Vaccine Hesitancy: Why It Happens and How to Move Through It

Vaccine hesitancy is on the rise globally. Vaccinations help protect against a variety of infectious organisms. Vaccine hesitancy could lead to previously eradicated infections recurring and taking hold. So, why do people hesitate to vaccinate?

Despite vaccination campaigns worldwide, upwards of 1.5 million children die each year from vaccine-preventable diseases. Despite scientific studies showing that vaccines prevent disease outbreaks, vaccine hesitancy abounds globally.

Measles resurgence? Let’s hope not!

Currently, theU.S. maintains a global measles-free status, meaning that the natural disease state has been eliminated – thanks to successful childhood vaccination programs! In 2019, this status was threatened due to a severe measles outbreak, the worst in over twenty years. Thirty-one states reported over 1200 cases of the disease. Unvaccinated people traveled outside of the U.S. to locales where measles remains endemic (it still exists naturally in the population). These people then returned to the U.S. and expose other unvaccinated people.

Measles, an easily transmitted disease, can be deadly, and it almost gained hold in the U.S. again. Vaccines have their place in public and individual health. Are all vaccines right for all people? No, but knowing all your facts and making an educated decision about what is right for you and your family is key.

The measles vaccination is just one example out of many. Regardless of the disease of concern, the area of the globe where you reside, whether you are an individual deciding on what vaccine you should get or you are a parent choosing for your children, healthcare workers, public health professionals, friends, and family all understand that the decision to vaccinate or not is an important one.

Why do people hesitate?

Immunizations save lives. Vaccines represent one of the biggest achievements of public health, protecting the global population against vaccine-preventable diseases. Yet, many people decide not to vaccinate or wait years before getting a certain vaccine. People may opt out of vaccines for numerous reasons, including:

• Concerns about vaccine safety.
• Concerns regarding vaccine side effects.
• Not understanding the way vaccines work.
• Misinformation.
• Distrust of healthcare professionals, government scientists, and related professionals.
• Religious beliefs.
• Feeling that the vaccine is worse than the disease it protects against.
• Fear of needles.
• Cost concerns –vaccines 100% covered by insurance are more readily accepted.

Vaccine misinformation

False information about how vaccines are developed, ingredients, side effects, and more is abundant on the internet. This makes it quite challenging for people to make educated decisions, as they do not know what resources to trust and which contain false information.

How do vaccines work?

Many do not truly understand how vaccines work, which causes confusion and misconceptions. Vaccines decrease one’s risk of becoming sick or getting a severe disease. However, no vaccine promises with 100% certainty that you won’t ever get sick. A bug has to be exposed to your immune system (taken into your body) to help protect you.

People who do not understand these factors see people develop symptoms despite a vaccine. They then assume it is because the vaccine failed or was bad, or make a wide array of other possibly incorrect assumptions. Learning how vaccines work and how they can protect you helps guide decisions to vaccinate or not.

Distrust of science, researchers, & scientists

Distrust occurs due to political conflict, incomplete or inconsistent recommendations, and, historically, due to unethical research practices, in the earlier parts of the 20th century. This medical mistrust in some communities historically traces back to the unethical and deadly experiment, the Tuskegee Study of Untreated Syphilis in the Negro Male (TSUS). Though in 2022, how much of a role this study, exposed in 1972, actually plays in vaccine hesitancy is debatable.

Numerous protections for participants in clinical studies exist today to prevent the atrocities faced by those in the TSUS. Still, social and racial inequalities exist, and attitudes and education about vaccines, like many other health issues, need to be acknowledged, understood, and accounted for when discussing vaccination.

In different racial and ethnic communities, additional vaccine hesitancy occurs because of:

• Perceived or true racial or ethnic discrimination.
• Inequity in healthcare.
  
• Accessibility - transportation to obtain vaccines, sufficient locations at which to receive vaccines, even cultural aspects and language barrier concerns.

Additional reasons for COVID-19-specific vaccine hesitancy arose throughout the pandemic, including:

• Political concerns.
• Emergency Use Authorization (EUA) – Many are not comfortable getting a vaccine that only has EUA rather than full approval from the Federal Drug Administration (FDA) or similar entities across the world. The expedited vaccination rollout concerned many.
• Conspiracy theories.
• The impact of the disease on healthy individuals vs. those with pre-existing conditions.
• The idea that COVID-19 illness was just another head cold. People feel that getting the disease isn’t a concern, so why bother with the vaccine?

How to move past hesitancy

If you are a vaccine hesitator (you do some vaccines but not others), your hesitancy likely boils down to concerns of confidence, low-risk perceptions, and a lack of convenience (or accessibility). Additionally, the simple fear of needles, pain, or vaccine reactions and side effects may affect a decision. Some tips to move past hesitancy include:

• Talk with your healthcare provider.
• Research the diseases and any consequences or complications.
  
• Research the vaccines.
• Get your information from reputable sources, and if you aren’t sure where to look, ask a healthcare provider.
• Seek out phobia-related behavior modification options if fear drives your hesitancy.
• Discuss your experiences with relatives and friends.
• Find out the facts about the disease in your area or where you may travel.

