Opinion | Vaccine hesitancy & COVID-19: A recipe for disaster

The human mind is surprisingly prone to fallacious thinking. It is fascinating how the reactionary mind operates, and how easy it is for us to deconstruct facts when mere emotive appeals are presented to us as ‘legitimate counter-evidence’. That is, when complete dismissal of an idea takes place, even with so little evidence to justify such a sudden change

This phenomenon manifests itself magnificently in what is known as vaccine hesitancy.

Preventive measures such as vaccination proved to be the most cost- effective interventions in public health, especially in low-middle income settings where high-quality healthcare services are a luxury, or when treatment is unavailable.

Therefore, there is substantial evidence proving that vaccination has over performed in improving health outcomes across the globe. and continues to do so. In this context, the emergence of vaccine hesitancy is not only appalling, but threatens our survival as a species.

Smallpox, the only eradicated disease so far (thanks to the advent of vaccination), killed an “estimated 300 million people in the 20th century alone.” According to Dr. Donald A. Henderson who directed the global smallpox eradication campaign for the World Health Organization (WHO) from 1966 to 1977. ¹

The international community is also making major strides in its attempts to eradicate Poliomyelitis. Thanks to the Global Polio Eradication Initiative (GPEI) launched in 1988, over 2.5 billion children are now vaccinated ², and 6 million cases of paralytic polio have been averted ³. Today, the world is polio-free with the exception of three countries that remain polio-endemic: Afghanistan, Pakistan & Nigeria.

However, the risk of an outbreak remains present across all countries of the world unless the disease is completely eradicated. Unfortunately, eradication can only be achieved through maximum vaccine coverage or herd immunity, whereby a high percentage of the community is immune to a disease (through vaccination and/or prior illness), making the spread of this disease from person to person unlikely.

Most of you would have seen pictures of crowds of protestors demanding justice for their children, having had to endure devastating side effects supposedly brought about by the administration of certain vaccines. These protests capture the grievances of parents, but they also capture the consequences of a dangerous idea that led to growing concerns in some countries of the developed world, regarding the safety and usefulness of vaccines.

One of the most publicized vaccine scares happened in the 1980s, when Andrew Wakefield, an English medical doctor, conducted a research study to test the presence of a link between childhood vaccinations (mainly the MMR vaccine which protects against 3 diseases: Mumps, Measles & Rubella) and the subsequent development of autism or Autism Spectrum Disorder (ASD). The research article was published in the Lancet – a prestigious journal in the UK – and had caused vaccine hesitancy in the UK and the USA leading to outbreaks across the countries. Later on, other studies were conducted to test Wakefield’s hypothesis but none were able to find an association between MMR and autism. Evidence also showed conflicts of interest & mistreatment of participants during the study, which undermined the credibility of the study and led to its removal from the journal. In 2010, Wakefield’s license to practice medicine was revoked as well. Afterwards, Wakefield headed to the US where he exploited people’s grievances and had them embracing his misleading narrative, as if it was water, and they were drought-struck farmers.”What I represent is the parents and the children who have been damaged.” He says, omitting the fact that his ideas are likely to cause damage to millions of other children.

The escalating political tension and the new trend of so-called critical thinking led to the awakening of an overzealous distrust in the institutions and a new form of radical skepticism that’s directed against science.

With the support of the mass-media, Wakefield succeeded in directing the public’s attention away from the major increase in child survival achieved thanks to vaccination campaigns, towards individual cases that most people can’t help but unconditionally sympathize with.

In the face of tragedy, thinking about the greater good makes us feel like we’re undermining other people’s suffering. I believe Wakefield was aware of this human characteristic, and as he took full advantage of it, he became –in the eyes of his followers – a celebrity wrongfully outcast by the science community. His fraudulent work became a masterpiece in deception. And ever since, vaccination has become a source of anxiety and a target for misinformation.

Vaccine hesitant individuals are not necessarily people who refuse to vaccinate their children. Some parents may accept all the recommended vaccines but still have doubts about vaccine efficacy and safety. Others may choose to delay the appointments.

Moreover, behavioural theorists say that an individual’s attitude towards vaccination is the result of a complex and dynamic interaction of different social, cultural, political and personal factors. However, it remains unclear how and why “vaccine acceptors” are now “cautious” and “unconvinced” but still choose to go along with it mostly because of social pressure.⁴                                                                       .

This idea of conformity is extremely worrisome when it comes to vaccination, because having a public that is compliant but is unsure and unconvinced, builds a frail structure, one that is destined to disintegrate as soon as the social and political settings change, especially if they do so in a way that allows the skepticism to flourish, and blossom into complete rejection of immunization.

This year, due to the ongoing crisis of COVID-19, the settings have changed. The Internet has made the dissemination of information (or in this case misinformation) uncontrollable. As early as February, the WHO declared the dissemination of misinformation about Covid-19 to be an “infodemic”. “We’re not just battling the virus,” said WHO Director-General Tedros Adhanom Ghebreyesus. “We’re also battling the trolls and conspiracy theorists that push misinformation and undermine the outbreak response.⁵

The spread of social media misinformation campaigns combined with the erosion of confidence in vaccines is likely to increase reluctance among parents, especially with the delays in routine immunization appointments under lockdown measures.

In the midst of chaos, the reemergence of vaccine preventable diseases and the undermined trust in our institutions will lead to consequences that are nothing short of calamitous.

 

 

 

References:

¹ Henderson DA. The eradication of smallpox — an overview of the past, present, and future. Vaccine. 2011 Dec 20; 29 Suppl 4:D7-9. doi:10.1016/j.vaccine.2011.06.080. Epub 2011 Dec 19. PMID: 22188929

² http://polioeradication.org/who-we-are/

³https://ourworldindata.org/polio#the-vaccine-against-polio

⁴ Eve Dubé, Caroline Laberge, Maryse Guay, Paul Bramadat, Réal Roy & Julie A. Bettinger (2013) Vaccine hesitancy, Human Vaccines & Immunotherapeutics, 9:8, 1763-1773

⁵dhttps://www.who.int/news-room/feature-stories/detail/immunizing-the- public-against-misinformation