Vaccine hesitancy

What is Vaccine Hesitancy?

Vaccine hesitancy is when people wait to get vaccines or decide not to get them, even when vaccines are available and known to work well. This can happen even if people know vaccines are safe and good at stopping diseases.

Sometimes, people feel unsure about which vaccines to get or put off getting them. Even though vaccines can have very rare side effects, most scientists say they are very safe and help keep people from getting serious diseases.

Why Does Vaccine Hesitancy Matter?

When many people choose not to get vaccinated, it can lead to diseases spreading again. These diseases can make people very sick or even cause deaths. The World Health Organization says that vaccine hesitancy is one of the biggest threats to health around the world.

Reasons for Vaccine Hesitancy

There are many reasons why people might not want to get vaccines. Some people may not understand how vaccines work, feel nervous about getting shots, or not trust health authorities. Others might think they don’t need a vaccine or find it hard to get to a place where they can get one. These feelings have been around since vaccines were first made.

Sadly, false ideas and misleading information from groups that don’t support vaccines can also make people hesitant. But almost all medical and scientific experts agree that the good parts of getting vaccines are much bigger than any risks. Some people also worry about being forced to get vaccines, feeling it takes away their choice.

Safety concerns

Vaccines are very safe, but like any medicine, there is a small chance of serious side effects. These side effects are much rarer than the diseases vaccines prevent. When vaccines work well, some diseases become rare. This can make people feel less worried about those diseases, even though they can still be serious. Sometimes, people hear stories about new health concerns and think vaccines might cause them, but these stories often lack strong evidence. Studies usually show that vaccines do not cause these health issues, and the benefits of vaccination far outweigh any small risks.

Ingredients concerns

Thiomersal

Thiomersal is a preservative used in some vaccines to prevent contamination. It breaks down into harmless substances in the body. Concerns that it could cause certain conditions have been studied extensively, and no evidence supports these claims. Scientists have found that thiomersal is safe when used in vaccines.

Formaldehyde

Small amounts of formaldehyde are used in vaccines to inactivate viruses. The body naturally produces more formaldehyde than what is in vaccines, and it can safely process these small amounts. There is no evidence that the formaldehyde in vaccines causes cancer or other health problems.

MMR vaccine

There was a concern many years ago that the MMR vaccine might be linked to a condition called autism. However, many studies have shown there is no connection between the vaccine and autism. Health organizations around the world confirm that the MMR vaccine is safe and effective.

Vaccine overload

Some people worry that giving many vaccines at once might overwhelm a child's immune system. However, studies show that this is not the case. Even when multiple vaccines are given, the immune system handles them well, and there is no evidence that vaccines weaken the immune system.

Prenatal infection

Some have worried that getting flu vaccines during pregnancy might affect the baby. However, health organizations recommend flu vaccines for pregnant women because they protect both the mother and the baby from serious flu complications. Studies have not shown any harm from these vaccines.

Sudden infant death syndrome

There have been questions about whether vaccines might be linked to sudden infant death syndrome (SIDS). Studies have looked into this and found no evidence that vaccines cause SIDS. In fact, some research suggests that vaccinated children might be less likely to experience SIDS.

Anthrax vaccines

After the Gulf War, some veterans reported health issues and wondered if anthrax vaccines might be involved. Extensive research has been done, and there is no clear link between the anthrax vaccine and these health problems.

Swine flu vaccine

In 1976, a swine flu vaccine was given to many people, but the outbreak did not happen as expected. Some people had rare side effects, leading to concerns. Later during the 2009 flu pandemic, there were also worries about the safety of the H1N1 vaccine, but studies found no strong evidence of serious risks.

Blood transfusion

After COVID-19 vaccines were introduced, some people worried about receiving blood from vaccinated donors. However, health experts say there is no evidence that this is a problem. Blood services do not track vaccine status, and most people have already been vaccinated.

Other safety concerns

There have been many other concerns about vaccines causing conditions like seizures, allergies, or autoimmune diseases. Scientists have studied these claims and found no evidence that vaccines cause these issues. Vaccines are carefully tested to ensure they are safe and effective. Some parents also worry about the pain of vaccines, but studies show that giving multiple vaccines at once does not cause more stress for children.

