hes-i-tant
/ˈhezədənt/
adjective
tentative, unsure, or slow in acting or speaking.
(Oxford Languages)
This is part of a communication series to health leaders in GHM’s partner countries. (sent August 2022)
Vaccine hesitancy has been making headlines – especially given the controversial nature of the COVID-19 vaccination. But it is not a new issue - vaccine-hesitancy predates the first vaccinations.
What is vaccine hesitancy?
Decisions regarding vaccination tend to fall on a continuum. The classification of vaccine hesitancy includes individuals who are not completely opposed to vaccinations but remain skeptical about some or all of them. Vaccine hesitancy is not associated with a specific race, religion, community, etc. nor does a singular factor uniformly influence it.
Understanding these differences – particularly those between hesitancy and resistance – is important. Vaccine resistance makes up the smallest proportion of the continuum. So health leaders may find the greatest amount of success in focusing on other areas of decision-making, including vaccine hesitancy.
BMC Public Health 22, 296 (2022), Adapted from Report of The SAGE Working Group On Vaccine Hesitancy
Why is vaccine hesitancy concerning?
In 2019 (before COVID-19), the World Health Organization identified vaccine hesitancy as a top ten threat to global health. Vaccine hesitancy threatens herd immunity, which is realized when a large majority percentage of a population is protected against (immune to) a specific pathogen. The spread of disease from person to person becomes unlikely when herd immunity is achieved. Thus, the whole community becomes protected — not just those who are immune.
The percentage of the population capable of getting a disease in order for it to spread is called a threshold proportion. If the proportion of the population that is immune to the disease is greater than this threshold, the spread of the disease will decline. This is known as the herd immunity threshold. The percentage of a community that needs to be immune in order to achieve herd immunity varies from disease to disease. The more contagious a disease is, and the less effective the vaccine (and the social behavior compliance), the greater the proportion of the population that needs to be immune to the disease to stop its spread. For example, because measles is a highly contagious illness, it is estimated that 94% of the population must be immune to interrupt the chain of transmission (Mayo Clinic).
The clustering of unvaccinated or partially vaccinated individuals creates pockets of under-immunization. Historically, these areas have seen a reintroduction of, or increase in, vaccine-preventable diseases. Measles outbreaks are often indicators of areas with low vaccine uptake, given the highly contagious nature of the disease. Vaccine hesitancy and reductions in vaccine uptake make herd immunity more difficult to reach. In 2020, global immunization coverage dropped to 83% (from 86% the previous year), well below the estimated immunity threshold of 94%.
What can be done to combat vaccine hesitancy?
Unfortunately, there is no “one size fits all” approach to addressing vaccine hesitancy. Some attempts to combat it have backfired and resulted in increased vaccine hesitancy, demonstrating the necessity for the consideration of contextual and cultural variances. For example, Malaysia is a largely Muslim country. Since the MMR vaccine is not certified as halal (acceptable), a mandatory vaccination campaign would be met with resistance. While there is no single universal evidence-based approach, there are some potentially helpful, experience-based actions.
Lessons for Global Health Leaders
Consider…
Location of vaccine administration
Some individuals fail to receive vaccines because they are inconvenient or difficult to access. Vaccination drives or relocating to schools and offices can increase uptake.
Language and word choice
The word choice and phrasing of recommendations can greatly impact vaccine hesitancy.
Statements that are strong and presumptive, such as “You are due for…” have proven to be more successful than those that are weak and participatory, such as “What are your thoughts on…?” Though the latter opens the conversation up for discussion, the lack of confidence from a trustworthy source may contribute to hesitancy.
Bilingual speakers may associate a specific language with trust.
Though the information received in multiple languages may be identical, research has shown one language may be associated with heightened credibility, thus allowing for a more informed vaccination decision.
Understand and address internal vaccine hesitancy
Prepare healthcare professionals to address vaccine decisions which are context-specific. Ideas include:
Equipping vaccine administrators with the necessary tools to communicate properly with vaccine-hesitant individuals and
Creating transparency in vaccine policy.
Health practitioners and leaders (including those administering vaccinations) are not without their own reluctance. A 2020 study of nurses in Southeastern France revealed high levels of vaccine hesitancy – approximately 44%. This statistic was not far below that of a nationwide finding of parents in 2016, in which 46% expressed vaccine hesitancy. A 2021 rapid systematic review of 13 studies discovered COVID-19 vaccination hesitation to range from 22.7% to 72.3% in health care workers.
If health professionals do not agree with specific vaccinations, does the public have an excuse to forgo vaccines?
Important actionable questions include:
How unified is your organization around the science of immunization … and how do you know? How can unity be increased without dismissing dissenters or hesitancy? How should your organization communicate with the community?
The current global climate, including the ongoing COVID-19 pandemic, has contributed to many discussions surrounding vaccination. Vaccine hesitancy is driven by various motivating factors, many of which are independent and personal. Nevertheless, a significant proportion of the population, including numerous health care workers, remains hesitant to vaccinations – particularly those for COVID-19. As health care leaders, it is imperative that efforts on this emerging threat target the health care system internally and the populations it serves.
Asante/Gracias/Misaotra/Merci/Nagode/Thank you for unifying the voice of healthcare professionals in your organization to help your community navigate vaccine hesitancy.
Note: Global Health Ministries Summer Intern Sophie Goldenberg, a Medicine, Health & Society major at Vanderbilt University, researched and prepared this message – thank you, Sophie!
Monkeypox Update
According to the CDC, as of 1 August 2022 …
There have been 23,620 confirmed cases of monkeypox in 80 countries. Over 98% of these cases have occurred in countries that have not historically reported monkeypox.
5,810 (nearly 25%) of the cases reported have been in the United States
As of 23 July 2022, the WHO declared monkeypox to be a “Public Health Emergency of International Concern." This designation is meant to mobilize the global community to take coordinated measures to control the spread of this disease and protect communities.
Covid-19 Update
According to Our World in Data, as of 2 August 2022…
Over two-thirds (67%) of the global population is at least partially vaccinated against COVID-19 (over 12.35 billion doses)
In low-income countries, only 19.9% of the population has received partial vaccination. That’s 47.1 percentage points lower than the global rate
According to the WHO Coronavirus Dashboard, as of 29 July 2022…
There have been over 572M cumulative, confirmed cases of COVID-19 and 6.39M deaths