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Philippa Whitford: Rebuilding trust in immunisation is key to tackling vaccine hesitancy

We must try to understand why increasing numbers of parents are reluctant to vaccinate their children

Vaccine hesitancy—a delay in acceptance or refusal of vaccines despite the availability of vaccination services—is on the rise. Across the European Union (EU), vaccine delays and refusals are contributing to declining immunisation rates in a number of countries and are leading to increases in disease outbreaks.

Advances in immunisation activities have had a major impact on reducing infectious diseases, with 2-3 million lives saved globally from vaccines every year. During 2000 to 2017, measles vaccination prevented an estimated 21.1 million deaths. However, at the same time, routine immunisation uptake of the first dose of a measles-containing vaccine, typically measles-mumps-rubella (MMR), has declined in 12 EU member states. This has contributed to a rise in the number of measles outbreaks across the European region; resulting in over 82,000 cases and the deaths of 72 children and adults in 2018. This escalation can be seen across the world, with measles outbreaks also in the United States, Philippines, Myanmar, and Brazil. In 2017 only 14 countries out of 194 reported no vaccine hesitancy, leading the World Health Organisation (WHO) to announce vaccine hesitancy as one of the top ten threats to global health in 2019.

While there is no doubt that vaccine hesitancy is not unique to one particular geography, the rise in Europe and other high-income countries, should be of particular concern to the medical community. In 2016, a 67 country survey conducted by the Vaccine Confidence Project found that the European region had lower confidence in the safety of vaccines than other world regions. As Europe is often held up as a gold standard of health to the rest of the world, hesitancy could easily spread further and wider if this is not addressed. A lack of action today could lead to a greater loss of life across the world in the future, particularly as infectious diseases are more widespread in many developing countries.

The reasons for rising hesitancy in Europe are complex, varying across time, place, and individual vaccines. Vaccines are a victim of their own success, eliminating diseases and their nasty side effects, thus making it easy to think that vaccination is not necessary. On a trip to Ethiopia in 2016, I saw a young man with the terrible deformity and disability of polio-induced paralysis and it struck me that, in recent years, I had seen hardly anyone with typical polio paralysis in the UK. Indeed, most people born after the 1960s may never have known, or even seen, anyone with polio. Why then would it seem necessary or relevant to have a vaccine against it? Alongside this complacency, there is a plethora of misinformation about vaccines; reducing public trust and confidence in their safety and efficacy. The rise of social media and “fake news” has only enhanced the spread of these messages.

At an event in parliament, the UK Secretary of State for Health and Social Care, Matthew Hancock, suggested that anti-vaccine messages should not be given credence, and I agree that it is unhelpful to engage in conversations with people who rely on pseudoscience and scaremongering to spread their messages. However, in order to tackle falling vaccine uptake, we must confront the reality that it is happening and try to understand why increasing numbers of parents are reluctant to vaccinate their children in one of the most successful public health initiatives of all time.

While a lack of trust in vaccines may come from pseudoscience and social media campaigns, there are genuine concerns that parents have about vaccines and their possible side effects. Sometimes these concerns have been dismissed as uninformed or uneducated but this is unhelpful and counterproductive. Genuine worries and fears about the risks of vaccines should not be cast aside or deemed marginal voices. No parent wants to put their child in harm’s way and this is an issue that transcends age, education, class or race. Any new parent who has heard about a friend’s child with apparent negative side effects from a vaccine, or read news articles online questioning their safety, is likely to be cautious and worried about taking their own child for vaccination. Social media companies are under increasing pressure to moderate anti-vaccine messages or campaigns, but it is also important that we accept that all medication can cause side effects, no matter how rare, and more needs to be done to inform parents of the risk and benefits of vaccination. Parents must be encouraged to voice their concerns and have their questions answered without fear of being labelled or side lined. We must bring in people with genuine fears for their children’s health, open the conversation, and rebuild trust around vaccines again. No question should be deemed unreasonable or unreasoned.

As a Member of Parliament, I believe that rebuilding this trust will require coordination between many different areas of government, including health, education, media and international development. Local communities, civil society organisations, and religious groups are also essential in building confidence in immunisation and must be given the tools to utilise their engagement in all areas of society. Furthermore, we must continue to work with our European and global counterparts to share good practice, learning and information on tackling hesitancy and increasing vaccine uptake, as well as in the surveillance of disease outbreaks and epidemics. As seen during the Ebola outbreaks, modern air travel means it is not possible to ignore infectious diseases that occur “far away” as of no concern here; the world has become very small. Vaccines, which prevent infectious diseases such as pneumonia, are also critical in tackling the looming threat of antibiotic resistance and research suggests a growing role in preventing or fighting cancer. However this promise will never be realised if the principle of vaccination is distrusted and rejected.

Within the UK parliament, I established the All-Party Parliamentary Group (APPG) on Vaccinations for All in 2017 to bring together parliamentarians with an interest in immunisation. In January, we published the report of our first inquiry into the availability of immunisation in the developing world where challenges remain in offering access to the full range of WHO-recommended vaccines. This is, of course, made even more difficult in countries destabilised by war or conflict. This year, we will be conducting an inquiry on increasing confidence in vaccines across the UK, Europe and North America; trying to gather evidence for a fuller picture of the current context along with a greater understanding of why hesitancy occurs, and what governments, institutions and societies can do to address it. We hope that holding this inquiry will examine evidence on the risks and benefits of vaccination, explore the concerns expressed by some parents and raise awareness of the need for urgent action to avoid the rising scourge of infectious diseases we had thought consigned to history.  

The APPG Vaccinations for All will launch its inquiry in May 2019. Please go to www.appg-vfa.org.uk for more information.

Philippa Whitford was a general and breast cancer surgeon for 33 years before being elected as an SNP MP for Central Ayrshire in 2015. She is the SNP health spokesperson in Westminster and currently serves on the Health and Social Care Select Committee.

Competing interests: none declared