Understanding those who do not understand: a brief review of the anti-vaccine movement
Introduction
Vaccines and the ability to prevent morbidity and mortality due to infectious diseases have been one of the greatest public health success stories [1]. On a global level, it is one of the few cost-effective medical measures that result in population-level broad benefit across the age spectrum. Despite this, there is evidence in Western Europe, the US, Japan, Australia, and other countries of a growing anti-vaccine movement. This movement has resulted in major disruptions and even cessation of vaccine programs, with resultant increased morbidity and mortality. Of interest is an examination of the factors that seem to contribute to the current trend of anti-vaccine sentiment. In this paper we will examine the current anti-vaccine movement and provide case studies involving pertussis and hepatitis B vaccines. We will then discuss the implications for public health vaccine policy. Finally, we will propose a framework for understanding how individuals make decisions about receipt of vaccines. This will be discussed in order to stimulate discussion and debate about how best to design public health policies aimed at improving immunization coverage rates.
Section snippets
Background
Infectious diseases have plagued mankind since the beginning of time. In fact, infectious diseases have been suggested as a major factor shaping the history of man [2]. It is therefore a considerable scientific and public health triumph to realize that mortality due to vaccine-preventable diseases is at an all time low [3]. In addition, once deadly or debilitating diseases such as smallpox, polio, and Haemophilus influenzae type b have either been eradicated or significantly reduced in most
Current cultural context and concerns
Many would argue that we have become a culture characterized by intolerance of any risk (particularly of co-mission as opposed to omission), such that when harm does occur someone is to blame. We have also become an information society where information, accurate or inaccurate, is widely available, utilized, and promulgated across the world via the internet. Influenced by these trends, many of the anti-vaccine groups also demonstrate an anti-authority stance (with implications for state or
Genesis of concerns
We must first acknowledge that vaccines can and do cause harm and may even theoretically carry unknown risks. Vaccines are immunobiologics, and all immunobiologics have been associated with adverse effects, from the frequent occurrence of brief and mild local inflammation following tetanus toxoid injection to the rare occurrence of paralytic polio following vaccination with the oral polio vaccine (OPV). Inescapable, however, is that it is impossible to fully know all the possible risks of a
Case study: pertussis and hepatitis B vaccines
During the 1970s, anti-vaccine groups increasingly voiced media-intense concerns about perceived ill effects due to the whole cell pertussis vaccines, while the disease itself caused millions of cases and hundreds of thousands of deaths, globally. The result of these concerns was widespread cessation of pertussis vaccine use in Sweden, Japan, UK, the Russian Federation, Italy, former West Germany, Ireland and Australia. A review of the association between the anti-vaccine movement in each
Understanding societal and individual decision-making regarding immunization
As others have demonstrated, as the incidence of vaccine-preventable diseases decreases due to efficacious vaccines, vaccine adverse events become more noticeable and highly publicized [19]. As a result, loss of confidence in the vaccine may occur, with the result that outbreaks once again occur. Fortunately, this usually leads to resumption in confidence of the vaccine [11].
So how then, does loss of confidence occur — at least at the population or societal level? We have proposed that a
Conclusion
In recent years, concerns about vaccine safety have hampered efforts at increasing immunization rates among individuals and important subsets of the population. As we have demonstrated within this paper, the controversy and alarm caused by anti-vaccine groups has a demonstrable detrimental effect on population-level vaccine coverage rates. This, in turn, increases the burden of human suffering, increases health care costs, consumes resources otherwise useful for a productive economy, and
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