The horror of the Covid-19 pandemic brought with it one small cause for optimism: the crisis accelerated the development of new vaccine technologies, with the potential to protect against other diseases. Yet this leap forward was accompanied by a dramatic backsliding in the delivery of existing vaccines, with 23 million children missing out on routine immunisations in 2020 and 25 million in 2021 – the largest sustained decline in three decades.
The World Health Organization reports that more prevalent and severe outbreaks of preventable diseases, including diphtheria and polio, are already occurring. While three-quarters of the children who missed out lived in just 20 countries, mostly in Asia, Africa and Latin America, there were declines in richer nations too. The UK Health Security Agency has warned that uptake of the meningococcal vaccine, and the last routine dose of the combined polio, diphtheria and tetanus vaccine, fell significantly last year among adolescents. Covid-19 overwhelmed healthcare systems and personnel, while lockdowns kept people away from facilities used to deliver shots. Supply chain disruption affected the availability of doses and syringes.
The WHO and others have now launched a drive to at least return to pre-pandemic vaccination levels, which were already plateauing. Catching up should be doable. Chad has actually increased its vaccine coverage since 2019. As Unicef warns, for many children, especially in marginalised communities, “vaccination is still not available, accessible or affordable”. This is the primary issue, and though it is not simple, it can be addressed. But even before the pandemic began, the WHO had identified vaccination hesitancy as a top threat to global health. Campaigns against diseases such as measles have been victims of their own success; since most people never encountered them, the threat began to seem less urgent or serious. Libertarian views, declining trust in authority and interest in alternative healthcare encouraged scepticism, along with the false claim of a link between autism and the measles, mumps and rubella vaccine. Doubt about one vaccine often spreads to others.
The pandemic made things worse. Research by the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine found that the public perception of the importance of vaccines for children declined in 52 of 55 countries studied. The speed with which the new Covid vaccines were developed prompted concern as well as relief. But disinformation was also critical, with the WHO warning of an “infodemic” of wild rumours and conspiracy theories. Though social media companies undoubtedly bear responsibility, the growth of political polarisation and sense of uncertainty help to explain people’s susceptibility.
The majority of people still value and want vaccines, and the rest are mostly not hostile but ambivalent or sceptical, often about particular vaccines. Treating them as crazed or foolish will not help. Showing respect, acknowledging their concerns and putting risks in context rather than dismissing them is more productive. There are sound reasons why some groups may doubt whether medical professionals or the state have their best interests at heart. As health experts have pointed out, focusing on hesitancy spotlights individuals – but underlying inequalities largely explain reduced take-up, and resolving them is key to improved public health in this as in so many other regards.
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