More than 220 years since their discovery, vaccines remain an integral part of our efforts to improve public health. This preventative method has saved millions of lives, and as our understanding of vaccines improves, so do global immunization rates. According to the World Health Organization, 85% of the world’s population is currently immunized.
However, these encouraging rates are lately threatened by a global wave of skepticism regarding the side effects of vaccines. Current trends indicate that conspiracy theories and misinformation, among other factors, may pose a real threat to the foundations of the public’s support for immunizations.
Personal or religious exemptions to state vaccination laws are increasing nationwide, and global vaccination rates have remained stagnant in recent years. [2] As such, it is crucial to consider solutions ranging from drafting legislation to creating social and financial immunization incentives in order to target the suspicion regarding vaccines, which has been fueled by massive public misinformation, a flawed healthcare system, and societal biases.
There are several reasons why vaccine skepticism should be worrisome even to those that are immunized.
First, the US spends billions in costs attributed to vaccine-preventable diseases. For example, every year the influenza (flu) virus alone costs the US 10.4 billion dollars in healthcare costs and more than 87 billion dollars in economic burdens like decreased productivity and lost wages. [3] However, on a more moral note, the increased skepticism for vaccinations poses a threat to our public health. Preventable diseases like measles are making a comeback both globally and nationally.
According to the World Health Organization, 2018 was the worst year for measles in the decade, with more than 41,000 cases in Europe and 220 in the US (compared to 24,000 and 120 in 2017 respectively).
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[4] The comeback of these deadly illnesses signals a decrease in herd immunity, or the concept that contagious diseases cannot be spread within a population if a sufficient percentage of individuals are immune. Since no vaccine is 100% successful, everyone is at risk when diseases like measles exist in our communities.
So what exactly lead to our current climate of increased hostility against vaccines? Taking a closer look, it becomes evident that three mechanisms have led to these current trends: Misinformation, a flawed healthcare approach, and societal biases.
Misinformation
Perhaps the leading cause of increased vaccine scrutiny is the level of medical misinformation that is perpetuated on a global level from people opposed to immunizations. One common misconception is that one does not need vaccines because they are not at risk. In 2013, a plurality of adults that did not receive the flu shot said it was because they believed they didn’t need it. [5[ This logic often derives from what can be called “The Paradox of Success”. As vaccine uptake increases, herd immunity builds up and vaccine-preventable diseases become less prevalent.
However, as the illness becomes more rare and fewer people experience these diseases, more may choose not to vaccinate themselves or their kids thinking that it is not necessary. Consequently, herd immunity wanes and everyone becomes at-risk. This concept resembles the free-rider problem. Everyone would benefit from increased vaccination rates. However, due to conflicting values or simply because they don’t believe in the need of the vaccine, people fail to cooperate and thus everyone must face the threat of vaccine-preventable diseases.
One other common way that flawed conceptions are formed is through conspiracy theories. The most common theory is that vaccines cause autism, introduced in 1998 by Dr. Andrew Wakefield whose research has since been widely refuted. However, the study’s effects remain prevalent even 20 years later, as this theory continues to be the most widespread conspiracy regarding vaccines. According to a 2017 study, when asked if some vaccines cause autism, 48% of American responded that they either do or that they weren’t sure. [6] Interestingly, recent studies have concluded that those who oppose vaccinations tend to cluster in the same geographical locations, not only making it easier for their concerns to be validated by each other, but also for diseases to be introduced in their communities, and eventually spread. [7]
Flawed healthcare approach
It is no secret that the US healthcare system is broken in many aspects, and immunizations are no different. Perhaps the most damming issue is that several physician billing programs only compensate healthcare professionals for the actual administration of the vaccine, not accounting for the time the doctor may spend to discuss the benefits and side-effects of the immunization with the patient. [8] As such, many doctors might feel inclined to simply accept their patients’ refusal rather than spend the time to foster discussion and eliminate their skepticism. On top of that, uninsured patients may choose not to vaccinate due to the costs, unaware of federal and state vaccine subsidy programs. [8] Unfortunately, unless the physician chooses to spend time that he or she may not be compensated for to explain these options to patients, those that cannot afford immunizations may never find out about these opportunities.
Societal biases
Another issue contributing to our current vaccine hostile climate is that of the numerous societal biases that exist regarding vaccines. Studies show that, when it comes to immunizations, people tend to exhibit “omission bias”, preferring a potentially harmful inaction (not receiving a vaccine and contacting the disease) to a potentially less harmful action (being immunized but suffering from minor side-effects). [9] In addition, it is observed that individuals may find more serious risks from a known disease to be more acceptable than smaller but more abstruse risks that may result from a vaccine. [9] Individuals tend to exhibit short-term horizons, focusing more on the costs they might experience at the moment of the vaccination (e.g. the costs or discomfort of immunizations), than on those likely to occur later (e.g. lost wages or severe illnesses). [9] These issues, interwoven in the way our societies think and act, only further the apathy expressed against vaccinations.
It is evident that we must act to reduce hostility, misinformation, and indifference against vaccinations before entire communities become at risk. Possible solutions are offered below.
