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Dose of Reality

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IT’S ARGUABLY THE GREATEST PUBLIC HEALTH SUCCESS STORY of the modern era. Vaccination campaigns eradicated the scourge of smallpox from the planet and have nearly eliminated polio, a paralyzing infectious disease that once struck fear in every parent. In 2000, the World Health Organization (WHO) declared that the United States had eliminated measles, culminating a decades-long public health effort to promote childhood immunization against a disease that, prior to the vaccine’s introduction in 1963, annually infected 3 to 4 million U.S. children, of whom tens of thousands were hospitalized and several hundred died.

But in 2019, during the largest U.S. outbreak in 27 years, the nation’s measles elimination status (defined not as zero cases, but as the disease no longer being constantly present) was nearly revoked. A primary cause, according to the U.S. Centers for Disease Control and Prevention: the declining vaccination rate.

The WHO recently included “vaccine hesitancy” as one of the 10 biggest threats to global health. “This is an emerging problem,” says Annette Regan, an adjunct assistant professor in FSPH’s Department of Epidemiology, who previously served as the vaccine epidemiologist for Western Australia and has studied strategies for promoting recommended vaccines in community settings.

Regan notes that although the overwhelming majority of U.S. parents follow the recommended immunization schedule for their children, a growing number either forgo the vaccines entirely, don’t complete the series on the schedule required for their child’s protection, or are selective about the vaccines they allow their children to receive. Many factors contribute, including religious objections and a distrust of government institutions and the pharmaceutical industry. As the immunization schedule for children has become more complex, some parents have worried that there are too many, too soon, although vaccines are rigorously studied and proven safe at current Dose of Reality As ‘vaccine hesitancy’ threatens public health gains, an FSPH expert weighs in. levels, Regan says. Reverberations also continue to be felt from a 1998 study that associated the measles, mumps, and rubella vaccine with autism, despite the study later being discredited and withdrawn by the journal that published it, and many subsequent studies showing no such connection.

In Australia, Regan participated in efforts to overcome these and other barriers. She continues to study how immunizations can be better promoted in the community, with a focus on pregnant women — a high-priority population with relatively low rates of receiving recommended vaccines, including flu shots and the Tdap that will protect their infant against potentially deadly pertussis, or whooping cough.

Educating primary care providers about the importance of counseling their patients on immunizations is a critical public health strategy, Regan contends; pregnant women, for example, are 10 times more likely to receive the pertussis vaccine if their doctor advises it. In general, Regan adds, many people simply need more and better information to overcome their concerns. “It’s easy to group vaccine attitudes into two categories — strongly for or strongly against — but it’s really more of a spectrum,” she says.

Perhaps the biggest challenge is the diminishing societal memory of diseases vanquished by immunization campaigns. “In a sense, vaccines are cursed by their success,” Regan says. “For people who haven’t seen these terrible diseases, it’s harder to appreciate the importance of preventing them.”