The campaign by anti-vaxxers poses a tremendous risk to public health, and the health of children. Here’s how we can fight it.
The World Health Organisation (WHO) has ranked vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – as one of the ‘ten threats to global health in 2019’. In the year that the wild poliovirus may finally be eradicated in Afghanistan and Pakistan, thanks to vaccination, diseases that vaccination made vanishingly rare in the US, UK and other developed countries are making a comeback.
Vaccine hesitancy is not new, of course. The first vaccine, developed against smallpox by country doctor Edward Jenner in 1796, faced massive resistance, not least from the medical community itself. The idea of being deliberately infected with a mild animal disease (cowpox) to create immunity to the much more serious smallpox was too much for many and anti-vaccine societies sprang up. It was not until the British government made it compulsory in 1852 and strictly enforced this in 1872 that smallpox began to be controlled in the UK. The US and France were much quicker to embrace vaccination and Jenner was honoured by both countries for his work.
What makes vaccine hesitancy such a problem in 2019 is that we are so far removed from understanding the problems that euphemistically titled ‘common childhood illnesses’ bring with them. Many of those making the decision not to vaccinate their children will have grown up in a time of high vaccine uptake and therefore may never have seen some of the complications that can be caused by measles or rubella. Ironically, the past success of vaccination campaigns is part of the reasons for the current reluctance to vaccinate. Many of us have, thankfully, never seen a child left blind or brain damaged by measles, or a baby born with birth defects after the mother contracted rubella in pregnancy. Unfortunately, this makes a growing minority of parents complacent.
“Ironically, the past success of vaccination campaigns is part of the reasons for the current reluctance to vaccinate. Many of us have, thankfully, never seen a child left blind or brain damaged by measles, or a baby born with birth defects after the mother contracted rubella in pregnancy.”
When parents refuse to vaccinate their child, they are making a decision not only to put their own child at risk, but also those children and adults who cannot be vaccinated due to health problems, or who have lowered immunity, perhaps due to other medical interventions such as chemotherapy. Ultimately, deciding not to vaccinate can result in death. The WHO estimates that vaccination currently prevents between 2-3 million deaths a year and another 1.5 million could be avoided if global coverage and take-up of vaccines improved. What is actually happening, however, is that vaccination uptake in countries like the US and UK is falling. The Centers for Disease Control and Prevention in the US report that more than 100,000 children have had no vaccinations, whilst many others have only had part of the recommended schedule. In the UK, 91 per cent of children were vaccinated in 2017-18, but this was the fourth year in a row that numbers dropped and in London coverage is just 85 per cent.
Why is this? Clearly the vast majority of parents who are refusing vaccinations for their children are not doing so out of malice or a lack of concern for their children. Many are refusing to vaccinate because they are concerned for their children. They believe that the dangers from vaccines are greater than the dangers from the diseases they vaccinations protect against. The plethora of websites promoting the anti-vaxx message means that parents can stoke their anxiety at the click of a mouse or swipe of a finger. An analysis of 480 anti-vaxx websites shows that they tend to use both scientific and anecdotal evidence to promote misinformation as to the safety of vaccinations. Common claims included that vaccines were dangerous, cause autism and “brain injury”.
How can we fight back against this? There is no easy way of counteracting the anti-vaxx message. Much like with climate change denial, the idea that there are two legitimate ‘sides’ to the argument is prevalent amongst anti-vaxxers and there is a tendency to view any attempts to introduce rationality as some kind of big-pharma conspiracy. However, this doesn’t mean that we should not attempt to change minds. Looking at past public health campaigns, there are a number of strategies that could gain some traction in combatting the anti-vaxx lobby.
The Vaccine Confidence Project monitors and refutes rumours and conspiracy theories found on anti-vaxx websites. This academic-run project is something that governments should be seeking to support or replicate. Aggressive promotion on social media may help some parents to see the that the ‘science’ on anti-vaxx sites is often weak or misrepresented. Confused parents, worried about doing the right thing for their child, may just be convinced by a factual refutation of the more common themes used by anti-vaxxers.
Social media companies can also play a role in reducing the reach of anti-vaxx information. Pinterest has recently led the way by actually preventing searches for words concerning vaccination. Type vaccine or similar into Pinterest’s search box and no results are found. Pinterest’s own analytics suggest that 40 per cent of parents and 52 per cent of parents-to-be use their site, so reducing access to anti-vaxx material can only be a good thing for vaccination rates. According to Pinterest, this is a temporary fix whilst they develop a long-term approach to the issue of misinformation. YouTube has demonetised anti-vaxx videos by not allowing them to show ads and is now trying to promote more authoritative content when people search for vaccinations. These responses to rising concern about anti-vaxx material are only in their infancy and will need to be evaluated for their impact in the long-term.
Any public health campaign needs to be able to clearly refute the arguments that the anti-vaxx movement rely on. They have barely changed and are generally easily refutable. Any effective pro-vaccine campaign has to tackle these arguments head on, repeatedly. It needs to show why the arguments are untrue. It’s not enough to just show scorn for these arguments, a pro-vaccine campaign needs to address them each in turn with clear evidence. We know that vaccines contain chemicals, but not all chemicals are toxic, similarly your immune system is more than able to cope with a vaccine, after all it is designed to deal with countless assaults from pathogens.
A pro-vaccine public health campaign needs to target the correct audience. Most parents who hesitate about vaccination are not conspiracy theorists. They are just concerned for their child. Most are looking for reliable information. The success of anti-vaxxers is that they are able to fill the void. Parents have lots of contact with health professionals in the early days of their child’s life. These health professionals need to be fully trained to speak to parents about vaccination and to dispel common myths as well as listening, and responding empathetically, to parental concerns. Berating parents is unlikely to result in much movement. Acknowledging concerns and showing parents the evidence to support the safety of vaccination is much more likely to sway parents. It might also be possible to use other parents who have vaccinated their children here. Anti-vaxx sites often rely on parental anecdotes. These could be harnessed by a pro-vaccination campaign as well. Parents may well react more positively to the stories of other parents who have had to make the same decisions.
There is always the option to make vaccinations mandatory. Whilst this would inevitably increase uptake, it is an uncomfortable position to support. California responded to a measles outbreak in 2014 by toughening up its laws on mandatory vaccination and removing many of the opt-outs. All states in the US require children attending public schools to be vaccinated, but most allow exemptions for religious or personal belief. This personal belief can be the belief that vaccinations are harmful. California now only allows exemptions for medical reasons, bringing it into line with states like Mississippi which has a vaccination rate of 99.7 per cent with the MMR vaccine. Michigan has gone for a more nuanced approach, requiring those who wish to opt-out of vaccination to discuss their choice with the local health department. This may work. If health professionals are well informed and willing to listen to parental concerns, many reasons for refusing vaccination could be overcome at this stage.
Obviously, none of this will challenge the conspiracy theorists who peddle the anti-vaxx nonsense in the first place. Whatever their motives they are too entrenched. However, the majority of those who are hesitant to take up vaccinations offered are doing so because they are convinced that they are doing the very best for their children. With a concerted effort from governments, public health officials, and health professionals, some of the most dangerous anti-vaccine propaganda can be countered. Even social media organisations seem to be accepting a share of the responsibility to tackle this threat to global health. Let’s pressure our governments to step up and support academics like those who run the Vaccine Confidence Project in combating the dangerous misinformation peddled by anti-vaxxers who do not have our children’s best interests at heart.
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