100 years of vax mandates and we’re still OK
Vaccines save 2.5 million lives every year, and protect millions more from disability and illness, according to the World Health Organization. Since the introduction of the COVID-19 vaccine, controversy over vaccine mandates and vaccine hesitancy in the United States has been highly visible in the media.
“Vaccine hesitancy” — refusing or delaying recommended vaccines — is identified by the WHO as one of the top 10 global health threats. Vaccine hesitancy is common in developed countries like the U.S., where vaccine-preventable illnesses are no longer commonplace, but remain a risk to society. It’s a paradox that threatens public health and will continue to bring back once-eradicated diseases. Measles, once eradicated here, has made a resurgence, most famously traced to Disney Land in California in 2014 and an even larger outbreak in 2018 in New York.
For 100 years, vaccine mandates in schools have resulted in decreased childhood mortality and eradication of disease. States like Connecticut have been working to combat hesitancy by strengthening childhood vaccine mandates. While no major religion opposes vaccination, some individuals avoid mandates through religious exemptions. Connecticut passed a bill recently that eliminated the religious exemption opt-out.
While “vaccine hesitancy” and “misinformation” are new terms, they are not a 21st century problem and have been around since the advent of vaccination itself. When Edward Jenner discovered the smallpox vaccine in the 1790s, many people refused it, citing widely disseminated misinformation that the vaccine may cause a person to grow cow horns. As obscure as this belief seems, it is not unlike reasons for refusal today. Parents frequently refuse vaccines due to misinformation from sources they trust, believing warnings that the risk of recommended vaccination outweighs the benefits. Some examples include that the influenza vaccine causes you to catch the flu, human papillomavirus vaccine has a risk of contracting cervical cancer and the measles/ mumps/rubella vaccine will put a child at risk for developing autism, all of which are false. Just like you can’t get horns from the smallpox vaccine, you can’t get the flu from the flu vaccine, cervical cancer from HPV vaccine, or autism from MMR vaccine.
Vaccine hesitancy is also complicated by misinformation disguised as science, most notably Andrew Wakefield’s article in the Lancet attempting to prove that the MMR vaccine caused autism, sparking the modern anti-vax movement. Wakefield’s work was later retracted for ethics violations and lack of reliability and validity, and his medical license revoked in 2010.
Allowing parents to decide if their children receive recommended vaccinations historically does not yield vaccination uptake levels needed to maintain herd immunity; hence vaccine mandates are a necessary tool to persuade the public to comply. Parental lack of confidence in vaccines, plus vaccine misinformation, leads to complacency. Past vaccine programs have been successful over the years, so many modern parents don’t see these diseases as the threat they are.
We need approaches that are clearly stated, informative and are backed up by high-quality scientific evidence. Federal, state and local governments and medical professionals have a responsibility to keep their communities safe from vaccine preventable illnesses. We can do this with (1) school mandates outlining clear reasons for exemption; (2) media coverage of why vaccine-preventable illnesses are a threat, highlighting safety of vaccines; (3) warnings about misinformation in search engines and social media, when individuals search for medical information; and (4) grassroots efforts that spread truth about vaccines by qualified community health leaders, especially in places of worship.
The elimination of Connecticut’s religious exemption and school mandates play an essential role ensuring our communities remain safe from vaccine-preventable illnesses like measles, diphtheria and polio, but vaccine hesitancy is a threat to herd immunity that cannot be ignored.
School nurses, registered nurses, nurse practitioners, nurse midwives, physician assistants, pediatricians and obstetricians are all excellent and underutilized first-line resources when seeking information about vaccines. As medical professionals, we get our information not just from one doctor, but from many experts. We rely on high-quality scientific evidence that is critically appraised and see that a study is replicated over and over before we consider it as truth.
We have access to databases other than Google, Facebook and Twitter to do our research. Our voices are underutilized in community settings, by elected officials, religious leaders and media outlets. Ask us about vaccines and ask us for help navigating vaccine hesitancy and medical misinformation in your community.