Why vaccination should not be a question of if, but a matter of how it can be more accessible globally.
Acquiring information from reputable sources has always been good practice, but it takes on another level of significance when this information pertains to human health, namely regarding the legitimacy of vaccines and immunization. Continuous consumption of unregulated media fosters an environment unconducive to critical thinking, and when these habits spill over to issues regarding personal health, this not only affects the health and wellbeing of ourselves and our families, but also those of entire communities. That is, herd immunity to infectious diseases such as measles, polio, and rubella can only be established if vaccination rates are sufficiently high. This ensures that a certain threshold proportion of population is immune to these diseases, which in turn stabilizes the immunity of the population as a whole.
Assistant director of the Office of Pharmacy Professional Development at the University of Connecticut School of Pharmacy Jeannette Y. Wick makes an apt analogy between vaccines and seatbelts in the Pharmacy Times. She emphasizes that among the many personal decisions we make as citizens, the act of vaccinating has a crucial distinction, as does wearing seatbelts, in that it has a direct impact on the health and safety of others. As “there are so many other things in society that could be a personal decision, but for the good of society we make them a legal decision,” we must be wary of the decisions having adverse effects on the safety of others.
The fact that a sizeable percentage of Canadian parents are vaccine hesitant, if not complete vaccine refusers, is still perplexing to many, and the reasons why this hesitancy exists are difficult to unpack. Among these reasons are “complacency, inconvenience in accessing vaccines, and lack of confidence,” as outlined by the World Health Organization, the same organization that identified vaccine hesitancy as a top ten threat to global health in 2019. Further, in a paper recently published in Canadian Family Physician by Shen and Dubey, it was shown that vaccine hesitant Canadian parents identified potential side effects, vaccine safety, and lack of perceived necessity as their major concerns.
Although these concerns are rooted in an understandable desire of parents to protect their children from harm, there are numerous studies indicating that the perceived risks of vaccination are farcically overblown. According to the article in Scientific American, “Fact or Fiction?: Vaccines Are Dangerous,” there is “overwhelming medical evidence [showing] that negative side effects are rare and minor.” The World Health Organization similarly states that “most vaccine adverse events are minor and temporary,” and “most serious adverse events occur rarely (on the order of one per thousands to one per millions of doses).” The Centers for Disease Control and Prevention, for instance, cites studies by Rowhani-Rahbar et al. and Klein et al. which show that febrile seizures following vaccination occur in four children for every 10 000 children who receive the Measles, Mumps, and Rubella (MMR) vaccine and varicella vaccine separately. Two of the most circulated myths about vaccination are that it is somehow linked to the development of autism and the onset of Sudden Infant Death Syndrome (SIDS), both of which have long been debunked. As far back as 2004, the Institute of Medicine “rejected the idea that vaccines had any relationship with autism.” Moreover, the American Academy of Pediatrics states that complete immunization reduces the risk of SIDS, rather than causing it.
The safety and importance of vaccines have been and are continuing to be emphasized and validated by the world’s most authoritative sources, yet the vaccine-hesitant sentiment persists, and occurrences of vaccine-preventable diseases (VPDs) are still far higher than they should be. There were nine major outbreaks of measles between 2005 and 2013, and the number of cases of measles has increased by 30% globally. For many VPDs, vaccine coverage is now below the target of 95%. This is particularly disheartening, since it is estimated that 1.5 million deaths could be avoided each year if the global coverage of vaccinations increased.
Access to vaccination is a privilege that many parts of the world are unable to enjoy. Approximately 19 million children remain unimmunized per year, and in 2018, coverage in the WHO Western Pacific Region for the Haemophilus influenzae type b (Hib) vaccine was particularly low, sitting at only 23%. Other relatively low-coverage diseases include yellow fever (49%), rotaviruses (35%), pneumococcal diseases, (47%), and hepatitis B (42%).
Fortunately, the shift in public opinion to defend vaccine hesitancy is not irreversible. Refusal to vaccinate is not an unstoppable, underlying biological mechanism, but merely a personal decision that admittedly many have made based on misinformation. Most Canadian parents still consider their health care providers as the most trustworthy information source regarding vaccinations, according to recent polls. If we take the proper steps to enhance physician-patient communication and improve access to other validated sources of information, it will be possible to make VPDs as obsolete as they deserve to be.