World Leaders Tackle Vaccine Hesitancy At Global Summit

At a first-ever Global Vaccination Summit, health leaders worldwide ramped up efforts to tackle “vaccine hesitancy”, which has prompted the recent resurgence of vaccine-preventable diseases such as measles.

“After many years of progress, we are at a critical turning point. Measles is resurging, and 1 in 10 children continues to miss out on essential childhood vaccines. We can and must get back on track,” said Dr Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, speaking Thursday at the meeting in Brussels, co-hosted by WHO and the European Commission.

While vaccine hesitancy isn’t the only cause of gaps in vaccination coverage, it has visibly contributed to the global increase in measles, with cases rising by 30% between 2016-2017.  Over the past three years, seven countries around their world, including four in the European Region, lost their status as measles-free countries, largely driven by gaps in coverage exacerbated by a spread of vaccine misinformation.

A girl receives a measles vaccine in Paraguay. Photo: PAHO

Countries including Albania, Czechia, Greece and the UK, which had previously eliminated the disease, lost that status. And the United States, where vaccine resistance has become a major public health debate, is in danger of losing its measles-free status due to an outbreak that occurred earlier this year. Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – was cited by WHO as one of the top 10 threats to global health in 2019.

Tackling Vaccine Misinformation

Vaccine hesitancy is driven by complacency, lack of convenience and confidence in vaccines, according to a WHO report. The spread of vaccine misinformation has greatly contributed to decreasing public confidence in the safety and efficacy of vaccines.

Some 48% of the EU public believes that vaccines can often produce serious side effects; 38% believe that they cause the disease that they are intended to protect against; and almost a third are convinced that vaccines actually weaken the immune system, according to a Eurobarometer poll.

“Misinformation about vaccines is as contagious and dangerous as the diseases it helps to spread,” noted Dr. Tedros in a statement, also referring to the role social media has played in spreading vaccine misinformation. Recent moves by Facebook and Pinterest to redirect “vaccines” searches to the US Centers for Disease Control and WHO vaccine sites have been applauded by the global health community as combating the propaganda of anti-vaccine groups, often known as “anti-vaxxers”.

Rising numbers of measles cases in the United States. Photo: CDC

However, people who choose not to vaccinate based on false information should not be attacked, speakers at the Summit underlined. Better education and engagement of health professionals in communicating with patients, particularly parents, about their concerns is key to improving acceptance of vaccination.

 “People who believe vaccine misinformation are not bad people… let’s not demonise them and build a wall, but rather extend a hand and build the bridges,” said Ethan Lindenberger, a formerly unvaccinated teen who has become a vaccine advocate, in a special address to Summit delegates.

Trust in Vaccination Tied to Trust in Healthcare

Vaccine resistance is not only a high-income country phenomenon, speakers at the Summit also underlined. People in developing nations also share concerns about vaccination, and  community mistrust in health systems contributes to vaccine hesitancy around the world.

Vaccine hesitancy may also be driven by an overall lack of access to essential health services. Members of under-served communities may become suspicious when a vaccine initiative is introduced, perceiving it as something imposed by outsiders with an agenda. Language around the introduction of new vaccines, must be thus be carefully designed in order to gain the trust of communities, particularly in places with historically low access to healthcare.

Introducing new vaccines as “experimental” for example, has at times generated pushback from under-served communities who don’t wish to be “guinea pigs” for the rest of the world, noted Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies.

Other participants noted that the response to the outbreak of Ebola in the Democratic Republic of Congo had suffered, particularly at the outset, as a result of the failure to gain community trust in the vaccine being used, despite its strong record of efficacy.

Vaccine Costs and Logistics Remain Barriers in Developing Countries

Along with combatting vaccine misperceptions, more effort still must be invested in overall support for the introduction and scale-up of vaccines in developing countries.

“It is inexcusable that in a world as developed as ours, there are still children dying of diseases that should have been eradicated long ago. Worse, we have the solution in our hands but it is not being put to full use,” said European Commission President Jean-Claude Juncker, in a statement.

Global vaccination coverage rose impressively in earlier decades before plateauing over the last few years at about 86% of newborns and infants under the age of 12 months.  According to Gavi, The Vaccine Alliance, over 20 million children remain unvaccinated every year because of barriers to access.

Costs of vaccines remain another key barrier, said Jakaya Mrisho Kikwete, the ambassador to Gavi and former president of Tanzania. He called on the international community to continue supporting governments in lower income countries, which cannot afford expensive vaccines on their own.

Gavi, a public-private partnership that helps low and lower-middle income countries introduce new vaccines, recently launched its third replenishment campaign, asking donors for US$7.4 billion to help finance a bold effort to vaccinate 300 million more people by 2025.

Problems in “reaching the last mile” – or reaching the most remote communities – have also plagued vaccine delivery systems. Over half of the 20 million unvaccinated children in the world live in crisis or humanitarian settings where health services delivery systems are weak or have failed.

And for the hardest to reach places, vaccination cannot just be the only health service delivered to these populations, notes the CEO of RA International, Soraya Narfeldt. It must be integrated into a comprehensive package of health interventions – so that people regain confidence in health systems.

Ultimately, she notes, “that trust comes from access to health services, caring health workers, and a health system that meets the needs of the people” regardless of the health intervention.

On that note, the Summit concluded with a call to integrate vaccination delivery more fully into the platform for Universal Health Coverage (UHC) platform, due to be the focus of a UN High-Level Meeting on 23 September, in less than two weeks time.

 

 

Image Credits: Pan American Health Organization (PAHO), CDC.

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