Vaccine hesitancy

Vaccine hesitancy refers to a reluctance or refusal to be vaccinated against contagious diseases. While the reasons people become vaccine hesitant vary, in many cases, it is because they are concerned about the safety of a vaccine. Some parents refuse to have their children vaccinated against diseases such as measles and whooping cough. Those who most strongly oppose vaccination have been labeled part of the anti-vaccination movement and may also be called “anti-vaxxers.”

While some individuals may have legitimate reasons for not receiving certain vaccines, health experts strongly recommend that most people be vaccinated as appropriate. Vaccine hesitancy can result in disease outbreaks and deaths from preventable diseases. The World Health Organization (WHO) views vaccine hesitancy as one of the top ten global health threats. Many fears about vaccines are driven by false conspiracy theories and amplified by political partisanship rather than based in scientific fact.

Vaccine hesitancy grew throughout the early twenty-first century as parents and caregivers began to decline safe, long-developed, scheduled childhood vaccines due to unwarranted fears over autism. Vaccine hesitancy became a major concern during the coronavirus disease 2019 (COVID-19) global pandemic that began in 2020. After COVID-19 vaccines became widely available in early 2021, public health experts hoped to achieve herd immunity, which occurs when a sufficient percentage of the population is immune to a disease, either because they have been vaccinated or have contracted and recovered from the disease. When herd immunity occurs, the disease is much less a serious threat to the community. Experts estimated that at least 70 percent of Americans throughout the country needed to be vaccinated against COVID-19 to achieve national herd immunity. However, a significant percentage of Americans proved reluctant to get the vaccine, complicating efforts to stop the spread of COVID-19. Data collected throughout 2021 showed that unvaccinated people were far more likely to be hospitalized or die from COVID-19 than those who were vaccinated.

To help reach herd immunity, President Joe Biden instituted a COVID-19 vaccine mandate. While the mandate was contested by some states—and the Supreme Court eventually struck it down—many states decided to enforce a vaccine mandate for onsite workforces in accordance with CDC guidelines.

Brief History

Large-scale vaccination campaigns have proven to be effective throughout the long history of vaccines. For example, vaccines have eradicated smallpox, a disease that was prevalent throughout the world in the eighteenth and nineteenth centuries and killed millions throughout history. Smallpox has a fatality rate of about 30 percent. However, because of vaccines, the World Health Organization (WHO) declared smallpox eradicated in 1980. Vaccines also eradicated polio in the United States. Polio causes paralysis and was widespread in the 1950s until Jonas Salk’s invention of a successful polio vaccine in 1955. Because of vaccinations, the number of cases in the country fell to one hundred in the 1960s and fewer than ten in the 1970s. The WHO estimates that more than two million deaths can be prevented throughout the world each year if people become vaccinated.

Vaccine hesitancy has existed for as long as vaccines have existed. In the late twentieth and early twenty-first centuries, outbreaks of disease have occurred because of vaccine hesitancy. Sometimes, vaccine hesitancy emerges as a direct response to issues with a particular vaccine. In 1974, in the United Kingdom, it was reported that thirty-six people had a reaction to the pertussis vaccine, which is used to prevent whooping cough. Because of the reactions, parents became concerned about the safety of the vaccine and did not vaccinate their children for whooping cough. This caused a whooping cough epidemic, which resulted in the deaths of some children.

In 2001, religious leaders in northern Nigeria became suspicious of Western medicine and told their followers not to vaccinate their children for polio. The result was an outbreak of the disease that spread to other places in Nigeria. Some Nigerian parents also stopped vaccinating their children for measles, resulting in twenty thousand cases and six hundred deaths from January to March 2005.

One of the most widespread examples of vaccine hesitancy came after a 1998 study purportedly linked the MMR (measles, mumps, and rubella) vaccine to the development of autism in children. While the study was later proven false, many parents in the United States stopped vaccinating their children after it was published. Large measles outbreaks occurred in the United States and other countries. While the disease was initially declared eliminated in the United States in 2000, there were 1,300 cases in 2019—the greatest number since 1992. The discredited autism study helped bolster the modern anti-vaccination movement, which spread further in the early twenty-first century thanks to the spread of misinformation over the internet.

