Vaccine Hesitancy IP

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VACCINE HESITANCY 1 Vaccine Hesitancy Shannon Murray Colorado Technical University

VACCINE HESITANCY 2 Vaccine Hesitancy Vaccines are a routine port of healthcare beginning as early as birth. The science surrounding vaccinations has continued to evolve over the last six centuries. As early as the 1400s people attempted to prevent illness by intentionally exposing healthy individuals to smallpox (WHO, 2021). This was called variolation. In 1872, Louis Pasteur created the first laboratory-produced vaccine. Thirteen years later he created the first post-exposure vaccine, which treated rabies. The Spanish Flue pandemic in 1918 made creating a vaccine a priority. The 1900s saw immense progress in vaccine science with the creation of vaccines for influenza, yellow fever, polio, hepatitis B, MMR, pneumococcal pneumonia, Hib, HPV, rotavirus, and many others. Vaccines have been attributed to eradicating many previously devastating diseases. In 1974, the WHO established the Expanded Program on Immunization to develop immunization programs worldwide. The first diseases targeted were diphtheria, measles, polio, tetanus, tuberculosis, and whooping cough (WHO, 2021). An example of disease eradication is polio and smallpox. The polio vaccine went into mass trials in 1954. The first nation to eradicate polio was Czechoslovakia in 1960 (WHO, 2021). In 1967 the World Health Organization (WHO) announced the Intensified Smallpox Eradication Program to eradicate smallpox in more than 30 countries through surveillance and vaccination. The WHO (2021) defines eradication as “the permanent reduction to zero of a specific pathogen, as a result of deliberate efforts, with no more risk of reintroduction.” In 1980 the World Health Assembly declared smallpox eradicated stating “ The world and all its people have won freedom from smallpox, which was the most devastating disease sweeping in epidemic form through many countries since earliest times, leaving death, blindness and disfigurement in its wake.” Following the Smallpox Eradication Initiative, in 1988 the WHO (2021) launched the Global Polio Eradication Initiative and by 1994 it was eradicated from the Americas and Europe in 2002. By 2003 polio was endemic in just 6 countries, down from the original 125.

VACCINE HESITANCY 3 The 1990s and 2000s continued to see advancements in vaccine science with the development and subsequent FDA approval. In 1995 it was proven that human papillomavirus (HPV) played a key role in cervical cancer. A vaccine would be fully FDA-approved in 2006. 2006 also saw the approval of a lower-risk rotavirus vaccine. In 2002 the Meningitis Vaccine Project was founded. Within 5 years, the vaccine had nearly eliminated serogroup A meningococcal meningitis in Africa, and it is now integrated into routine national immunization programs (WHO, 2021). The COVID-19 pandemic was deemed a Public Health Emergency of International Concern by the WHO (2021) on January 30, 2020. The WHO officially declared COVID-19 to be a pandemic on March 11. Efficient COVID-19 vaccinations, some of which used mRNA technology, were created, and made available at unprecedented speeds. The first COVID-19 vaccination was given in December 2020, or around a year after the first instance of the virus was detected. Ever since the first vaccination against smallpox was developed more than 200 years ago, people have been protected against fatal illnesses through vaccinations. History has shown us that a comprehensive and successful worldwide response to diseases that can be prevented by vaccinations demands patience, funding, teamwork, and ongoing attention. From inventive techniques in the 1500s to the newest technologies present in COVID-19 vaccines, science has come a long way. As of right now, immunizations provide defense against more than 20 illnesses, including cervical cancer and Ebola. Vaccinations have been a major factor in the 50% reduction in child fatalities that have occurred in just the previous 30 years. Still, more work needs to be done. Worldwide, one in five youngsters still do not have their vaccines. International cooperation, funding, commitment, and vision are required if no kid or adult in the ensuing decades is to suffer from or die from a disease that can be prevented by vaccination. Vaccinations became a public health initiative at their inception. As per the Mayo Clinic (n.d.), Massachusetts was the pioneer state to require children to receive a smallpox vaccination prior to

