By Ipshita Rishi
Published 6:00 EST, Sat November 13th, 2021
Discussion from the role play of a doctor.
When the word “hero” is mentioned, people usually envision a mighty warrior vanquishing an enemy, or a firefighter rescuing children from a burning building. Though these are examples of courage and certainly qualify as heroes, so do some scientists and doctors. Researching quietly day after day, year after year, they work to find new ways to combat disease by creating vaccines.
Vaccines play an important role in the application of scientific research; they help save millions of lives globally each year. They help to reduce the costs of healthcare and are a vital part of public health policy (Kassianos & Ramsay, 2019).
According to the British Columbia (Immunize BC, 2018), vaccines are ‘products that protect people against serious and potentially deadly diseases.’ Now, as a doctor, this immediately attracts my attention. Protection against deadly diseases is the most obvious and well known advantage of vaccines. Since 1796, scientists and researchers have created 26 vaccinations (World Health Organization, 2020).
Vaccines are one of the few medical interventions with which most people have a personal experience with, and as a result they are sometimes used as a proxy for trust in the broader healthcare system. Vaccines have not always been positive, having generated anxiety amongst people, but their uptake has generally been widespread enough that many infectious diseases such as cholera, diphtheria, and polio have disappeared in several countries.
Returning to the original statement – the response is not that straight forward. The issues are multifactorial, and I am going to be discussing this controversial and interesting statement: “Attitudes towards vaccinations are evidence of a disconnect between the public and healthcare professionals.” In this discussion, I shall explore the various viewpoints of the public, experts, and healthcare professionals like me to understand people’s attitudes towards vaccines around the world. It is also to exploit and understand the strengths and flaws of the attitudes that exist about vaccinations in society and healthcare. I will also explain an approach to a beneficial lifestyle of better health, and an improved relationship amongst the public with healthcare professionals.
Vaccine Confidence and Herd Immunity
Over the past 10 years, there has been a significant increase in the number of studies that have documented an increase in the number of people in high-income and low-income countries who have been seen to lose confidence in vaccines, resulting in decisions to not vaccinate their children. As a doctor, this not only raises concern, but also questions as to why this is happening. Organizations such as WHO and UNICEF say that there has been “gains in the world’s fight against vaccine-preventable diseases are at risk.” This is not only due to a severe lack of confidence in the safety and and effectiveness of vaccines and trust in the healthcare system, shortages of workers and supplies, depleted or destroyed health infrastructure, or poverty and difficulties to access the nearest clinic; these are just some of the reasons which threaten to disrupt the effectiveness of all vaccination projects.
Vaccine hesitancy has been identified by the WHO as “one of the top ten health threats to the word” in 2019; the organization defines it as “the delay in acceptance or refusal of vaccines despite the availability of vaccination service.”
The Wellcome Global Monitor project in 2018 recorded some shocking statistics:
- Globally 79% of people agree that vaccines are safe.
- 92% of parents worldwide said that their children have received a vaccine.
- 6% said they did not let their children receive a vaccine.
- 2% said they don’t know if their child had been given a vaccine.
- In France, 1 in 3 people disagree that vaccines are safe; it is the highest percentage for any country worldwide.
People who choose not to vaccinate, due to whatever reason, are not only taking a personal risk. It poses a threat to others as well. Being vaccinated protects an individual from being infected themselves; if enough people are vaccinated, it prevents the disease from spreading to the larger population. Many epidemiologists, experts in this field, refer to this as “herd immunity,” which is protection from the disease for the entire population, including people who cannot be vaccinated due to medical reasons. (Bhargava, MD, 2016)
Society seems to have become less responsible these days. People have started to think more about themselves than for the community. Many who cannot be vaccinated against deadly diseases due to age or immunosuppression strongly rely on herd immunity and the help of others who are vaccinated for preventing them getting infected. It is hugely important for us to carry our weights for social responsibility.
But in order for herd immunity to function, a large proportion of the population needs to be vaccinated. The size will vary on how contagious the disease is, for example, approximately 90-95% of the population will need to be vaccinated against measles for herd immunity to work. For less contagious diseases such as polio, the vaccination uptake needs to be 80–85% of the population. For influenza, the figure is closer to 75% for vulnerable groups (very young children, people with chronic illnesses and the elderly). If enough people choose not to be vaccinated and only rely on herd immunity for protection, then outbreaks of preventable diseases become more common, seen recently with measles in several countries including US, India, Brazil, and Ukraine.
Failure: Victim of Vaccinations
Maintaining high vaccination rates is highly dependable on public confidence. This is why, much of the recent studies and analysis on attitudes towards vaccinations has primarily focused on vaccine hesitancy, especially in scenarios where vaccines are declined even when they are available. As an experienced doctor, I have heard and come across many horrific stories, some of which are true and some simply to scare the people on social media. Recently, I had spoken to the mother of a victim of a poor vaccine reaction, Rachana Sinsinwar, and she had a sorrowful story to narrate.
“I took my son , then 14 months old, to the doctor and he gave two vaccinations (one 2 months before stipulated time) within weeks his body was covered with bruises. Doctors immediately saw and hospitalised him. Platelets in his body dropped to 6000 (normal levels are 150000-450000) at one point counts were lower than the least count of the measuring machine and manual counting was done – 800 platelets. The fear of internal bleeding was looming large.
The vaccine played with the immune system which has a directory of its own body items and platelets went out of this directory after vaccination. Now the strong and healthy baby’s immune system started attacking its own platelets and that would mean he was bleeding without injuries internally and externally.
