Rebuilding the vaccination movement

Artwork by Erika Notarianni

In light of vaccine hesitancy and anti-vaxx groups, Tharani Ahillan considers how we might strengthen the vaccination movement.

Ellie* is 20 years old. As I sit opposite her, she tells me that she has had to take a year out of university. The culprit? She had contracted mumps. The post-viral fatigue was preventing her from taking exams. She had not been vaccinated as a child, and didn’t think it was something to worry about. 

This story is all-too familiar. Across the the world, cases of vaccine-preventable diseases are on the rise. With such a threat to public health and an unprecedented number of cases of previously-unseen diseases, the falling vaccination uptake rate poses a question for public health - how should we rebuild the vaccine movement?

The vaccination movement

Immunisation has been practised for hundreds of years: Buddhist monks drank snake venom to try and acquire immunity to snake bite. However, it was only in the late 18th century that Edward Jenner, dubbed as the “Father of Immunology,” would inoculate an 8-year-old boy to protect against smallpox. It was here that vaccinology was founded.

From there this field has grown in leaps and bounds, illustrated by the eradication of smallpox. In fact, UNICEF estimates that around five lives are saved every minute of every day, and the success of vaccines has led the World Health Organisation (WHO) to label it as the second most important public health intervention, behind clean water.

However, in 2019, the WHO labelled “vaccine hesitancy”, the reluctance or refusal to vaccinate despite the availability of vaccines, one of the top ten threats to Global Health. But is this actually the case, and if so, what are we doing to tackle this health issue? 

is the vaccination uptake actually decreasing?

According to NHS data, 2019 saw a decline in coverage for all routine vaccinations. Helen Bedford, Professor of Children’s Health at UCL’s Great Ormond Street Institute of Child Health, cautions that “the decline in uptake over the last five years has been small and uptake still remains high”. However, Jonathan Kennedy, Senior Lecturer in Global Public Health at Queen Mary’s University, explains that while the decline may be minimal, measles vaccine coverage is currently 90.3% in England and Wales, which is below the 95% target recommended by the WHO to avoid outbreaks. Within UCL, Emma Hughes, coordinator of UCL vaccination sessions, is positive. She says “vaccination uptake has always been very popular at UCL specifically, and seems to have remained consistent over the years.”

vaccine hesitancy

Vaccine hesitancy" dominates media coverage. As Dr Kennedy asks, “why [is it], when experts say vaccines are safe and effective, do people not believe them?”. A “Vaccine Confidence Index” was created in summer 2019 to attempt to measure the levels of distrust. Whilst Europe had the lowest vaccine confidence globally, the UK ranked favourably within this: with confidence levels in vaccine safety at 75%, compared to, say, France which had confidence levels under 50%. Interestingly, lower income countries such as Bangladesh, Rwanda and Ethiopia had the highest levels of confidence in vaccines, at almost 100%. 

Dr Kennedy explains why this may be the case: “people in poorer countries are more likely to trust vaccines because these are the countries where vaccine-preventable diseases are more common and the threat is high. In high-income countries where vaccine-preventable diseases are rare, many parents have become complacent.” He goes on to suggest that the rise in vaccine hesitancy could be related to the rise of populism and distrust towards politics and elites. This then manifests as distrust towards doctors, public health authorities, and pharmaceutical companies. “On some level this is understandable,” he says. “Look at the opioid crisis and the role Big Pharma played in that. It is no wonder that people believe conspiracy theories about the dangerous side effects of vaccines being hidden from the public by greedy capitalists.”

Certainly, the Measles, Mumps, and Rubella (MMR) vaccine has suffered from a loss of public confidence. 20 years ago, a 1998 Lancet paper implied there was a link between the MMR vaccine and a “new syndrome” of autism and bowel disease. Following a vaccine scare, the findings were discredited, with numerous epidemiological studies consistently finding no evidence of a link between the MMR vaccine and autism. The paper was finally retracted twelve years later. Yet Measles and Mumps cases continue to rise in the UK. Most of what we are seeing now is the legacy of the low vaccine uptake 20 years ago, with outbreaks being predominantly driven by cases in older teens or young adults who weren’t vaccinated as toddlers, not because uptake is low now. 

This raises the question of what counts as “misinformation” and whether citizens should be shamed for questioning taxpayer-funded health initiatives. Homeopathy International agrees, riling against its label as “anti-vaxx”. Instead they describe themselves as “pro-children and pro-informed consent”, emphasising the need to consider “all the possible benefits and complications of a planned procedure, and that the financial bonus given by NHS to GP practices may result in a lack of financial transparency and conflicted interests.”

access to vaccines

Access to vaccines is not what most people think of when they consider the reasons for rising cases of vaccine-preventable diseases. But timing, availability, and location of appointments can all be key barriers to vaccination, whatever the age. As Dr Kennedy explained further, “some parents face problems in accessing vaccination devices. This is particularly the case for poorer families, as parents might be unable to take time off work or can struggle to afford transport to the clinic.”

The suggestion of mandatory vaccinations, however, has challenges in terms of autonomy, availability of choice, and parental rights and responsibilities. Indeed, Professor Bedford thinks that the situation in the USA, where states have mandatory vaccines as a prerequisite for pre-school, may have inflamed the anti-vaxx movement, and cautions against a similar story in the UK. 

what are the solutions?

Professor Bedford instead emphasises the role of  “flexible, accessible, family-friendly immunisation services. This involves reminding parents of when vaccines are due, and ensuring that health professionals have time and are equipped to discuss parents’ questions and concerns.”

With regards to vaccine hesitancy, Dr Kennedy explained, “the public still have a large amount of trust in doctors and nurses. We need healthcare professionals to keep explaining the importance and safety of vaccines to patients.” He concedes that public health has become very politicised in recent years: Matt Hancock’s recent suggestion of making child immunisations mandatory was met with fury online. He cites countries like Italy which have also received backlash for its mandatory vaccination programme. However he concedes that “public health is political, for better or for worse, and we need to consider this when improving vaccine uptake.” 

Meanwhile what did Ellie think about her experiences? “I’m definitely pro-vaccines now,” she said, “it’s not something you ever think about until it happens to you and I want to share my story to show that it’s still very much a threat.” 

*Name changed for privacy

This article was originally published in Issue 725 of Pi Magazine.