How Lack of Trust in Childhood Vaccines Could Lead to More Outbreaks of Preventable Disease

In the early days of the pandemic, millions of children in the United States missed routine pediatric appointments where they would have received vaccinations against diseases such as measles, polio, and whooping cough, alarming many pediatricians and public health experts.

the latest data from the Centers for Disease Control and Prevention (CDC) show that most of these children have already received their vaccinations. However, the national childhood vaccination rate among kindergarteners dropped by 1%, from 95% in 2019 to 94% in 2021.

“One percent may sound like nothing, but it’s nothing … when you put it in terms of number of doses or children,” says Kelly Whitener, JD, associate professor in the Center for Children and Families at the McCourt School of Public Policy. from Georgetown University. .

According to CDC data, approximately 211,000 kindergarten children did not have all required immunizations in 2021, compared to approximately 201,000 in 2019, even with a 10% reduction in enrollment from 2021.

Globally, the damage has been even more severe. World Health Organization announced in july that 25 million babies worldwide did not receive life-saving vaccines in 2021. While these drops are primarily due to disruptions created by the COVID-19 pandemic, public health experts are concerned that the trend has been exacerbated by vaccine mistrust that gained momentum during the launch of COVID-19 vaccines.

If this mistrust continues to grow and extends to routine vaccinations, public health experts warn the United States could see an increase in outbreaks of diseases that Americans haven’t seen spread widely in decades.

“It’s getting harder and harder for me to convince people to vaccinate their children,” says Jason Terk, MD, a practicing pediatrician in Keller, Texas. “We will be reacquainted with some of these diseases that we thought were relegated to history.”

preventable diseases

Modern Vaccine Science dates back to 1796, when Edward Jenner, now known as the father of vaccines, created the smallpox vaccine by injecting people with fluid from a similar, but milder, cowpox sore. The smallpox vaccine continued to be developed for the next 150 years, and a successful global vaccination campaign in the mid-20th century led to the eradication of the deadly disease in 1980. Between 1900 and 1980 alone, smallpox killed an estimated 300 million people. around the world and left many more survivors. scarred.

In the late 1940s, health care providers were recommending vaccination against smallpox, diphtheria, a serious bacterial infection that killed 5% to 10% of those infected, and whooping cough, or “whooping cough.” convulsa,” which can be particularly deadly for children. In the late 1950s, the polio vaccine was added to the list of recommended vaccines, relieving many parents who feared their children would be paralyzed or die from the highly contagious pathogen. In the 1960s, vaccines for measles — which was killing 400 to 500 people in the US annually and causing brain swelling in about 1,000 Americans each year — mumpsY rubella were added, helping to control, though not eliminate, these diseases in the United States.

Today the CDC recommends vaccinate children against more than a dozen preventable diseases by age 6. All 50 states and the District of Columbia require certain vaccinations to attend school, with most of them allowing a religious or philosophical exemption.

About 2.2% of kindergarten children received an exemption from these requirements in 2021, and public health experts fear that misinformation and public mistrust of COVID-19 vaccines, as well as political opposition to vaccine requirements, may lead to higher exemption rates, creating ground for disease outbreaks.

These are likely to be seen first in communities that are ideologically similar and have lower vaccination rates, according to Terk.

“When people vote with their feet to bring their children together in communities of like-minded people with like-minded values, you have a nest built and ready for preventable diseases,” he says.

For example, in 2019, the CDC recorded the most measles cases since 1992, including one major outbreak in an Orthodox Jewish community in New York, where vaccination rates were low.

Although the United States has yet to see an increase in measles cases, cases are on the rise globally because the COVID-19 pandemic has strained public health resources and delayed conventional vaccination campaigns.

In addition to pockets of vaccine hesitancy among like-minded communities, the US has also seen a rise in mistrust of vaccines in certain regions of the country. In Texas, for example, conscientious exemptions increased from 0.45% of K-12 students in the 2010-2011 school year to 2.7% in the 2021-2022 school year, according to data from the Texas Department of State Health Services. For private schools, the vaccine exemption rate for the last school year was 4.23%, but some schools report even higher rates. One private school in Travis County, Texas had 43% of its student population exempt from at least one vaccine, while nearly 50 schools had more than 10% of their student population exempt.

Measles is so contagious that it requires a 95% immunity rate in a community to prevent an outbreak.

“As community immunity drops, the risk of these types of outbreaks increases,” explains Terk. “The immediate impact is that people will get sick. … Most people who get measles have a self-limited illness, although they do get quite sick. A percentage could have fatal complications in the future.”

Low vaccination rates reflect more than a simple ideological rejection of vaccines. the The latest data from the CDC they also show lower vaccination rates among children who are uninsured, African-American, Hispanic, or living below the federal poverty line compared to those who are privately insured, white, or living above the poverty line.

“There [are] there are a number of factors behind those trends, and it’s not just vaccines,” says Whitener. “It has been through access to the health system. Successful solutions would have to have a broader focus.”

Preparing for the challenges ahead

Paul Offit, MD, director of the Center for Vaccine Education and an attending physician in the Division of Infectious Diseases at Children’s Hospital of Philadelphia, hoped at the start of the COVID-19 pandemic that it would finally put an end to anti-vaccination movements. that he had falsely claimed that vaccines caused autism Y brain damage.

Instead, he was dismayed to see the opposite occur.

“It strengthened them,” he says.

In many ways, he worries that there is little scientists can do to reverse the trend of distrust in vaccines.

“Academic institutions can answer scientific questions… [but] most are not [refusing vaccines] because there is a specific scientific concern,” says Offit. “The data is there; the issue is this cultural issue” of mistrusting the government and federal mandates.

Rupali Lamaye, PhD, MPH, deputy director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, also believes there will be repercussions down the road from continued vaccine resistance.

“I think this is going to be our future for a while. We are going to continue to see outbreaks,” she says. “We have lost too much confidence because of the pandemic.”

Now the focus should be on reaching people through their pediatricians and community leaders whom they already trust. For example, some vaccination campaigns against COVID-19 have success seen working with pastors in African-American churches and in other faith-based communities.

Whitener says it’s important to make sure doctors are trained in how to have culturally sensitive conversations with parents who are hesitant to vaccinate their children and that they are compensated for spending more time on vaccine counseling.

But Terk worries that pediatricians like him could experience burnout and moral damage if they start seeing more sick children with preventable diseases when their families refuse to receive vaccines.

“Pediatricians are in the ‘bad stuff prevention’ business,” he says. “It’s disheartening when, in good faith, we try to do that work and get resistance from families. [But] the most important thing is to continue participating and continue recommending [the vaccines].”

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