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VACCINE HESITANCY 4 starting school in 1855. By 1963, twenty states had adopted similar laws, requiring children to receive multiple vaccinations before starting school. The United States launched the Childhood Vaccine Initiative in 1977 with the goal of vaccinating 90% of children by the end of two years. Every state in the United States would have regulations pertaining to vaccinations and school enrollment by 1980. As of 1998, students entering kindergarten through the 12th grade were required to have vaccinations in all but four states. Despite all the good vaccines have done, parents are becoming more skeptical of the necessity and safety of vaccinations. Due to this, vaccination rates have decreased to dangerously low levels in various communities. According to McClure et al. (2017), vaccine hesitancy is defined as "a delay in acceptance or refusal of vaccines despite the availability of vaccination services." This term was devised to neutralize the rhetoric against vaccinations. In 2019 the WHO listed vaccine hesitancy as a top 10 threat to world health (Wilson & Wiysonge, 2020). Throughout history, democracies have been linked to better health outcomes because of increased public education, public accountability, and generally higher wealth levels. However, statistically wealthy, and highly educated democracies are where anti-vaccination sentiment is currently the most concentrated (Wilson & Wiysonge, 2020). Regarding the MMR vaccine in the US, parents' reluctance to vaccinate their children may be largely impacted by misinformation or disinformation regarding the safety of the vaccine and the alleged low measles risk. Despite the overwhelming body of scientific evidence supporting the safety and efficacy of vaccinations, there have recently been calls for the creation of a special government commission on vaccine safety (Lo &Hotez, 2017. The already declining trends in vaccination coverage among US children could worsen if the panel were to draft policies that loosen childhood vaccination requirements. Lo and Hotez (2017) performed a research study on the consequences of decreased MMR vaccination and the effect it would have on measles. They found that a 5% decrease in MMR vaccination

VACCINE HESITANCY 5 nationwide would result in a projected three-fold increase in measles cases in children 2-11 years old annually. They also determined that this would increase healthcare costs by $2.1 million. These statistics would be significantly higher if unvaccinated infants, teenagers, and adults were also considered. In 2016 the WHO (2021) declared that the Americas region was “free of endemic measles.” However, this status was lost two years later after an outbreak caused by gaps in vaccination coverage. McClure et al, (2017) found that “ compared with vaccinated children, children whose parents refuse pertussis-containing vaccines are 23 times more likely to be diagnosed with pertussis, that children whose parents refused varicella vaccine are 9 times more likely to be diagnosed with chicken pox, and that children whose parents refused pneumococcal conjugate vaccine are 6 times more likely to be hospitalized for invasive pneumococcal disease or lobar pneumonia.” Studies have also shown that communities and states with higher vaccination exemption rates are more vulnerable to vaccination- preventable disease outbreaks, including measles, mumps, and pertussis. Parental refusal or delayed scheduling of childhood immunizations is a major contributor to the perseverance of vaccine- preventable disease outbreaks, and it has been linked to greater inpatient admission and emergency department utilization rates, as well as increased morbidity and mortality (McClure et al, 2017). Many attempts have been made to create practical solutions for parents who are reluctant to get their children vaccinated. These efforts have yielded a variety of results. Effective evidence-based strategies for addressing vaccine hesitancy at the community level or communicating with parents who are reluctant to get vaccines are still lacking. Most vaccine hesitancy interventions employ the Information Deficit Model, which presumes that misperceptions result from ignorance and that increasing information is the means of resolving them (McClure et al., 2017). School entry requirements in the United States serve to promote and enforce the childhood vaccination schedule. In the US, vaccination exemptions are permitted in all states. California, Mississippi, and West Virginia, only permit medical exemptions. The remaining 47 states permit