Nine hospitalisations in three months and treatments later with no improvements seen, the doctors told us they could have surely cured him if it was cancer but not Idiopathic Thrombocytopenia (ITP) Idiopathic meaning the origin is not known. Well the origin was “not owned” is how I see it.
Who will own it ? The doctors, the pharma industry that is trialling new and advanced vaccines, often cosmetic purpose vaccines on children with parents unaware of the consequences? Collateral damage of a business model devised to scare make anxious parents try to save their children’s future health by contaminating their natural healthy immune systems.
I never vaccinated my daughter beyond DTP and polio, she is doing fine!’’
Being a doctor, you must be reading this and questioning why I have presented this real life story to you. You must be immediately shocked and disturbed by the article, or you may not understand why a doctor who is attempting to change the attitudes of the public is scaring them about vaccines.
Reading it again more closely you should realise that Mrs Sinsinwar’s son was given a vaccination 2 months before the stipulated time, this could have been the doctor’s mistake, but it was not a blame to be taken on its own. The lack of education is another primary reason that some experiences with vaccinations are failures rather than a success.
Educations vs Confidence
In most regions, people who have high trust in doctors and nurses are very likely to consider that vaccines are safe. However, this is less true in Western and Eastern Europe in a recent study, proving that the solution isn’t as easy as we think. In 2015, a part of the Wellcome Global Monitor Project also carried out a questionnaire based on the Vaccination Confidence Index to measure public trust in the safety, effectiveness, and importance of vaccines.
Before fully implementing the questionnaire in over 140 countries, it was tested in 10 countries in local languages to “establish whether the terms used were broadly well understood and interpreted across countries and different socio-economic groups.” (Wellcome.ac.uk, 2018). One of the findings from the testing was that it is important to provide simple definitions of technical terms to ensure that people understand what they are being asked about, and whether they have previously heard of the term.
The first question in the Wellcome Global Monitor Questionnaire defined the word vaccine, and then asked people about their familiarity with the term, as follows:
“A vaccine is given to people to strengthen their body’s ability to fight certain diseases. Before today, had you ever heard of a vaccine?”
Those who answered ‘yes’ were asked specific questions about the safety, effectiveness and importance of vaccines. Before the survey, 89% globally had heard of vaccines. The findings show that in only 2 of the 18 global regions (Southern Africa and Southeast Asia) a significantly higher proportion of people say that they have not heard of a vaccine, 54% and 26% respectively.
In general, people seemed to understand what a vaccine does when shown the action of administering one, even if they did not recognise the word itself. Levels of education influence confidence in vaccines differently across the world.
Although there is no direct relationship between the levels of education and vaccine confidence globally, in many places like Northern Europe and Northern America, people with higher levels of education are less likely to believe that vaccines are not safe. A stark contrast is seen in places like Eastern Europe, Central Africa and Southern Africa, as people with lower levels of education are more likely to believe that vaccinations are not safe. In Western Europe, 63% of people who have “a lot of” trust in doctors believe vaccines are safe. Western Europe, however, has among the highest levels of trust in doctors and nurses of all regions, suggesting attitudes to vaccines are somewhat separate from overall healthcare perceptions.
In developed countries with free healthcare (UK), there could be a broken system with less resources. In a country with poverty and harder access to health care (India), there can be less awareness and knowledge and access. In countries with better access but paid health care (US), there could very well be a lack of trust and confidence in the health care system and doubts if the healthcare professionals are in it.
In my personal opinion as a doctor, social media has a major role to play in the poorer uptake on vaccines. More people are happy to take medical advice from personal experiences of strangers unknown on social media than a healthcare professional. Dr. Google has become more popular than any medical doctor. There are two sides to any coin, so people always need to understand to take this with a pinch of salt.
The health secretary of the UK, Matt Hancock, who has expressed interest in mandatory vaccinations for children before they are allowed to go to school, said, “Falling childhood vaccination rates are unacceptable. Everyone has a role to play in halting this decline. The loss of our measles-free status is a stark reminder that devastating diseases can, and will, resurface. We need to be bold and I will not rule out action so that every child is properly protected.”
My research has allowed me to believe that confidence in vaccinations is generally very high globally, particularly in LICs. Whereas people living in HICs have less confidence, most people in these regions think vaccines are effective at preventing infectious diseases, approximately 50% of people in Eastern Europe have concerns over safety. As we also know, levels of education are greatly associated in some of these regions with less confidence in vaccinations. This is clearly evident that putting out more scientific information, or trying to educate more people, will not be enough to change minds on this issue.
“In France, 1 in 3 people don’t agree that vaccines are safe, but only 19% disagree that they are effective. Just 10% disagree that it is important for children to be vaccinated – although if 10% of people remain unvaccinated against measles, for example, that can be enough to allow the infection to spread and cause dangerous outbreaks.” – Wellcome Global Monitor 2018
People with better trust in the healthcare system tend to be more likely to agree that vaccines are safe. Conversely, those who have sought information about science, medicine, or health recently appear to be less likely to agree. There is no evidence of what information people were seeking, but is there something about people who actively seek information that have the tendency to be sceptical about vaccines?
More than 90% of parents globally say their children have been vaccinated, including countries like France. However, recent outbreaks of measles in the US, Brazil, and India suggest that we cannot take herd immunity for granted – it is vital to keep understanding trends in people’s attitudes towards vaccinations in order to maintain public health in the years ahead.
“No parent should be in any doubt of the devastating impact of these diseases. It’s vital that everyone recognises the value of vaccines and takes up this life-saving offer.” – Anonymous
Ipshita Rishi, Youth Medical Jorunal 2021
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