Vaccine hesitancy

Vaccine hesitancy is when people delay getting or refuse vaccines even though they are available and proven to work well. This can happen even when people know vaccines are safe and effective. Sometimes, people feel unsure about which vaccines to use or put off getting them. Even though vaccines can have rare side effects, most scientists agree they are very safe and help protect people from serious diseases.

When many people choose not to get vaccinated, it can lead to outbreaks of diseases that vaccines can prevent, which can make people very sick or even cause deaths. The World Health Organization says that vaccine hesitancy is one of the biggest threats to global health.

There are many reasons why people might be hesitant to get vaccines. Some people may not understand how vaccines work, feel nervous about getting shots, or distrust 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 existed ever since vaccines were first invented.

Unfortunately, false ideas and misleading information spread by groups that do not support vaccines can also make people hesitant. However, almost all medical and scientific experts agree that the benefits of vaccination far outweigh any risks. Some people also worry about being forced to get vaccines, feeling it takes away their freedom or that companies might be making too much money from them.

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. As vaccines become more successful, some people worry more about these small risks instead of focusing on how vaccines protect us from serious illnesses.

When vaccines work well, some diseases become rare. This can make people feel less worried about those diseases, even though they can still be very 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 worry about vaccines because of different myths and misunderstandings. These include thinking 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 also 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, there have been times when false information about vaccines 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 started in the 1970s when some groups like chiropractic and homeopathy began sharing ideas against vaccines. These groups believe vaccines are not needed because they think diseases come from other causes.

Some chiropractors still today do not support vaccines. They believe that 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 these treatments instead of real vaccines.

Psychological factors

Some people choose not to get vaccines because of how they think. This can include believing unlikely stories, feeling upset about getting shots, or having strong personal views. These thoughts can affect whether someone decides to get 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 from certain groups are less likely to trust doctors because of past unfair treatments and experiments. There have been real examples where people were treated without their agreement, like some drug tests in different countries. Experts say the best way to build trust is to make sure everyone is included in medical studies, get clear permission from all participants, and be open about how medicines are made and tested.

CIA fake vaccination clinic

Main article: CIA Vaccination Cover in Pakistan

In Pakistan, a group tried to use a fake health check to find a person they were looking for. This led to some people being hurt and made many wary of health workers. Some groups now believe health checks are dangerous plans. This made it harder to stop a sickness that can cause paralysis, especially because of other actions taken by forces from another country.

Fake COVID-19 vaccines

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

Religion

Main article: Vaccination and religion

Many religions do not have rules about vaccines because they existed long before vaccines were created. 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 between 12% and 28% of parents had doubts about vaccinating their children. Researchers have looked at how factors like money and education affect vaccine hesitancy. Both people with more and less money, and those with higher and lower 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, where people often have less money and education.

In Europe, trust in vaccines changes depending on where and when you look, and which vaccine you’re talking about. A 2016 study found less confidence in vaccines in Europe compared to the rest of the world. Refusal of the MMR vaccine has grown in twelve European countries since 2010. Younger adults tend to have less confidence than older people. Confidence in vaccines has gone up in some countries like France and Italy, but dropped in others like Finland and Sweden. Many doctors in some places also had concerns about the safety of certain vaccines.

Countermeasures

Vaccine hesitancy is challenging, and the best ways to address it are still unclear.

One approach includes helping communities with fewer vaccines, making vaccines easier to get, teaching people more about vaccines, and sometimes requiring vaccines. The World Health Organization suggests that experts should focus on helping everyone understand, rather than just arguing with those who refuse vaccines. This can help people recognize misleading information.

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 ways 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 also 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 important health groups, such as the Infectious Diseases Society of America, the American Medical Association, and the American Academy of Pediatrics, believe that all children should get their required vaccines without any exceptions for nonmedical reasons.

Vaccination rules can be difficult because some people feel that governments should not make decisions about a family's health. Others believe that vaccines are important for everyone's health. In some places, children must get certain vaccines to attend 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 believe that children have a right to the best medical care, including vaccines, even if their parents do not want them to get vaccinated. This can create difficult choices for doctors and schools, especially when families cannot find another doctor for their children.

History

Variolation

Early attempts to stop smallpox included using a milder form of the disease, called Variola Minor, to give people immunity. Some religious leaders argued against this, saying it was against God’s will to try to prevent disease.

Smallpox vaccination

After Edward Jenner introduced the smallpox vaccine in 1798, some people still opposed it. There were concerns about safety and effectiveness, especially when early vaccines were not always clean or reliable. These concerns led to protests, especially when laws were made to require vaccination.

England

In England, laws were passed to make vaccination compulsory, leading to protests and fines for those who refused. By 1889, a Royal Commission was formed to look into these issues, resulting in laws that allowed some people to avoid vaccination for personal reasons.

United States

In the United States, similar debates happened, and the Supreme Court even ruled on whether states could require vaccination.

Brazil

In Brazil, a public health campaign led to riots in 1904 when people did not trust the new vaccination program.

Later vaccines and antitoxins

As new vaccines were developed, there were also new concerns. Some people worried about the safety of these new treatments, especially when there were incidents where vaccines or treatments caused harm.

COVID-19

In 2020, when a COVID-19 vaccine was being developed, surveys showed that many people were willing to take it. However, some people had concerns about safety or did not trust the vaccines.

Events following reductions in vaccination

When vaccination rates dropped in some places, diseases like measles and whooping cough returned. For example, in Stockholm, Sweden, a drop in vaccination led to a smallpox outbreak. In the UK, lower vaccination rates for whooping cough led to more cases and some deaths. Similar situations happened in other countries, showing how important vaccines are to keep these diseases away.