VACCINE HESITANCY 6 exemptions based on religious or personal beliefs. Legal measures to promote vaccination and combat vaccine hesitancy have primarily targeted the elimination of non-medical exemptions or increased difficulty in obtaining exemptions. If nonmedical exemptions are eliminated, vaccination rates might increase. Nevertheless, political and ethical considerations favor maintaining nonmedical exemptions while making them more challenging to obtain. Proponents of government control and vaccination may become politically active if they believe that vaccination is mandatory and takes away people's freedom of choice and personal liberty. What legislative strategy works best to combat vaccination reluctance is still up in the air. Most state vaccination laws aim to create a balance between individual freedom and the health of the population. The difficulties healthcare professionals encounter when deciding whether to reject families who refuse vaccinations reflect these worries. 21% of pediatricians say they always or frequently turn away families that refuse one or more vaccinations (McClure et al, 2017). States with more lenient exemption policies had a smaller percentage of doctors who dismiss families, indicating a possible relationship between state-level vaccination laws and the dismissal of families. States with stricter exemption regulations are known to have higher immunization rates; however, it is unknown how much the practice of dismissing families contributes to those higher rates. Online dissemination of information is another approach. Numerous parents claim to have learned about vaccine-related topics via internet sources; however, some of these sites may spread misinformation or disinformation. Web-based interventions to address vaccination hesitancy are a potential strategy because parents are already using the internet for information and healthcare providers are under time constraints during hectic office appointments. Internet media may help track reluctance as well as for educating people about vaccinations. The Vaccine Sentimeter is a tool for "global monitoring of vaccination conversations" that analyzes and finds patterns in content, geography, and time using information from social media and online news sources (McClure et al., 2017). Public

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VACCINE HESITANCY 7 health organizations will be better equipped to respond to changing vaccine concerns over time by keeping an eye on news media and online discourse about vaccines. Additionally, doctors may discover that web-based communication strategies can address hesitancy outside of the time constraints of an office visit. Social norms may be another effective avenue to address vaccine hesitancy, in addition to values. In underdeveloped nations, social norms have also been effective in encouraging vaccination. Given that most families approve of vaccinations, supporting parents who make this decision and speaking out against the widely disseminated arguments of those who oppose vaccinations can be helpful. Washington's Immunity Community program is the result of a public-private partnership called VaxNorthwest (McClure, 2017). Parents who endorse vaccinations receive training to help them communicate and advocate for the children in their communities. These community outreach initiatives have the potential to mobilize the support of vaccinating parents to combat vaccine reluctance and to advance immunization as the accepted societal norm. Vaccination is a crucial component of pediatric preventative care. Even though vaccine hesitancy is not new, the growing number of parents choosing not to vaccinate their children poses a serious risk to public health. Despite a great deal of study on vaccine reluctance, there aren't many evidence-based tactics for dealing with it. It may be possible to raise vaccination rates by fortifying state laws on vaccine mandates for students. The study of vaccination hesitancy tactics is a new area of study with many potential approaches.

VACCINE HESITANCY 8 References Lo, N. C., & Hotez, P. J. (2017). Public health and economic consequences of vaccine hesitancy for measles in the United States. JAMA Pediatrics , 171 (9), 887–892. https://doi.org/10.1001/jamapediatrics.2017.1695 Mayo Clinic. (n.d.). History of vaccine requirements and research highlights . Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/history-disease-outbreaks-vaccine-timeline/ requirements-research McClure, C. C., Cataldi, J. R., & O’Leary, S. T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics , 39 (8), 1550–1562. https://doi.org/10.1016/j.clinthera.2017.07.003 WHO. (2021). A brief history of vaccination . World Health Organization. https://www.who.int/news- room/spotlight/history-of-vaccination/a-brief-history-of-vaccination Wilson, S. L., & Wiysonge, C. (2020). Social Media and vaccine hesitancy. BMJ Global Health , 5 (10). https://doi.org/10.1136/bmjgh-2020-004206

Vaccine Hesitancy IP

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