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Vaccine hesitancy – a worrying trend

Last week the WHO named the 10 greatest health threats to the world for 2019. Bacterial resistance to antibiotics and noncommunicable disease like diabetes are amongst the usual suspects in the top ten. The big surprise was the growth of ‘vaccine hesitancy’, a reluctance or refusal to accept vaccination, notably in ‘advanced’ nations with readily accessible programmes (often free of charge) who ignore or refuse vaccination for themselves and their children.

Why should we worry – what are the consequences? You could take the view that measles or mumps are, for you, a minor risk worth taking. But this is not just an issue of personal risk. Pathogens are opportunistic – reductions in disease resistance affect populations, not just individuals. Disease resistance is best established in childhood. A schoolroom rapidly becomes an incubator for some potentially nasty – possibly very nasty – illnesses. ‘The more parents who choose not to vaccinate their children, the greater the risk of spreading diseases’ (WHO Europe Information for parents 2012).

The next major outbreak of serious disease will not be due to a lack of preventive technologies. Instead, emotional contagion, digitally enabled, could erode trust in vaccines so much as to render them moot.

Several reasons are given for this worrying trend:

Complacency – people may have forgotten, or perhaps never saw, the painful realities of conditions such as polio or pertussis.

Inconvenience – which surely links to complacency? If you regard vaccination as trivial, you won’t go out of your way to visit you GP, clinic or pharmacy for a shot.

‘Confidence issues’ – perhaps the worst villain of the piece. Vaccination has proved itself of incalculable value as a means of eliminating disease for over 200 years. Poor education about the safety of, or need for vaccination can and should be dealt with in schools, clinics and as a part of public health information programmes. However, gainsayers who spread dangerous untruths (let’s avoid the words ‘lies’ and ‘prejudice’ for a moment) have much to answer for. Ill-informed chatter about autism (MMR never did cause autism) or toxins in vaccines (another falsehood) is dangerously misleading. The facts are that influenza deaths are rising, outbreaks of measles and mumps are increasingly common. And that’s just the early warning. Writing in the journal Nature, Professor Heidi Larson of the London School of Hygiene and Tropical Medicine stated that the next major outbreak of serious disease “will not be due to a lack of preventive technologies. Instead, emotional contagion, digitally enabled, could erode trust in vaccines so much as to render them moot.”

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PHE Publications Gateway Number: 2016045

I’m 67 and have dodged the grim reaper so far, I’ve had all my shots (thanks to the NHS), so why all the fuss? Well, in the same week as the WHO released the ‘10 greatest threats’ bulletin, I had a call from my daughter, herself a biologist. Her youngest daughter, a very bright, cheerful and healthy 10-year-old has just been diagnosed with pertussis – whooping cough to most of us. “Surely she’s been vaccinated?” was my reaction. Yes, as a baby, however in the hurly burly of busy family life, she missed a booster shot. Pertussis is still a serious illness, causing around 50,000 infant deaths each year. My beloved granddaughter is taking a course of antibiotics and I’m sure she’ll be fine. But this underlines the importance of vaccination if we are to avoid returning to a bleaker time when disease lurked incurable, ominous and terrifying. And, lest we forget, the safety net of antibiotics is not universal (it’s of no use against viruses anyway) and is itself under threat from bacterial resistance. Let’s get real, acknowledge disease as a real and present danger and embrace vaccination as our first line of defence.

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