In the United States, measles cases have increased 17-fold in the first quarter of 2024 alone, and epidemiologists are seeing similar patterns all over the world. Parts of England are experiencing their highest rates of measles since the 1990s, while the illness is prevalent in low- and middle-income countries across Africa, the Middle East and Asia. Although scientists created an effective vaccine for this highly infectious disease over 40 years ago, around one in five children have not received measles vaccines and therefore face the highest risk of complications.
Measles acts as a “canary in the coal mine” — it highlights gaps in vaccination due to its high transmissibility. But why have we been seeing such a significant resurgence of this disease that could be gone if we wanted it to be?
There is no doubt that global vaccination programs have taken a hit due to global conflict, displacement and the COVID-19 pandemic. However, another key culprit for the rising rate of preventable diseases is vaccine hesitancy. Though the pandemic highlighted vaccine hesitancy, the phenomenon existed long before then and is only getting worse. As the World Health Organization’s (WHO) World Immunization Week, which is dedicated to appreciating the growth of vaccination programs and developments in technology and approaches, we must examine this key issue that impacts us close to home and worldwide.
Dr. Edward Jenner created the first vaccine, which prevented the deadly disease smallpox through the injection of the less deadly cowpox virus, over 200 years ago. Jenner thereby coined the term “vaccine” from the Latin word for cow, vacca. This vaccine allowed the world to eradicate smallpox in 1980. Since then, researchers have created dozens of vaccines to prevent diseases like hepatitis, influenza and polio.
However, the controversy started brewing much earlier. The 1905 Supreme Court case Jacobson v. Massachusetts saw observers first viewing vaccines through the lens of public skepticism, with the case questioning whether a state’s enforcement of compulsory vaccination infringes upon personal liberty.
One of the major drivers of vaccine hesitancy, however, brings us back to measles. Discredited physician Andrew Wakefield falsely linked the MMR vaccine — proven to prevent measles, mumps and rubella — to autism in a 1998 paper published in The Lancet, a prestigious public health journal. Researchers have completely debunked all of Wakefield’s claims, and The Lancet retracted the paper in 2010.
However, this scientific misinformation lives on in the eyes of the public. Misinformation has similarly driven hesitancy in the case of human papillomavirus (HPV) vaccination. As a result, HPV vaccination rates are much lower than other vaccination rates — even those of vaccines made available to the public within the same year, like the tetanus, diphtheria and acellular pertussis (Tdap) vaccines. Claims on social media have linked the HPV vaccine to side effects like fainting and dizziness — but scientists have since proven that doctors can attribute these links to the anxiety and stress surrounding vaccination, rather than the vaccine itself.
Another important example of vaccine hesitancy lies in the COVID-19 vaccination campaign. Though considered a paramount scientific accomplishment of the 21st century, the rapid development and use of the COVID-19 vaccine caused trust in many vaccines to plummet. This phenomenon, “spillover hesitancy,” has resulted in mistrust of the influenza and measles vaccines, too. Vaccine hesitancy is casting its shadow around the world, resulting in drops in vaccine confidence in 52 out of 55 countries one UNICEF survey polled. To understand how to combat this global issue, we must look back to its source: misinformation.
False claims about vaccines, propagated through social media and their politicization, are a significant aspect of vaccine hesitancy. Misinformation not only drives fear but also obstructs solutions. To mitigate vaccine misinformation and mistrust, it is important to understand how heterogeneous the problem is — vaccine hesitancy disproportionately affects certain populations, particularly racial and ethnic minorities.
The prevalence of hesitancy, and subsequent lower vaccination rates, tend to exacerbate existing health disparities. To combat this, the WHO developed the Tailoring Immunization Programmes initiative, which uses a community’s values and beliefs to inform solutions. It is also important to foster community engagement through tailored communication techniques, which utilize practices like presumptive provider communication, where the provider relays information with the assumption that the individual will get vaccinated, to increase levels of understanding and build trust. Vaccine advocates should also use social media to their advantage, making both tailored communication and broader vaccine campaigns more accessible and visible.
The fundamental principle of vaccines lies in herd immunity, the concept that vaccinating a certain percentage of the population prevents the spread of the disease overall. Every person, as part of a larger community, can act as a vaccine advocate, taking the initiative to learn more about vaccine efficacy and tackle misinformation and polarization. It’s time to combat vaccine hesitancy. Our lives — and the lives of others — depend on it.