Vaccine myths and misinformation

Some people have worries about vaccines because of myths and misunderstandings. They might think that getting a disease naturally is better than getting a vaccine, or that diseases vaccines prevent aren’t really dangerous. Others might worry that vaccines aren’t effective or that there are hidden plans by the government or health groups.

Even though vaccines are safe and helpful, some people still believe wrong ideas about them. For example, many people have heard that vaccines can cause autism, but studies have shown this is not true. Vaccines do not cause autism, and there is no link between them.

Some parents worry about giving vaccines to children who are sick. It’s generally safe to give vaccines to children who are only a little sick, like with a mild cold. But if a child is very sick, doctors might wait until the child gets better before giving certain vaccines.

Unfortunately, false information about vaccines has sometimes spread online. This can make people unsure about whether vaccines are safe. It’s important to trust reliable sources like doctors and health organizations when learning about vaccines.

Alternative medicine

Many types of alternative medicine do not support vaccines. This began in the 1970s when some groups like chiropractic and homeopathy started sharing ideas against vaccines. These groups think vaccines are not needed because they believe diseases come from other causes.

Some chiropractors today still do not support vaccines. They think problems in the spine cause illness, not germs. Some homeopaths also do not recommend vaccines. They use special water treatments instead, but these do not protect against real diseases. Some people who support these treatments make money by selling them instead of real vaccines.

Psychological factors

Some people decide not to get vaccines because of how they think. This can include believing stories that are not true, feeling worried about getting shots, or having strong personal views. These thoughts can affect whether someone gets a vaccine.

For example, a study in 2021 looked at people in Ireland and the UK who were unsure about getting the COVID-19 vaccine. The study found that these people often did not trust traditional news sources and had similar worries about vaccines, no matter where they lived.

Many people feel nervous about getting shots because of a fear of needles. This fear can stop some from getting their vaccines. There are ways to help with this fear, like focusing on something else during the shot or using methods to reduce pain. Experts suggest using friendly and positive images in vaccine messages to help people feel more comfortable. They also mention that new ways to give vaccines, like oral treatments, might help reduce this fear.

Social and political

Beyond misinformation, many things affect whether people choose to get vaccines. Things like money, how much schooling someone has, their age, and where they live can all play a part. For example, older people who live alone might be less likely to get vaccines than those who live with others. Some groups, like racial minorities, may also have lower rates of vaccine use.

People who are healthier or have stronger immune systems might not feel as urgent about getting vaccines, while those with weaker immune systems or long-term health problems often choose to get vaccines when their doctors suggest it. Sometimes, political views can also influence people's feelings about vaccines.

Malpractice and fraud

Unethical human experimentation and medical racism

Some people do not trust doctors because of past unfair treatments. There have been cases where people were treated without asking them first. Experts say the best way to build trust is to include everyone in medical studies, get permission from all participants, and be clear about how medicines are made and tested.

CIA fake vaccination clinic

Main article: CIA Vaccination Cover in Pakistan

In Pakistan, a group used a fake health check to find a person. This hurt some people and made many scared of health workers. Some groups now think health checks are dangerous plans. This made it harder to stop a sickness.

Fake COVID-19 vaccines

In 2021, some people in India gave out salt water instead of real vaccines. Over 2,600 people paid for these fake shots. In some areas, people were told they would get a real COVID-19 vaccine but were in a test group where some got only a harmless liquid instead.

Religion

Main article: Vaccination and religion

Many religions do not have rules about vaccines because vaccines were made long after these religions began. Still, some people have refused vaccines for religious reasons since vaccines were first used. Some early Christian leaders thought stopping diseases like smallpox went against God's will. Even today, some religious groups have concerns about vaccines.

