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Insights into Editorial: Deadly spread: On ‘vaccine hesitancy’

Insights into Editorial: Deadly spread: On ‘vaccine hesitancy’


The world is facing multiple health challenges.

These range from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-resistant pathogens, growing rates of obesity and physical inactivity to the health impacts of environmental pollution and climate change and multiple humanitarian crises.

The threat from vaccine hesitancy, which is defined as the “reluctance or refusal to vaccinate despite the availability of vaccines”, only appears to have grown more dangerous to public health.

There has been a sharp increase in the WHO European region too with 90,000 cases recorded in the first six months that more than the numbers recorded for the whole of 2018.

The measles infection spread in the European region has been unprecedented in recent years that around 1,74,000 cases from 49 of the 53 countries between January 2018 and June 2019.

Last month the U.K., Greece, the Czech Republic and Albania lost their measles elimination status.


About Measles Infection:

With a 30% increase in measles cases worldwide in 2018, the World Health Organization, in January 2019, included ‘vaccine hesitancy’ as one of the 10 threats to global health. 

  • Measles is a deadly disease which can lead to –Pneumonia, Diarrhoea and other deadly threats. Measles is an acute illness caused by a virus of the paramyxovirus family.
  • According to the WHO : Measles cases rose 300% worldwide through the first three months of 2019 compared to the same period last year.
  • Measles, which is highly contagious, can be entirely prevented through a two-dose vaccine.
  • The reason for rise is attributed to impact of anti-vaccination stigma.
  • Most measles-related deaths are caused by complications associated with the disease. Serious complications are more common in children under the age of 5, or adults over the age of 30.
  • The most serious complications include blindness, encephalitis (an infection that causes brain swelling), severe diarrhoea and related dehydration, ear infections, or severe respiratory infections such as pneumonia.
  • Severe measles is more likely among poorly nourished young children, especially those with insufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases.
  • The respiratory disease measles remains a leading cause of death among young children, despite the fact that a safe and effective vaccine has been available for 40 years
  • It is one of the most contagious diseases and many children who do not have sufficient immunity contract measles if exposed.
  • During the first few weeks after contracting measles, a child’s immune system becomes weakened, and a normal cold or diarrhoea can become a life-threatening illness.


Vaccine Hesitancy: A generation at risk:

  • Vaccine hesitancy, which is defined by WHO as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”, has been reported in more than 90% of countries in the world.
  • In many areas, immunisation for measles, a vaccine-preventable disease that was largely eliminated following widespread use of the measles-mumps-rubella (MMR) vaccine, has decreased to less than the 95% threshold set by WHO as that required for herd immunity.
  • Vaccine hesitancy is threatening the historical achievements made in reducing the burden of infectious diseases, which have plagued humanity for centuries.
  • According to a March 2019 report, only 52% respondents from 28 EU member states agree that vaccines are definitely effective in preventing diseases, while 33% felt they were probably effective.
  • More alarming is that 48% of the respondents believed that vaccines cause serious side effects and 38% think vaccines actually cause the disease that they are supposed to protect against.
  • It found younger people (18-34 years) and those with less education are less likely to agree that the measles, mumps, and rubella (MMR) vaccine is safe.
  • If we fail, the future health of unvaccinated children and their communities will suffer greatly.


India has fourth highest number of measles cases in the world: WHO

India has taken several initiatives to protect its children and has made significant progress in decreasing measles incidence and related mortality and morbidity.

However, Children under the age of one get infected by the virus the most in India as they have the highest incidence rate of 76.4 per million population, according to WHO.

Moreover, this is the same age bracket that has received highest number of zero doses of measles vaccination between July 2018 and June 2019.

After a surge in measles cases in 2018, there have been around 3,65,000 measles cases reported from 182 countries in the first six months of 2019.

The biggest increase, of 900% in the first six months this year compared with the same period last year, has been from the WHO African region, with the Democratic Republic of the Congo, Madagascar and Nigeria accounting for most cases.


Misinformation need to be Addressed:

  • A striking similarity was seen in India too. A 2018 study found low awareness to be the main reason why 45% of children missed different vaccinations in 121 Indian districts that have higher rates of unimmunised children.
  • While 24% did not get vaccinated due to apprehension about adverse effects, 11% were reluctant to get immunised for reasons other than fear of adverse effects.
  • Thus, much work remains to be done to address misinformation.
  • With social media playing a crucial role in spreading vaccine disinformation, the commitment by Facebook to “reduce distribution” of vaccine misinformation will be helpful in winning the war against vaccine deniers.
  • Measles vaccine not only provides lifelong protection against the virus but also reduces mortality from other childhood infections.
  • This is because measles viruses kill immune cells, leaving the child vulnerable to infectious diseases for two to three years.



Paediatricians and family doctors have a key role in helping parents appreciate the benefits of vaccination.

Physicians advice has been shown to be the most important predictor of vaccine acceptance.

All child health workers must promote vaccination conflicting advice from medical professionals is especially damaging and must be afforded sufficient time with each family to effectively do so.

Increasing and maintaining vaccination uptake is vital for vaccines to achieve their success.

Governments and Health policy makers also play an essential role in promoting vaccination, educating the general public, and implementing policies that reduce the public health risks associated with vaccine hesitancy.

Addressing low vaccination requires an adequate understanding of the determinants of the problem, tailored evidence-based strategies to improve uptake, and monitoring and evaluation to determine the impact and sustainability of the interventions.

Only a collaborative effort between paediatricians, family doctors, parents, public health officials, governments, the technology sector, and civil society will allow myths and misinformation around vaccination to be dispelled.