Addressing these issues
One possible remedy is to outright mandate vaccinations. Under this plan, the federal government would require that everyone receives some specific important immunizations. There are several ways to go about enforcing this policy, but the most common and logical one would be to require that children obtain these vaccinations before they attend school. In this way, vaccines are administered early in life, decreasing the risk of contracting these diseases early on.
Today, all 50 states mandate specific vaccinations for students, but different exemptions are allowed in each state, with the most common ones being personal, medical, or religious. [10] However, as stated earlier on, the rates of people opting out of vaccinations are steadily increasing around the nation, jeopardizing heard immunity and public health. For example, exemptions due to personal objections have more than doubled in California since 2007, endangering about a quarter of the state’s schools. To combat this problem, California joined West Virginia and Mississippi in 2015 to prohibit personal and religious exemptions to mandatory vaccinations. [2]
While this decision may seem too extreme, these states do have legal grounds. Two major US Supreme Court Cases have affirmed the government’s authority to enforce mandatory vaccination laws. Specifically, the court argued that “religious freedom does not include liberty to expose community or children to communicable disease” (Prince v. Massachusetts, 1904) and that “there are manifold restraints to which every person is necessarily subject for the common good” (Jacobson v Massachusetts, 1944). These decisions arguably enable the government to reject all kinds of exemptions against mandatory vaccination. [11&12]
Mandating vaccinations would ensure that everyone gets immunized, from the people that are massively misinformed to those that are simply not interested or believe they don’t need the vaccine. However, the moral argument to be made against this solution is that relying on measures like laws or courts to advocate for vaccination would eventually create an unfortunate and damaging atmosphere for public support. Trust is in the core of public health and forcing people to go against their personal will may only increase the hostility against vaccinations.
Another technique to improve immunization rates would be investing in social programs centered around vaccination encouragement. Techniques utilizing subtle social messaging are already used in hospitals and other workforce environments and are considered successful in promoting immunizations. [9] For example, some hospitals have annual influenza campaigns, in which employees receive a flu shot and then sign a banner that is displayed at a central location in the hospital. In this way, other employees and patients can be subtly influenced into receiving the vaccine as well, due to the perceived social pressure that they might be an outlier in their own community. [9] Such methods and campaigns can be implemented nation-wide and don’t necessarily have to be limited to flu shots. Psychological research shows that people can often be persuaded into an action because they want to fit in and be part of their community. [9] Investing in social campaigns that tout the wide circulation of vaccines could help motivate those that are uninterested or apathetic, eventually improving immunization rates.
A social campaign, however, would yield much greater results if coupled with the improvement of current educational and informational resources. Investing money into better informing the public about the wide benefits and minimal risks of vaccinations would save not only countless lives, but also billions of dollars annually. The first step in such an incentive would be to ensure that doctors have both the necessary resources to combat the latest misinformation about vaccines, and the means to distribute it. This would include changing insurance coverage policies to ensure that physicians are compensated for vaccination consultations. [8] Another crucial step would be increasing the funding accessible to organizations for vaccine education.
It is estimated that for every dollar the US invests on immunizations, it saves $16 on healthcare costs, lost wages, and decreased productivity. [13] Increasing funding for nation-wide vaccination educational campaigns can be of tremendous benefit to the United States and all its citizens. Combining social and educational solutions is not only cost-efficient, but also very ethical and logical since it targets not only the uninterested but also the misinformed. However, one possible downside to these solutions is that they can be timely. Rebuilding educational programs and shattering social biases does not happen easily, and it may take years before we start seeing any significant improvements.
Lastly, another viable option would be to improve current financial incentives regarding vaccinations. Research has suggested that increasing the instant benefits of vaccines can help overcome cognitive biases and eventually improve immunization rates. [9] One example would be to give parents a small financial reward for vaccinating their children. Examples of this tactic are already seen today in cases like Target, which provides gift cards to those who receive a flu shot at a Target CVS pharmacy. Subsidizing and expanding immediate reward programs could help incentivize those who choose not to spend the time and effort to get immunized. A more aggressive approach would be following the footsteps of Australia, which prohibited families that opt out of mandatory vaccinations from claiming family tax benefits and saw its once declining vaccination rate increase again. [14] Critics of these methods, however, argue that they might end up benefiting the wealthy and those that can afford to miss a tax cut, while at the same time endangering everyone. Additionally, such methods may be considered problematic and unethical, as they can be perceived more like coercion than incentives.
Despite the dire image this paper may have painted, the truth is that most still believe in the safety of vaccinations. However, there is no guaranty that public opinion will not evolve. As such, it is important that we act now to ensure public safety and prosperity. At the moment, immensely flawed circulated beliefs regarding the costs and benefits of vaccines find a companion in our broken healthcare system and social indifference in allowing them to endanger our communities. Improved social and educational programs, coupled with some form of financial incentives or legislation mandating vaccinations, can help ensure that the government does the job it is meant to do: take any action necessary for the good of its people.
Misinformation and Skepticism About Vaccines. (2022, Feb 17). Retrieved from https://paperap.com/misinformation-and-skepticism-about-vaccines/