Vaccine Hesitancy and COVID-19

With the outbreak of the COVID-19 global pandemic in 2020, experts once again became concerned about vaccine hesitancy. By early April 2021, all adults in the United States were eligible to get a COVID-19 vaccination. The following month, adolescents aged twelve to fifteen were also approved to receive the Pfizer-BioNTech COVID-19 vaccine. Yet the results of a 2021 NPR/Marist poll released that April indicated that one in four Americans did not plan to get a vaccine. Another 5 percent were undecided whether they would be vaccinated. By May 2021, researchers feared that the United States would not reach herd immunity, the point at which most people have been vaccinated, have had COVID-19, or both. The spread of a new, highly contagious variant of the virus, called the Delta variant, further complicated the country's chances of achieving herd immunity. Most experts believed the immunization rate in the US needed to be 85 percent or higher, with the Delta variant circulating so rapidly. Hospitalization and death rates due to COVID-19 spiked again from July to September 2021, predominantly among the unvaccinated.

The reasons for the vaccine hesitancy varied. Some felt that because they were healthy, they did not need to get the vaccine. People who had already had COVID-19 were less likely to receive a vaccination than those who did not, even though the Centers for Disease Control and Prevention (CDC) recommended they get vaccinated anyway. Others feared complications from the vaccines, especially since they had been developed very quickly. Though experts acknowledged that side effects could occur, they noted that the risks associated with contracting COVID-19 far outweighed the risks of the vaccines and pointed out that millions of Americans were safely vaccinated. The anti-vaccination movement also contributed to vaccine hesitancy, spreading false information and outlandish conspiracy theories about the COVID-19 vaccines that were amplified by some right-wing politicians.

Certain groups were more likely to have vaccine hesitancy. These included Republican men, people living in rural areas, and those under the age of forty-five. Geographic patterns also emerged. According to several surveys, by January 2022, the states with the highest vaccine hesitancy rates were West Virginia (29.4 percent), Wyoming (27.6 percent), and Idaho (27.5 percent). Additionally, Alabama, Alaska, Arkansas, Tennessee, Louisiana, and North Dakota all had vaccine hesitancy rates higher than 15 percent. Vaccine hesitancy was highest in the poorest regions of the country. In areas where vaccine hesitancy was high, the median household income was slightly more than $47,000. In places where the vaccine hesitancy rate was less than 15 percent, the median household income was nearly $70,000.

Observers also pointed out racial and ethnic correlations to vaccine hesitancy. While Black Americans were three times more likely to get COVID-19, their vaccination rates were much lower than those of White Americans, particularly during the first half of 2021. A distrust in the health care system, a lack of health insurance, and a lack of access to the vaccine were considered possible factors in this disparity.

As experts predicted, areas with the highest vaccine hesitancy rates tended to have the greatest number of COVID-19 cases and deaths. However, spikes in case counts and hospitalization rates in a given area often also led to declines in the rate of vaccine hesitancy, as many people apparently were convinced to get vaccinated after witnessing the toll of the disease. Others ultimately decided to get vaccinated after having waited to see longer-term results. Meanwhile, health experts continued efforts to educate people about COVID-19 vaccines and encourage people to get the shot. Some businesses also began requiring employees or customers to be vaccinated, which helped convince some people. The government also took steps of its own, including vaccine mandates for certain workers and members of the military. While such moves drew criticism from some quarters, they were credited with helping to slowly improve vaccination rates among those who were truly just hesitant rather than strongly entrenched in the anti-vaccination movement. As the 2020s progressed, general vaccine hesitancy, whether for COVID-19 or childhood immunizations, continued to impact public health in the US.

As the 2020s progressed, general vaccine hesitancy, whether for COVID-19 or childhood immunizations, continued to impact public health in the US. Misinformation spread over the Internet and social media, varying cultural and religious beliefs, distrust of government institutions, and lack of access contributed to continued vaccine hesitancy. Educational campaigns continued to promote regular vaccinations but often needed help to combat public misinformation and arguments over human agency. While concerns over COVID-19, specfically, waned in the US and globally, the lessons of vaccine hesitancy remained relevant for future pandemics.

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