Recently, the world has seen a reemergence of measles outbreaks. This disease has been on the decline ever since the introduction of the MMR vaccine. However, there is a growing minority of people who refuse to vaccinate despite the benefits of the MMR vaccine. The goal of this literature review is to understand vaccines, why people avoid vaccines, the anti-vaccination movement, and what can be done about it.
What are the dangers of avoiding vaccines?
McCarthy (2016) writes that avoiding vaccine makes you more susceptible to catching the disease. While medical advancements will help aid your healing if you catch the disease, it is still nonetheless very dangerous and could be lethal. However, not vaccinating also compromises the health of the community. The World Health Organization defines herd immunity as 95% of the population immunized (cited by Astrup, 2019). If herd immunity is maintained, the majority of the population, who are less likely to catch the bug, won’t get sick and spread it to people who cannot receive the vaccine. If less than 95% of the community is immunized, the disease could spread to people who are physically unable to receive the vaccine.
Why do parents avoid vaccines?
It’s worth noting that most parents do vaccinate their children. The anti-vaccination movement is only a small majority. In the UK, 90% of parents automatically vaccinated when their child was due, while only 2% of parents refused vaccination (Astrup, 2018).
Najera (2018) argued that the effectiveness of vaccines has virtually eliminated fear of catching an illness. Furthermore, Najera (2018) writes that most parents use Google as their source of information. Parents “get led astray by celebrities or by people and organizations that sound official” (Najera, 2018). This misinformation and fear combined with a parent’s need to protect their child have led to the rise of vaccine hesitancy. He notes that he has also faced a similar hesitation for vaccinating his child, despite his knowledge of the benefits tied to vaccines. McCarthy (2016) has argued a similar point on the invisibility of diseases. She writes “[parents] most want to talk to me about are possible side effects of the vaccine. … They rarely worry about the diseases that vaccines prevent” (McCarthy, 2016). The Royal Society for Public Health had similar findings and reports, “fear of side effects was the most common reason for choosing not to vaccinate” (cited in Astrup, 2019).
Handley (2011) reports that there is a rise in the rates of Autism in children. Since the causes of Autism are unknown, a lot of parents of autistic children are lost looking for answers. Heuvel (2013) talks about Jenny McCarthy, a celebrity who has appeared on the United States national television to discuss her views on vaccines. Parents of autistic children may agree with Jenny McCarthy’s unfounded views because they are scared, confused, or desperate.
PublicHealth.org (n.d.) says some parents may avoid vaccines because they think vaccines contain toxins. However, these are not toxins, but substances meant to boost the effectiveness of the vaccine (What goes into a vaccine? n.d.; Colorado Children's Immunization Clinic, n.d.).
Where did the Anti-Vaccination movement originate?
Heuvel (2013) writes the origin of this movement comes from a paper published in The Lancet by Andrew Wakefield. The paper claimed there was a link between MMR vaccine and autism. Heuvel (2013) makes it very clear that this claim is entirely fabricated and false, and Wakefield’s study has been thoroughly debunked by extensive research. Despite this, the damage had been done and there has been a decrease in immunization rates. To reiterate, there is no connection between the MMR vaccine and autism. (MMR vaccine does not cause autism., 2019; Vaccine myths debunked., n.d.; Colorado Children's Immunization Clinic, n.d.; Heuvel, 2013)
How has the Anti-Vaccination movement spread?
Heuvel (2013) writes Jenny McCarthy added fuel to the Anti-Vaccination movement. Jenny McCarthy has appeared on the Oprah Show, Larry King Live, and Good Morning America (Heuvel, 2013). Larry King Live had Jenny McCarthy debate a doctor. This implied that her disproven ideas should be given the same equivalence as those of a medical expert. Nyhan argues “‘he said’ ‘she said’ coverage simply puts ‘unsupported claims alongside credible arguments’” (cited in Heuvel, 2013). Graham & Clarke (2013) researched the effects of falsely balanced reporting of autism-vaccine controversy. They found that articles which pose both sides as equally valid reduced reader’s vaccine confidence more than articles that showed no-link between autism and vaccines. The spread of misinformation isn’t based solely on people who believe in Anti-Vaccination, but also includes journalists who don’t put the Anti-Vaccination movement in context. Journalists are then also to blame for the fueling of Anti-Vaccination, and Heuvel (2013) blames these television networks for allowing Jenny McCarthy to spread misinformation about vaccines causing autism.
