On January 15th, the World Health Organization (WHO) released its annual list of the Top 10 Threats to Global Health that it pledged to combat this year. Alongside well-established issues like Climate Change and Antimicrobial Resistance, a surprising addition was ‘Vaccine Hesitancy;’ a reluctance or refusal to receive vaccines despite availability of services. Weighing in at number eight, it was deemed a major contributor to a near-worldwide resurgence of previously preventable diseases – including ones that are life-threatening or incurable.Right now, the WHO estimates that vaccines save 2.3 million lives every year, and a further 1.5 million could be saved if vaccination coverage increases.
Unfortunately, recent trends reveal that increases are failing to take place. A recent report by the WHO revealed that that 2017 was the first year since 2000 to actually increase in prevalence of preventable diseases in Europe, North America, and the Mediterranean – including in countries previously declared free. The most notable of such cases is measles, which is estimated by the WHO to have experienced a 30% increase in cases globally after being nearly eliminated in recent years. Though preventable by vaccine, measles has no known cure and is extremely contagious, requiring only 15 minutes of contact with an infected person to contract it. In severe cases, it can result in complications like blindness, encephalitis, and death. Its severity is also exacerbated in those with pre-existing medical conditions such as HIV, Leukemia, or Vitamin deficiencies, leaving a sizeable portion of the world’s population even more vulnerable.
Now in 2019, multiple measles outbreaks have been reported over the past year including in major metropolitan centres. In late 2018 and early 2019 for example, New York City and its surrounding county reportedly had its worst outbreak in recent history, with additional cases being reported worldwide. In 2017, the total death toll for measles was 110,000– mainly children under the age of five. High immunization rates and a reputation as a ‘historical’ disease has left modern citizens complacent, but it’s still very much a threat.
As mentioned previously, for ‘vaccine hesitancy’ to be present a crisis mustconsist of lowered vaccination rates despite widespread availability. This factor distinguishes it from vaccine-related struggles happening for other reasons (Venezuela, for instance, saw a rapid increase in measles cases following the crumbling of public service infrastructure in the country’s political crisis). Primarily occurring in industrialized countries, the movement has long since been dismissed as a disreputable fringe movement associated with clueless suburbanites, Whole Foods hippies, or wacky conspiracy theorists. An article by noted business publication Fortunecalled the crisis ‘entirely solvable,‘ as if it could be mopped up by a couple of well-distributed flyers and in no way warranted the same reaction as diabetes and heart disease (the list’s number two). As the WHO established, however, the issue is much more complex than commonly believed. Far from a sudden global fear of autism or surge in anti-governmentalism, vaccine hesitancy seems to result from highly varied factors dependent on specific political and cultural contexts. These differ even between Euro-American countries.
The version shared by the US and UK is perhaps the most well-known. Taking off in 1998 after the infamous (and debunked) Lancet paper linking vaccines with autism, the movement is commonly characterized by a belief that the medical and ‘Big Pharma’ industries collaborate inappropriately with governmental forces to downplay the negative effects of vaccines in order to maximize profit. In its apparent conviction, the US anti-vaccine movement has been highly active in the political sphere; lobbying zealously and successfully preventing politicians from introducing pro-vaccine legislation. Speculatively speaking, this form of hesitancy can be linked back to issues surrounding the USA’s unapologetically for-profit stance on public service industries, from health care to education to baby formula, and is further aggravated by a lack of education on issues like autism and radical libertarianism in the American southwest. In the UK, the Lancet paper’s British origins have gained it a platform in the country, and its shared language with the USA has rendered it vulnerable to the same misinformation. Now, England’s vaccination rate for children of the Measles, Mumps and Rubella (MMR) vaccination is just 87%– well below the 95% necessary to prevent outbreaks via herd immunity.
In Mediterranean Italy, however, the movement has a different flavour. In 2018, its populist right-wing government passed an amendment that struck down mandatory vaccination for schoolchildren; suspending a law that required parents to provide proof of vaccinations before enrolling their children in kindergarten or preschool. Introduced amid a series of measles outbreaks, the law had been an attempt to mitigate Italy’s status as the source of 34% of measles cases in the European Economic Area and the 2ndhighest nation in Europe. However, experts warned that legislated forced inoculations were unlikely to go over well in Italy, who has had 65 increasingly polarized governments since overcoming fascism in 1946 and been plagued with corruption scandals since the 1990s. This, as argued by a CNN source, resulted in a widespread oppositional sentiment towards governmental institutions and towards ‘anyone with a specific expertise.’ The subsequent mentality of individualism in the face of incompetent and untrustworthy governments has led to an anti-vaccine movement on ideological grounds, with citizens resenting the idea of being forced into decisions by their government. Admittedly also fueled by the same medical misinformation plaguing other Western nations, Italy’s issue can be considered an indicator of a deeper underlying problem occurring with the country’s descent into right-wing populism.
That being said, vaccine hesitancy takes on less flagrant tones in northern and central European countries. Using Sweden and Switzerland as examples, studies confirmed that the main reason given for not vaccinating children was a belief that doing so would strengthen their children’s immune systems, seeing vaccines as ‘artificial intrusions’ into the natural workings of the human body even if their children were to contract the diseases. A far cry from the approaches of other regions, northern Europe’s vaccine hesitancies reflect instead a different kind of misinformation with an equally cultural rationale. Needless to say, such a mindset warrants completely different coping methods. Attempts to target vaccine hesitancy in these areas should mainly centrearound increased education on the vaccination process, the severity of MMR diseases, and immunology to parents by medical officials.
Other factors in the vaccine hesitancy debate vary even more heavily when different regions are compared to one another. In the US state of California, for instance, a potential positive correlation was identified between vaccine hesitancy and socioeconomic status, whereas in Europe vaccination rates have declined most rapidly in its poorest countries, such as Bulgaria and Greece. The same study also alleges that American non-vaccination rates are highest in non-Catholic, Christian schools (the USA’s largest and most mainstream religious group) whereas European countries’ rates are highest for marginalized minority groups like the Somali migrants in Sweden and Roma communities in Eastern Europe. Politically speaking, southern European vaccine hesitancy has been adopted by right-wing organizations, with Italy’s Five Star movement correlating with parties like France’s National Rally Party (formerly the National Front). In the USA, it seems present on both sides of the political spectrum (see ‘Whole Foods Hippies’). There is very little consistency across the board, but all movements generate the same result.
If anything can be learned from this smorgasbord of factors, it’s the need for an equally multifaceted approach for combatting all of them. Whilst certain factors are widespread (both North America and Europe were impacted by the Lancet ‘autism’ paper and have experienced populist movements advocating for ‘vaccine choice’), the underlying motivations for them remain diverse. Attempts have already been made – the WHO has since launched a campaign designed to combat vaccine hesitancy particularly towards measles, including Twitter hashtags like ‘#measles’ and ‘#vaccineswork.’ This leap from statistical reporting to social media is particularly effective as the WHO’s official report as well as numerous academic studies have found social media and the internet to be the most prolific sources of anti-vaccination propaganda. In addition, the WHO recommended a multi-pronged approach using methods specifically tailored to each region – arguably the best hope of overcoming what is fundamentally an emotive issue heavily dependent on context. It’s the best the WHO can do whilst lacking the insight apparently held by the writers at Fortune Magazine. It’s far from ‘easily solvable.’ It’s exactly the opposite – and we have a long road ahead of us.
Banner Image: Image Courtesy of S.C. Air National Guard via Flickr Images © 2013, public domain