Vaccine hesitancy: As old as vaccines

I was born in 1929 in the city of Szeged, then the second largest city in Hungary. By the time I was 8 years old I had survived measles, chicken pox, whooping cough, and a mild case of scarlet fever. In those days getting through infectious diseases one by one was almost expected as part of growing up. In the late 1930s, Europe, including Hungary, was in the midst of a severe polio epidemic. For a whole summer I was not let out of the house to have fun on the local playgrounds. In 1955 during my internship at St. Paul’s Hospital in Vancouver we were still on standby to respond to calls from the polio ward at the George Pearson Centre in case electrical failure required manual operation of the iron lungs. The polio vaccine was introduced in 1955. In 1957, 2 weeks after I told a set of parents that I thought their feverish child was about to develop mumps, I came down with it too, plus some complications.

Vaccines are some of the most significant public health measures that shape the health of the public. Vaccination programs have immense positive economic and social impacts, including work productivity, educational achievements, income levels, and other personal and societal issues well beyond the health benefits. The success of a vaccination program is dependent on widespread public acceptance. Yet there is a rise of anti-vaccination movements that pose a threat to people’s health and to the collective community immunity. 

Resistance to vaccination is not new. In the late 1700s vaccines were seen by some as “diabolical operations” and by many as an attempt to oppose God’s punishments upon people for their sins. Others objected to vaccinations for political or legal reasons. In the 1800s the Anti-Vaccination League in London saw its mission to protect people’s liberties from being invaded by compulsory vaccination laws. In recent years, publication in the Lancet of Andrew Wakefield’s claim (now declared as utterly false) of a connection between certain vaccines and autism rejuvenated the anti-vaccination movement. A study of Canadian Internet users searching for influenza vaccine information on social media networks found that a majority promoted anti-vaccination sentiments. 

Stuck, a recent book by Heidi J. Larson, an anthropologist, focuses on “why vaccine rumors stick–and getting them unstuck.” The book pulls together many findings from the Vaccine Confidence Project and explores themes such as rumor, dignity, distrust, risk, emotional contagion, choice, and accepting beliefs over facts. Larson argues that as no vaccine or medical product is totally risk free, there will always be ground for rumors. The challenge is not only to delete misinformation but to find the reasons for the underlying distrust. To avoid problems of acceptance before the COVID-19 vaccines become available, concerted efforts will be required by doctors, health professionals, public health agencies, governments, and other organizations to listen to, involve, and engage individuals and communities to make a case for vaccination.

The Canadian Paediatric Society’s 2018 update, “Working with vaccine-hesitant patients,” offers evidence-based guidance to clinicians: do not dismiss vaccine refusers from practice, identify specific concerns, use clear language to present risks and benefits fairly and accurately, reinforce parental responsibility, and do not forget to explain how you manage pain on immunization. 

And may I add a personal request: let us not label vaccine-hesitant patients as anti-vaxxers. 
—George Szasz, CM, MD

Suggested reading
Gellin B. Why vaccine rumours stick—and getting them unstuck. Lancet 2020;396(10247):P303-304.
Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: A regression in modern medicine. Cureus 2019;10:e2919.
Larson HJ. Stuck: How vaccine rumors start – and why they don’t go away. New York, NY: Oxford Library Press; 2020.
MacDonald NE, Desai S, Gerstein B. Working with vaccine-hesitant parents: An update. Paediatr Child Health 2018;23:561-562.

This post has not been peer reviewed by the BCMJ Editorial Board.

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