Dr Andy Raffles
Oh No! Not Another Vaccination Article!
Current risks of vaccination are far outweighed by the risks of disinformation preventing children and young people from receiving timely routine vaccinations.
Imagine a highly contagious virus circulating in the community. Many infected children have a fever and some general misery but recover without incident. Rarely, devastating complications occur, leading to hospitalisation, severe illness, and occasional deaths. Susceptible adults fare worse, with higher rates of poor outcomes. Would you want your child vaccinated against this disease? But which virus are we imagining causing such havoc?
It’s Measles!! (was that a surprise)
As the SARS-CoV-2 vaccinations for adults aged 16 and above are rolled out, initially to the older populations and then to the highest-risk groups, the current stage of the Covid-19 pandemic is a source of vaccine misinformation.
Vaccination could enable us to return to school or work, celebrate family events, meet our grandchildren – (that’s a personal gain!) holiday with family and friends, eat in restaurants, travel, run marathons – or at least go for a long walk in the countryside! and whatever else you fancy. Suddenly everyone becomes an expert about phase 3 trials and cold-chain logistics and mRNA vaccines. We look to vaccines to give us back our world. We need children to help us get there. Since nearly a quarter of the population is under 18 years old — effective herd immunity will require our children to be vaccinated eventually. Vaccinating children is likely to have benefits both direct (protecting children against rare severe cases of Covid-19 and postinfectious conditions such as Multisystem Inflammatory Syndrome in children [MIS-C]) and indirect (protecting others by reducing spread). Those “indirect” benefits also reduce the family toll of parental illness, failing economies, and chronic stress.
So we need to think creatively and empathically about what motivates parents to accept vaccination for their children. How do you as responsible adults, parents, and carer’s balance the risks and benefits when children are not themselves at the highest risk? What do we owe children and their families for helping to protect the rest of us?
Do we live in and apply rules in our societies that prioritise children’s needs, including keeping schools open and safe? We need flexible sick-leave policies, widespread access to testing, and financial support for parents, teachers, and other caregivers all of which would help protect families in this stressful time. We must minimise children’s risk, maximise their chances of returning to school, and mitigate the pandemic’s effects on their families.
Experience of Measles and Measles vaccination campaigns have already provided some insight into parents’ and carer’s decisions regarding vaccinating children they don’t believe are at serious risk; about trust, access, and equity; about using education campaigns to advance public health goals; and about how disinformation about a safe and effective vaccine can endanger public health.
Measles is so highly infectious that it was once nearly universal in childhood. In 1963 the first measles vaccine was introduced. Outbreaks among vaccinated children led to a recommendation for an MMR booster, and by 2000, endemic measles had been eliminated. In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, Chickenpox is endemic (steady-state) in the United Kingdom, but Malaria is not. But this is a fragile situation, as the outbreaks in the UK in 2019 show.
Since a now discredited and retracted article suggesting a link between MMR vaccine and autism was published in The Lancet in 1998, media attention and parental anxiety have been targeted by antivaccine activists and organisations, despite extensive international research that has failed to find any verifiable link to neurodevelopmental disorders. Many recent outbreaks have involved children left unvaccinated by parents who had been targeted in this way. Ongoing Measles transmission in regions with fragile immunisation systems can seed outbreaks elsewhere, including in countries like the United Kingdom, with pockets of under vaccination, despite high overall vaccination rates.
Today, the media tell us that some people have expressed mistrust regarding the safety of Covid-19 vaccines. But the Measles vaccine story reminds us that we have an obligation to provide equitable access and clear information, as a national coordinated approach is essential and that doubt, distrust, and disinformation can undermine safe, effective vaccination campaigns.
We need to consider lessons from recent Measles epidemics - and the vulnerability to deliver successful vaccine campaigns without careful, sensitive, accurate public health messages. Perhaps a campaign that would actually thank children and parents for helping to protect others might convince those that doubt, the value of vaccines!