4.12 Opposition to vaccination
Another major challenge is parental opposition to vaccination because of concerns about vaccine safety. Some parents are understandably anxious about taking a healthy child to be given a vaccine derived from infectious agents. Most vaccines are injected, which can be a frightening and painful experience for a child. Of even greater concern is that some children experience a negative reaction to a vaccine, most often inflammation around the injection site and/or a mild fever lasting a day or two, but rare instances of more severe reactions such as convulsions sometimes occur.
Hesitancy about vaccinating a child is increased if parents have no experience of the disease the vaccine prevents, because it has become rare in communities with high vaccine coverage. Some parents conclude that vaccination is unnecessary and might expose their children to an avoidable risk.
Negative rumours about a vaccine are another deterrent. For example, the myth that vaccination is a Western plot to sterilise Muslim children has deterred parents in northern Nigeria, Pakistan and Afghanistan from allowing their children to be vaccinated against polio (Figure 14). Terrorist attacks have occurred against polio vaccination teams in all three countries – the only remaining locations where polio had not been eradicated by the WHO target of 2015.
An inevitable consequence of falling vaccination rates in a community is an increase in infections, sometimes with fatal outcomes. In 2014, the WHO warned that progress on eliminating measles had stalled and the number of deaths had begun to rise – from 122 000 in 2012 to 145 700 in 2013 (WHO News release, 2014). Dr Peter Strebel, from the WHO Department of Immunization, Vaccines and Biologicals warned that:
Countries urgently need to prioritize maintaining and improving immunization coverage. Failure to reverse this alarming trend could jeopardize the momentum generated by a decade of achievements in reducing measles mortality.
Even in countries where over 90% of children are fully vaccinated, uptake rates can plummet under pressure from negative rumours. For example, false claims in 1998 that the MMR vaccine caused autism led to a sustained fall in vaccinations in the UK, followed by a significant rise in measles cases and, to a lesser extent, mumps. The largest outbreak of measles around Swansea in Wales in 2012–13 caused more than 1200 cases and one death (Public Health Wales, 2013). Once parents saw the reality of measles infection and the misery and discomfort it causes, a rapid increase in uptake of the MMR vaccine followed the outbreak. The memory of infection fades in well-protected communities, until an outbreak reminds everyone of how devastating infectious diseases can be.