How distrust of childhood vaccines could lead to more preventable disease outbreaks?

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) shows that most of those children have since received their injections. However, the national childhood vaccination rate for preschool children fell by 1%, from 95% in 2019 to 94% in 2021.

“One percent may sound like nothing, but it’s not nothing…when you put it in terms of number of doses or children,” says Kelly Whitener, JD, an associate professor at Georgetown University McCourt School of Public Policy’s Center for Children and families .

According to CDC data, about 211,000 preschoolers did not have all the required vaccines in 2021, compared to about 201,000 in 2019, even with a 2021 enrollment of 10%.

Worldwide, the damage is even more serious. The World Health Organization announced in July that 25 million infants around the world will have missed life-saving vaccines by 2021. While these declines are primarily due to disruptions from the COVID-19 pandemic, public health experts worry that the trend has been exacerbated by vaccine mistrust that gained momentum during the COVID-19 vaccine rollout.

If this distrust continues to grow and spread to routine vaccinations, public health experts warn the United States could see an increase in disease outbreaks that Americans haven’t seen widespread in decades.

“It’s becoming more and more challenging for me to convince people to get their children vaccinated,” says Jason Terk, MD, a 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 an ulcer caused by the similar but milder cowpox. The smallpox vaccine continued to evolve over the next 150 years, and a successful global vaccination campaign in the mid-1900s led to the eradication of the deadly disease in 1980. Between 1900 and 1980 alone, smallpox killed an estimated 300 million people worldwide, leaving many more survivors left scarred.

By the late 1940s, health care providers recommended vaccination against smallpox, diphtheria, a serious bacterial infection that killed 5%-10% of those infected, and whooping cough, or “whooping cough,” which can be particularly deadly for children. In the late 1950s, the polio vaccine was added to the list of recommended vaccines, bringing relief to many parents who feared their children would become paralyzed or die from the highly contagious pathogen. In the 1960s, measles vaccines — which kill 400 to 500 people in the U.S. each year and cause brain swelling in about 1,000 Americans each year — added mumps and rubella, controlling but not eliminating these diseases. . the United States.

Today, the CDC recommends that children be vaccinated against more than a dozen preventable diseases by age 6. All 50 states and the District of Columbia require certain immunizations to attend school, most of which allow a religious or philosophical exemption.

About 2.2% of preschoolers were granted an exemption from these requirements in 2021, and public health experts worry that misinformation and public mistrust of the COVID-19 vaccines, as well as political opposition to vaccine requirements, could can lead to higher exemption rates – leaving fertile 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 built-in, ready-made nidus for preventable disease,” he says.

In 2019, for example, the CDC recorded the highest number of measles cases since 1992, including a major outbreak in an Orthodox Jewish community in New York, where vaccination coverage was low.

While the United States has not yet seen a rise in measles cases, cases are rising worldwide as the COVID-19 pandemic has strained public health resources and slowed down conventional vaccination campaigns.

In addition to vaccine hesitancy among like-minded communities, the US has also seen an increase in vaccine mistrust in certain regions of the country. In Texas, for example, conscience exemptions have 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 waiver rate for the past school year was 4.23%, but some schools report even higher rates. A private school in Travis County, Texas, had 43% of its student population exempt from at least one vaccine, while nearly 50 schools registered more than 10% of their student population with exemptions.

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

“As community immunity goes down, the risk of these types of outbreaks increases,” explains Terk. “The direct effect is that people get sick. … Most people who get the measles have a self-limiting illness, although they do get quite sick. A percentage can have fatal complications in the long run.”

Low vaccination rates reflect more than just ideological rejection of vaccines. The latest data from the CDC also shows lower vaccination rates among children who are uninsured, black, or Hispanic, or living below the federal poverty line compared to children who are privately insured, white, or living at or above the poverty line.

“Over there [are] there are a number of factors behind those trends, and it’s not just vaccines,” Whitener says. “It’s about access to the health care system. Successful solutions should have greater image focus.”

Brace yourself for future challenges

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

Instead, he was stunned to see the opposite happen.

“It has strengthened them,” he says.

In many ways, he worries that scientists can do little to reverse the trend of mistrust about vaccines.

“Academic institutions can answer scientific questions… [but] the majority do not [refusing vaccines] because there is a specific scientific problem,” says Offit. “The data is there; the problem is this ‘cultural issue’ of mistrust in 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 consequences on the road to continued vaccine resistance.

“I think this will be our future for now. We will continue to see outbreaks,” she says. “We have lost too much confidence because of the pandemic.”

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

Whitener says it’s important to ensure that doctors are trained in having culturally sensitive conversations with parents who are hesitant to vaccinate their children and that they are compensated for taking extra time for vaccination advice.

But Terk worries that pediatricians like him could suffer burnout and morale if they start seeing more sick children with preventable diseases while their families have refused the vaccines.

“We pediatricians are concerned with preventing bad things,” he says. “It’s discouraging when we try to do that work in good faith and get resistance from families. [But] the most important thing is to keep participating and keep recommending [the vaccines].”

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