The Guardian). An approach taken by California is to require vaccines in children attending public schools and to not allow religious or philosophical exemptions (SF Chronicle). This policy has had a positive effect on immunization rates. However, policies have their issues as well.
“Policy is effective,” states Reingold. “Unfortunately, there are ways around it. The number of children given medical exemptions to vaccines has increased twofold, however, the medical issues that would result in medical exemptions have not. There are even doctors who advertise that they will sign off on medical exemptions, often times on unfounded reasoning.” Multiple doctors have been brought toward the California Medical Board due to charges that their work surrounding medical exemptions has been unethical (Consumer). Meanwhile, 20 other states have moved in the opposite direction, proposing bills that make it easier to obtain non-medical exemptions for vaccines (CNN). When asked what can be done to curb this rise, Reingold states, “Vaccine-hesitancy is a global problem. Unfortunately, we just don’t have the solutions at this point in time.”