Opinion: The real problem with vaccine hesitancy

A health worker prepares a vaccine at a community health center in Kathmandu, Nepal. Photo by: Public Services International / CC BY-NC

If we stopped vaccinating children, how long would it take before a host of deadly diseases came back with a vengeance? If the news that Albania, Czechia, Greece, and the United Kingdom have all now lost their official measles elimination status is anything to go by, the answer is not long at all.

Immunization coverage doesn’t have to drop by much before outbreaks start to occur. And with 130 million new children born globally every year, it would take just a year or two before mortality rates for diseases, like diphtheria, tetanus, whooping cough, measles and others, would once again start to soar.

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With 20 million children having missed routine immunization last year, politicians and campaigners met in Brussels to discuss the rising emergency.

It’s easy to blame people who are fundamentally opposed to vaccines — the so-called anti-vaxxers — for the U.K.’s decline in vaccine coverage and for the three-fold global increase in the number of measles cases this year. But that would give them too much credit. In fact, while the ease and sheer speed at which misinformation can now spread is a big part of the problem and one that has led to vaccine hesitancy, we should be careful not to confuse the two. Vaccine hesitancy is a much broader problem, and the biggest trigger comes not from antivaxxers, but rather from something far more insidious — complacency.

The only thing preventing most diseases from coming back is the fact that an average of 86% of the world’s children now receive basic vaccination — as measured by receiving three doses of a diphtheria-tetanus-pertussis-containing vaccine — up from just 5% in 1974. This is a huge accomplishment, but it has also helped create a false sense of security that modern medicine can make infectious disease a thing of the past.

The reality is that there are very few diseases that can be completely eradicated, like smallpox. For the vast majority of them, we can at best keep them at bay. The fundamental failure to understand this is what lies behind vaccine hesitancy. If we don’t solve this problem now and start to recognize the relentless nature of this battle, then there is a very real risk they will start to make a more significant comeback as more people, unfamiliar with the diseases become complacent.

As things stand, global immunization efforts are already stagnating, in part because of population growth. By its very nature, this makes such efforts Sisyphean — a perpetual and increasingly uphill struggle. Vaccinating enough children just to keep infectious disease at bay, let alone in decline, requires us to reach a few million more children each year. And as all children enter this world un-vaccinated, in effect, it’s like having to start from scratch every single year. Also, fertility rates are some of the highest within fragile, displaced, extremely poor or conflict-affected communities, which are the hardest for health workers to reach. But even if we reach them and increase vaccination coverage, so that it’s high enough to prevent outbreaks, there is a different kind of threat looming.

When diseases disappear from our lives, when we forget the horrors they entail, or — for an increasing number of parents — grew up never knowing them in the first place, a dangerous complacency can start to fester. At the moment this attitude is mainly only a problem among a relatively small number of parents in wealthy countries, where medical treatment is more likely to be available and the number of deaths and rate of spread can be kept down. The worry now is that if — or when — the same kind of vaccine hesitancy, fed by false rumors, starts to spread to poorer parts of the world, the death toll and the risk of outbreaks escalating will be considerably higher.

Currently, parents in such countries need no convincing of the value of vaccination. They know only too well the dangers of not protecting their children and are, as I’ve witnessed personally in many countries, often willing to travel great distances and stand in lines, sometimes for hours, for a chance to do so. But as we make further progress in increasing vaccine coverage and reducing disease in such countries, there is now a very real danger that the kind of complacency we are seeing in wealthier parts of the world will also start to set in and, because of social media, spread like wildfire.

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That would be nothing short of a disaster. Because as things stand, global trends are already making it easier for outbreaks to spread. Urbanization is one example, with 2.5 billion more people — almost all in developing countries — expected to be living in cities by 2050. As human density increases so too does the potential for the rapid transmission of infectious agents.

Similarly, climate change will continue to create opportunities for disease to spread within vulnerable communities through famine, floods, and extreme weather. It is also likely to increase the range of disease-carrying vectors, such as mosquitoes, enabling them to spread to new regions. And with 1 billion people traveling outside their country every year, diseases can now spread across the globe, literally, at the speed of a jet plane.

This places us at a critical juncture. Gavi, the Vaccine Alliance powered by the World Health Organization and UNICEF, is working to bring us closer to the point where everyone on this planet is protected from vaccine-preventable infectious disease. But as we do so vaccines are in danger of becoming a victim of their own success. Because the closer we get to preventing vaccine-preventable disease outbreaks altogether, the greater the risk that vaccine hesitancy will start to unravel that progress.

So, it’s not anti-vaxxers that we need to only worry about the most. An even bigger challenge comes from those who kind of recognize the value of vaccines but have come to take them for granted, making them vulnerable to the misinformation being so efficiently circulated.

This year, Devex has been exploring the rise of vaccine hesitancy and what it means for global health efforts. Read about how it has put aid workers at risk in Pakistan, how people are avoiding vaccination requirements in Nigeria, and understand the drivers and potential solutions to the issue globally.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Seth Berkley

    A medical doctor and epidemiologist, Dr. Seth Berkley joined Gavi, the Vaccine Alliance as its CEO in August 2011, spearheading its mission to protect the world’s poorest children by improving access to new and underused vaccines. Under his leadership, Gavi has now reached more than 640 million children in the 73 poorest countries, in its 16 years of existence. Prior to Gavi, Dr. Berkley founded the International AIDS Vaccine Initiative in 1996, the first vaccine product development public-private sector partnership, where he served as president and CEO for 15 years.