Alternative vaccination methods

How much vaccine hesitancy stems from fear of needles and injections? In a 2020 U.S. survey, 11.8% hesitated to consider COVID-19 vaccination because of a fear of injections and needles.

In a 2021 U.K. study by Freeman et al. on injection fears and COVID-19 vaccine hesitancy, they found that fear of injections led to vaccine refusal for vaccines, including influenza, pneumococcal disease, and tetanus. Thus, while it is not the main reason for vaccine hesitancy, it plays a role.

Needleless vaccination – are we close?

Wouldn’t it be great if we could have vaccines with no needles? Sure! Many people hesitate to get vaccinated simply because of a needle phobia. For some, the sight of needles makes them woozy. However, while a few vaccines have been developed and given intranasally (in the nose), such as a flu vaccine for children, it doesn’t always translate into equal protection for all age groups. Additionally, it may fail to perform sufficiently in scientific studies.

Generally, vaccines are given in the muscle (I.M., intramuscular) or under the skin (I.D., intradermal). A recent clinical trial is underway for an mRNA COVID-19 vaccine using a ‘solid microneedle skin patch’ method that is reportedly non-painful. The study is entering phase 2. This phase helps determine if the mode of delivery will be effective while also evaluating short-term side effects and safety.

Needleless micro-shock waves, patches, and even oral or intranasal vaccination have been proposed for various diseases. Oral vaccination and intranasal alternative methods are used in animals, so the scientific community knows there is a possibility.

Needleless animal vaccines include an oral vaccination against rabies, dropped in wildlife areas for at-risk species such as raccoons or foxes. Intranasal vaccines are used in dogs against Bordetella bronchiseptica, a common cause of kennel cough in dogs. However, developing appropriate immunity, and establishing a safe and effective way to deliver the vaccine, while providing protection and enhancing the immune response, proves challenging. Therefore, we aren’t close to revolutionary new delivery methods that do not use needles.

Vaccine myths

Myth #1: Vaccines cause autism

Truth #1: No, vaccines do not cause autism – A single ‘scientific’ study published in The Lancet in 1997 by a British physician, Andrew Wakefield, claimed that vaccines cause autism. However, not only has that been disproven, but Mr. Wakefield lost his medical license for ethical violations, improper study practices, and false claims. Despite this retraction and studies disproving the notion that vaccines cause autism, people latched on to this one article, and misinformation ran rampant. The paper’s author rescinded his statement, saying it was based on false data and, in fact, untrue, but to this day that single paper remains used by those against vaccinations as justification not to immunize.

Myth #2: Vaccine ingredients are harmful

Truth #2: Remember that anything can cause illness or death when taken in excess, even those things considered safe or necessary for life, like water. Ingredients in vaccines may seem concerning or unsafe. However, the doses of many substances you would naturally be exposed to in the environment, food, or other manners are much higher than ever would be used in vaccinations.

The Centers for Disease Control reports that ingredients in vaccines, such as the COVID-19 vaccines, primarily include those used in the foods you eat – things like salts, sugars, and fats. Vaccines do not contain preservatives, latex, metals, aborted fetal cells, or other tissues.

Myth #3: Vaccines are worse than the diseases they protect against

Truth #3: Vaccines save lives. Immunizations, especially against childhood-preventable diseases like measles or mumps, have prevented countless suffering and deaths worldwide. While some conditions may seem like no big deal, vaccines prevent suffering, boost the immune system, and are generally well tolerated with only a day or two of soreness and maybe a few aches and pains.

Even if a disease isn’t life-threatening, many illnesses can have lifelong complications, including chronic gastrointestinal and neurological problems. Generally speaking, vaccine reactions are mild and short-lived. At the same time, natural disease infections can be long-lived and cause life-long turmoil.

Myth #4: I don’t need to vaccinate my children because the kids around them are vaccinated

Truth #4: Sadly, only 85% of the world’s population is vaccinated against measles. To ever consider eradicating the disease, and truly prevent natural disease outbreaks, 95% or more of the world’s population must be vaccinated to achieve herd immunity.

Herd immunity refers to the percentage of the population needed to be vaccinated to protect the whole community. When enough people are vaccinated, the disease can’t spread easily from one person to another, causing the disease itself to die out. Herd immunity can occur if enough people have been infected and become sick with a virus or organism. However, it can also be achieved without suffering and loss if we can prevent illness or severe disease via vaccinations. We still see measles because this herd immunity level has not been met globally, though it has been reached in the U.S. Routine vaccinations can help keep it that way.

Vaccines save lives

Vaccines eradicated naturally occurring poliovirus in the U.S. and smallpox worldwide. Vaccinations minimize disease severity, risk of hospitalizations, and even death; some may prevent disease occurrence completely.

Sadly, too much false information exists, making it hard for people to navigate the vaccine world. When looking for vaccine safety, effectiveness, and recommendations, go to reputable sources and scientific literature. Ask your healthcare professional and gather information before making an educated decision about a vaccine. Don’t check out Facebook, Twitter, or the local gym to get valid information to help you make an informed, educated, and potentially life-saving decision for yourself and your family.

Waiting to vaccinate to obtain the information necessary to make an informed decision is admirable. But failing to vaccinate could negatively affect you, your family, and those around you.