Generation Rescue, Jenny McCarthy’s organization, also has a website titled “Fourteen Studies” which aims to provide evidence for the autism-vaccine link. However, do not be deceived. The studies on this website have been thoroughly disproven. Gorski (2009) published an article disputing every study. To reiterate, none of these studies were conducted properly and there is no proof of an autism-vaccine link. Autism and Vaccines have no link. There is no correlation or causal relationship.
Social media may also be another cause of the spread of anti-vaccination ideas. Astrup (2019) found that 2 in 5 parents are exposed to anti-vaccination messages on social media. For parents of children under 5 years of age this number grew to 1 in 2 parents. A poll by PHE found that one in ten parents saw information that made them question whether to vaccinate their child. (cited in Astrup, 2019) Shirley Cramer claims social media is the cause of the spread of anti-vaccination (cited in Astrup, 2019) As shown in Graham & Clarke’s (2013) study, false equivalence is enough to reduce reader confidence in vaccines. Xu, Ellis, & Umphrey (2019) also found in a study that Anti-Vaccination articles tend to be more engaging than Pro-Vaccination counterparts. It is easy to be exposed to misinformation on social media, parents may begin to doubt whether to vaccinate their children or not.
What is being done and how can we combat the Anti-Vaccination movement?
As getting more people immunized increases the overall benefit of the community, many countries are treating immunizations as a public health issue. As such, countries are tackling this problem in a range of ways.
Scutti (2018) writes that Australia has the “no jab, no play” policy. Failure to comply removes government benefits and welfare rebates for parents of unvaccinated children, and child-care centers and preschool facilities cannot accept their unvaccinated children. What they have seen in Australia are the immunization levels rise to above 95%, the World Health Organization’s definition for herd immunity. Yet, there are still a small amount refusing to vaccinate their children. This could pose a bigger problem as “unvaccinated people tend to cluster in certain locations. This can decrease vaccination rates in some locations to below the necessary herd immunity percentage” (Scutti, 2018). Leask writes that,
They are children with a right to education and family support payments like any other eligible child…a low-quality child-care market may be growing in support of the families who forfeit benefits to uphold their anti-vaccination beliefs (cited in Scutti, 2018). While the overall community of Australia sees higher immunization rates, it may become increasingly difficult to reach those who firmly believe in Anti-Vaccination.
Scutti (2018) also writes Italy are also using punitive measures to counter the decrease in immunization rates. Italy requires “proof of vaccination when enrolling their children in government-run nurseries or preschools” and “parents of children who have not been vaccinated will be fined” (Scutti, 2018). Astrup (2018) notes that compulsory vaccinations are a highly controversial idea. Germany moves away from compulsory vaccination by requiring proof of vaccination counseling attendance before enrolling children. Schools are not required to report parents who have not been counseled by doctors (Scutti, 2018). The United Kingdom considered compulsory vaccinations, however they have decided to use non-punitive measures. The British Medical Association is calling for instead “’increasing efforts to improve awareness’… ‘sufficient funding to deliver fully resourced vaccination services’” (cited in Astrup, 2018). Larson notes that “Generally, European nations tend to prefer voluntary vaccination to mandates.” Furthermore, as schooling and health care get better, there “are clear trends reflecting more questioning about vaccines,” (cited in Scutti, 2018).
In the United States, up-to-date vaccinations are required for children to attend school. Although some states allow medical, religious, and philosophic exemptions. While this does increase immunization rates, you see similarly from Australia, parents who believe their children have the right to attend school. Lahey writes that parents “can feel like being encouraged to get immunizations gives them a loss of control” (cited by Scutti, 2018).
It’s important to note that there will always be a small minority who refuse to vaccinate, or physically cannot receive the vaccine. However, as noted by Najera (2018), most parents are in the middle. Simply hesitant about vaccines. Astrup (2018) writes that forcing parents who are on the fence to vaccinate their children may push them to become Anti-Vaxxers. The general public still trust their medical provider for advice (Astrup, 2019). Medical providers should answer parent’s questions and concerns and build trustful relationships. Brewer says, “Most parents just want to know that (vaccination) is something a provider recommends.” Brewer and his colleagues created “the announce approach, where physicians start off with just announcing a child is due – a presumptive announcement,” (cited in Scutti, 2018).
