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The real reasons people don’t vaccinate

With the United States on track to record its worst measles outbreak since the elimination of the vaccine-preventable disease almost 20 years ago, the role of a global, social media-driven anti-vax movement has again come under scrutiny.

There has been a global resurgence of the highly infectious measles virus in recent years, despite the rollout of a vaccine that saw the United States declare the disease eradicated in their country in the year 2000.

Source: WHO

Some two decades later, the US now finds itself in the grips of an outbreak set to be the worst on record since then, with officials in New York attempting to enforce a ban on unvaccinated children frequenting public places in a bid to stem infections.

Australia is experiencing a similar resurgence, with 83 cases reported already this year — comparable to the total number seen in all of 2017 and not far off the 103 recorded cases in 2018.

In response, Health Minister Greg Hunt this week announced a new awareness campaign aimed at bolstering vaccine coverage.

The global outbreak has stoked criticism of a growing global anti-vax movement blamed for the return of the illness, which continues to kill more than 100,000 people every year — largely among those under 5 years of age — and can cause pneumonia, encephalitis and blindness.

But are anti-vaxxers the full story? In an opinion piece cross-posted here with permission, epidemiologist Gideon Meyerowitz-Katz urges a more nuanced view of why people don’t vaccinate.


Gideon Meyerowitz-Katz writes:

Vaccines are a contentious topic. Partly that’s because we all have a very reasonable fear of being stuck with needles, and this often comes with the risk of Very Hot Takes On Twitter.

It’s also partly down to the fact that they are an incredible invention that has saved countless lives over the course of the last century.

Of course, it’s also partly because discredited charlatans spread poisonous fear about effective medical interventions.

Parents are an understandably fertile field on which to spread this deadly manure. Being suddenly responsible for another human life is a terrifying experience, and among the myriad decisions it can be easy to be misled by the loudest voices, even if they are medically untrained and wrong.

And with the resurgence of measles in countries across the globe, it’s becoming more and more clear that children just aren’t getting their vaccines any more. We’ve become complacent, convinced that, since many of us haven’t seen someone with measles in at least 4 decades, it’s not harmful.

Never mind that 100,000 people die each year from the disease. We’ve never seen it happen, so it won’t.

The easiest place to point our fingers is anti-vaccination activists. They are the ones, after all, who are spreading fear and mistrust. I’ve been guilty of this narrative myself — these activists are the loudest voices out there, and the screaming charlatan gets the grease*.

But it’s worth remembering that there are more elements to public health than a single group of people, and vaccination decision are no different.

Here are the top three reasons that children miss their vaccines. They might surprise you.

Poverty

The first thing on this list is a fairly common public health issue. If you want to be healthy, the first thing to do is be born rich. If you can’t manage that, being born white in a developed nation is the next best bet.

Vaccines are no different.

There is a very large body of research showing that, across the world, the number one reason that kids miss their vaccines is that they simply can’t get them.

Whether it’s because health services are rare, because their parents work and can’t get them to the doctor, or simply because health services are often inaccessible to the people who need them most, kids who are less well-off are much more likely to miss their vaccines.

In fact, it’s likely that this is one of the reasons that poor kids get sick more often.

Not having a stable home

One thing that’s often missed in these discussions is that another big risk factor for kids not getting vaccinated is moving around a lot.

It’s really not that surprising — if you’ve moved three times in the last year, vaccines are often not the first thing on your mind.

It turns out that groups of people who move a lot, particularly those who move between countries, are less likely to vaccinate their kids.

Because these people tend to cluster, and also go back to their home countries where vaccine-preventable diseases may be more common, you can see disease outbreaks more often.

The main solution to this is culturally-specific vaccine programs, which can be very effective, but with the world’s refugee crisis it’s still a pressing issue.

Vaccine hesitancy

The last, and least surprising, reason that people don’t vaccinate is that they are worried that the vaccine will hurt their child. And I’m going to say something a bit controversial: their worry is justified.

What do I mean by that? Well, as I’ve said repeatedly, vaccines are safe and effective. They are FAR safer than actually getting the disease, usually by hundreds or thousands of times.

But risks and benefits are hard to understand, and vaccination is a complex equation. Protecting your child is one thing, but the arguments about protecting society can be quite hard to understand.

There’s a whole field of research examining why parents get worried about vaccines and how to reassure them.

The problem is, on the side of science you’ve got complexity, but on the side of charlatanry you’ve got certainty. They might be completely wrong, but anti-vaccine activists sound like they know what they’re talking about.

So yes, parents’ worry is justified. They have unscrupulous quacks belting out nonsense doing their best to cover over the fact that decades of research proves vaccines safe.

Get vaccinated

Ultimately, there are many reasons children miss their shots. Sometimes it’s because of anti-vaccine activists, but often it’s down to social issues that are in many ways harder to combat.

We can promote vaccines in any number of ways, but it’s often much harder to change society. Reaching at-risk groups with vaccines can be much harder than persuading rich people that the local all-natural life coach purchased their degree for $10 from an online “university” and doesn’t actually know what they’re talking about.

Protecting society against infectious diseases is a long, hard slog, and it’s worth remembering that anti-vaccine activists aren’t the only problem.

If you’re worried about vaccines and the impact that they might have on you or your kids, the World Health Organization has some great materials — in a range of languages — that answer most of the common questions.

You should also definitely talk to your doctor, because they are the best person to give you advice about vaccine-related questions.

And if you think vaccines are great, maybe throw a few dollars towards a charity trying to provide them to people who might otherwise struggle with access.

Disease sucks, and vaccines are great.

Let’s make sure that everyone can get them.

*Note: Grease = money in this case

Gideon Meyerowitz-Katz is an epidemiologist working in chronic disease in Sydney’s west. He won the 2017 Gavin Mooney Memorial Essay prize with this piece on prisoner health.

This piece originally appeared on Gideon’s blog and is published here with permission.

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017