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Unpacking the Root Causes and Consequences of Vaccine Hesitancy

Jaime Rosenberg
This is part 2 of a 3-part vaccine series covering the potential of vaccines for infectious diseases, the impact of the antivaccination movement, and the promise of vaccines for cancer treatment.
Read part 1

The headlines are hard to ignore: the number of measles cases are nearing a new high since the disease was thought to have been eliminated in 2000. In the first 3 months of 2019, there were more cases of the measles than in all of 2018, and as of April 19, 626 cases of the measles have been confirmed in 22 states. Mumps outbreaks, albeit less prevalent, have also occurred, most notably at Temple University.

A piece in STAT made the rounds in March, as it detailed the experience of a 6-year-old boy who had never been vaccinated and got a cut on his forehead in 2017. The boy got tetanus, marking Oregon’s first pediatric case of tetanus in more than 30 years. After a weeks-long stay at the hospital, which came with a bill of more than $800,000, his parents still refused to allow doctors to give their son vaccinations for measles and other disease.

Stories like these have continued to make headlines over the last year, highlighting a prominent, global issue: vaccine hesitancy.

In January, vaccine hesitancy was named 1 of the top 10 threats to global health by the World Health Organization (WHO). According to WHO, addressing vaccine hesitancy requires not just an understanding of the magnitude of the problem, but also a diagnosis of the root causes, tailored evidence-based approaches to addressing hesitancy, and monitoring and evaluating the interventions.

To understand vaccine hesitancy, it’s also crucial to note that no single intervention will address the issue because there can be multiple interrelated determinants underlying vaccine hesitancy.

“It’s important to remember when looking at the general public that among those who are vaccine hesitant, many of them are hesitant for different reasons,” explained Amesh A. Adalja, MD, FIDSA, FACP, FACEP, senior scholar, Johns Hopkins Center for Health Security, in an interview with The American Journal of Managed Care®. “It’s not as monolithic as it’s portrayed. You have to look at each case individually.”

Understanding Vaccine Hesitancy and Its Origins
Vaccine hesitancy’s origins date back to the invention of vaccines when the small pox vaccine was created in 1796, explained Adalja. But while vaccine hesitancy is nothing new, it has taken on a more voracious form in recent years.

Adalja credits the start of the modern antivaccine movement to the 1982 film "Vaccine Roulette," which falsely linked the diphtheria, pertussis, and tetanus vaccine to neurologic disorders. This alleged link was later debunked, and the neurologic disorders were proven to be caused by a genetic defect. “But this really galvanized certain parents who were worried about vaccines and who then made themselves into a social pressure group,” explained Adalja.

This movement further gained steam in 1998 when the well-known, now retracted, study published in The Lancet1 by Andrew Wakefield and his colleagues, which suggested the measles, mumps, and rubella (MMR) vaccine may cause autism in children. Despite the small sample size, the uncontrolled design, and the speculative conclusions,1 the paper yielded a strong response, with MMR vaccination rates dropping due to parents’ concern about the risk of autism following vaccination.

The study has since been debunked multiple times, most recently by a study published in the Annals of Internal Medicine—one of the largest studies to date about the issue—that affirmed that there is no connection between the MMR vaccine and autism, even in subgroups of children that some of those opposed to vaccines have claimed might be more vulnerable to the perceived effects.

However, despite the evidence, vaccine hesitancy stemming from both the documentary and the study have persisted. This hesitancy has been exacerbated even further by celebrities like Jenny McCarthy, Jim Carrey, and Robert F. Kennedy Jr, who have been vocal about their antivaccine beliefs.

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