The infrastructure for receiving vaccines is also not very effective. Recordkeeping, appointment management, appointment reminders are outdated in most areas, Brewer writes. Improvement in this field would receiving vaccinations more convenient. Brewer also writes that the government directly reaching out to parents using promotional campaigns aren’t effective. However, “if someone in your social circle… puts vaccination forward as a ‘social norm, that does seem to encourage people to be more likely to get vaccination’” (cited in Scutti, 2018).
So, while medical professionals may have a lot of power in convincing parents to vaccinate their children, the general public can also help as well. Do not treat vaccine-hesitant parents with condescension, that will only push them further to one side. Instead respond with understanding, because most parents only want the best for their child. It also goes to note that you should try limit the spread of anti-vaccination messages on social media. Sometimes, sharing an article with commentary may send it into the hands of someone who may begin to agree with the ideas. While good intentioned, sharing may do more harm than good. The Anti-Vaccination is still small and by being mindful and understanding you can help stop the spread of the Anti-Vaccination movement.
References
Astrup, J. (2018). Mandatory vaccinations? Community Practitioner, 91(2), 14-16. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=128716019&site=eds-live&scope=site&custid=s3818721
Astrup, J. (2019). Catching the anti-vax bug. Community Practitioner, 92(5), 14-17. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=136738689&site=eds-live&scope=site&custid=s3818721
Colorado Children's Immunization Clinic. (n.d.a). Aluminum | immunize for good. Retrieved from http://www.immunizeforgood.com/fact-or-fiction/aluminum
Colorado Children's Immunization Clinic. (n.d.b). Autism | immunize for good. Retrieved from http://www.immunizeforgood.com/fact-or-fiction/autism
Dixon, G., & Clarke, C. (2013). The effect of falsely balanced reporting of the autism–vaccine controversy on vaccine safety perceptions and behavioral intentions. Health Education Research, 28(2), 352-359. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=sso&db=ccm&AN=104254763&site=eds-live&scope=site&custid=s3818721
Gorski, D. (2009). Welcome back, my friends, to the show that never ends, part II: Generation rescue, the anti-vaccine propaganda machine, and “Fourteen studies”. Retrieved from https://sciencebasedmedicine.org/welcome-back-my-friends-to-the-show-that-never-ends-part-ii-generation-rescue-attacks-14-studies/
Handley, J. B. (2009). Autism is preventable and reversible. Larry king live blogs () Retrieved from https://link.gale.com/apps/doc/EJ3010133274/OVIC?u=usfca_gleeson&sid=OVIC&xid=000d7ce6
Heuvel, K. v. (2013). Jenny McCarthy's vaccination fear-mongering and the cult of false equivalence. Nation () Retrieved from https://link.gale.com/apps/doc/EJ3010938209/OVIC?u=usfca_gleeson&sid=OVIC&xid=ff05cafb
Jamison, A. M., Quinn, S. C., Qi, S. H., AlKulaib, L., Chen, T., Benton, A., . . . Broniatowski, D. A. (2018). Weaponized health communication: Twitter bots and russian trolls amplify the vaccine debate. American Journal of Public Health, (10), 1378. doi:10.2105/AJPH.2018.304567
McCarthy, C. (2016). The inconvenient truth of vaccine refusal. Retrieved from https://www.health.harvard.edu/blog/the-inconvenient-truth-of-vaccine-refusal-201603229426
MMR vaccine does not cause autism. (2019). Journal of Paediatrics and Child Health, (8), 996. doi:10.1111/jpc.14509
Rene F., N. (2018). In defense of the common anti-vaxxer | history of vaccines. Retrieved from https://www.historyofvaccines.org/content/blog/defense-of-common-antivaxxer
Scutti, S. (2018). Encouraging vaccination around the world. Retrieved from https://www.cnn.com/2017/06/06/health/vaccine-uptake-incentives/index.html
Vaccine myths debunked. (n.d.). Retrieved from https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/
What goes into a vaccine? (n.d.). Retrieved from https://www.publichealth.org/public-awareness/understanding-vaccines/goes-vaccine/
Xu, Z., Ellis, L., & Umphrey, L. R. (2019). The easier the better? comparing the readability and engagement of online pro- and anti-vaccination articles. Health Education & Behavior, 46(5), 790-797. doi:10.1177/1090198119853614