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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.
Social Media
With technology and social media booming over the last decade, these platforms have become a go-to outlet for vaccine hesitant individuals to dispel misinformation about vaccines through avenues like private Facebook groups and Pinterest boards.

“It’s unfortunate that people are using this great technology of social media to spread an anti-technology message,” said Adalja.

In March, 18-year-old Ethan Lindenberger appeared before a Senate committee to discuss his decision to get vaccinated despite the wishes of his mother, who is antivaccine. Lindenberger had grown up without common vaccinations, such as the MMR or chicken pox vaccine, before getting vaccinations starting in December 2018. Lindenberger credited his mother’s antivaccine beliefs to “deeply rooted misinformation” online from organized groups that spread disinformation and “instill fear into the public for their own gain, selfishly.”

Later that month, the American Medical Association (AMA) sent a letter for the chief executive officers of Amazon, Facebook, Google, Pinterest, Twitter, and YouTube urging them to ensure their users have access to accurate, timely, and scientifically-sound information on vaccines.

Recognizing the role they play in stopping the spread of misinformation, some platforms have already taken measures to try and contain this information. Pinterest has blocked all searches for vaccines, which falls under the company’s health misinformation guideline implemented in 2017.

Facebook said in March that it will no longer be recommending groups and pages that spread misinformation and hoaxes about vaccines, will reject ads that include misinformation, and won’t show or recommend content that contains misinformation on Instagram or hashtag pages.

The Role of States
While every state has legislation requiring specified vaccines for students, almost all states grant religious exemptions 17 allow philosophical exemptions for those who oppose vaccinations because of personal, moral, or other beliefs.

In response to recent outbreaks, some states have initiated efforts to remove religious and philosophical exemptions. The Maine House this week approved a bill that removes these exemptions for public school vaccination requirements, and last week, the Washington Senate passed a bill removing personal exemptions for the MMR vaccine.

States that have housed some of this year’s outbreaks have also put forward measures to contain these outbreaks. Public health officials declared public health emergencies in Clark County, Washington, and in certain zip codes in Williamsburg, Brooklyn.

“The goal here is to send a message that people need to act immediately to get vaccinated, and that vaccination is available readily here in the neighborhood and throughout the city,” said New York City Mayor Bill de Blasio as he announced the declaration. As part of the declaration, unvaccinated individuals who live in the named zip codes are required to receive the MMR vaccine. If they do not get vaccinated, they could face a $1000 fine.

According to Adalja, eliminating these exemptions for school-required vaccinations is a move in the right direction. “There’s so many things you can’t bring to school. You can’t bring peanut butter to school, but you can bring measles to school or chicken pox,” he said.

The Role of Healthcare Stakeholders
In addition to the AMA urging media platforms to contain the dissemination of misinformation about vaccines, the association also urged healthcare professionals to encourage vaccination, stating that “parent and patient education provided by physicians is an important factor in influencing higher vaccination rates.”

Public health officials, including Surgeon General Jerome Adams, MD, MPH, have been vocal about the importance of getting vaccinated. In an opinion piece in The New York Times, Adams; CDC Director Robert Redfield, MD; and Brett P. Giroir, MD, assistant secretary for health at HHS, underscored the importance of vaccines, writing, “For those of us who have treated critically ill children with vaccine-preventable diseases, we know firsthand the devastation to the child—and to the family and community—of a death, limb amputation, or severe brain damage that could have been avoided by a simple vaccination.”

1. Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [published online February 28, 1998]. Lancet. doi: 10.1016/S0140-6736(97)11096-0.

2. Rao TS, Andrade C. The MMR vaccine and autism: sensation, refutation, retraction, and fraud [published online April 2011]. Indian J Psychiatry. doi: 10.4103/0019-5545.82529.

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