Some Jewish leaders support vaccines. For example, Rabbi Nachman of Breslov said parents should vaccinate their children early, calling it very important. In recent years, some Jewish and Muslim groups worried about vaccines that might contain gelatin from pigs, but leaders said these vaccines are still acceptable when no other options exist. In India, false rumors spread that a vaccine was part of a plan to affect Muslim population sizes, causing some schools to refuse vaccines. Some Christian groups have concerns about vaccines that use cells from old medical procedures, but leaders say using these vaccines is okay until better ones are made. In the United States, some parents have used religious reasons to avoid vaccines even when their real concerns are about safety.

Geographical distribution

Vaccine hesitancy is a growing concern, especially in wealthy countries. For example, a study in Europe showed that some parents had doubts about vaccinating their children. Researchers have looked at how different things like money and education affect vaccine hesitancy. People with different amounts of money and education levels have shown hesitancy in different places.

In Australia, a study found that people with lower incomes were less likely to get vaccines, but this wasn’t because they disliked vaccines—it was more about practical challenges. During the COVID-19 pandemic, vaccine hesitancy spread in some remote Indigenous communities in Australia.

In Europe, trust in vaccines changes depending on where you look and which vaccine you’re talking about. A study found less confidence in vaccines in Europe compared to the rest of the world. Refusal of the MMR vaccine has grown in some European countries since 2010. Younger adults tend to have less confidence than older people. Confidence in vaccines has gone up in some countries but dropped in others. Some doctors have also had concerns about the safety of certain vaccines.

Countermeasures

Vaccine hesitancy can be hard to handle, and the best ways to deal with it are still not fully known.

One way to help includes supporting communities with fewer vaccines, making vaccines easier to access, teaching people more about vaccines, and sometimes requiring vaccines. The World Health Organization suggests that experts should focus on helping everyone understand, instead of just arguing with those who refuse vaccines. This can help people see misleading information more clearly.

Talking with families in a kind and honest way is important. Experts suggest listening to concerns, sharing facts simply, and pointing to trusted sources for more information. Some ideas to make vaccines easier for children include using distraction, comfort methods, and combining vaccines to reduce the number of shots. Being sensitive to different cultural views can also help. It’s important to guide families to reliable sources of information and avoid confusing online searches. Some places have used rewards or requirements to encourage vaccination.

Policy implications

Further information: Vaccination policy

Many health groups, like the Infectious Diseases Society of America, the American Medical Association, and the American Academy of Pediatrics, think all children should get their required vaccines.

Vaccination rules can be tricky because some people think governments should not decide about a family's health. Others think vaccines are important for everyone. In some places, children must get certain vaccines to go to school. As of January 2021, five states – Mississippi, West Virginia, California, Maine, and New York – no longer allow families to choose not to vaccinate their children for religious or personal reasons.

Some people believe children have a right to the best medical care, including vaccines, even if their parents do not want them to get vaccinated. This can be hard for doctors and schools, especially when families cannot find another doctor for their children.

History

Variolation

People tried to stop smallpox by using a milder form of the disease to help others become immune. Some religious leaders did not agree with this, saying it was wrong to try to prevent disease.

Smallpox vaccination

After Edward Jenner introduced the smallpox vaccine in 1798, some people still did not want it. They worried about safety and if it really worked, especially when early vaccines were not always clean. These worries led to protests, especially when laws said people had to get vaccinated.

England

In England, laws made vaccination required, which led to protests and fines for people who refused. By 1889, a Royal Commission looked at these problems, and new laws let some people avoid vaccination for personal reasons.

United States

In the United States, there were similar debates, and the Supreme Court even decided if states could require vaccination.

Brazil

In Brazil, a public health campaign caused riots in 1904 because people did not trust the new vaccination program.

Later vaccines and antitoxins

As new vaccines were made, there were new worries. Some people were concerned about safety, especially when there were times when vaccines or treatments caused harm.

COVID-19

In 2020, when a COVID-19 vaccine was being made, many people wanted to take it. But some people were worried about safety or did not trust the vaccines.

Events following reductions in vaccination

When fewer people got vaccinated in some places, diseases like measles and whooping cough came back. For example, in Stockholm, Sweden, less vaccination caused a smallpox outbreak. In the UK, lower vaccination for whooping cough led to more cases and some deaths. This happened in other countries too, showing how important vaccines are to keep these diseases away.