Vaccine Hesitancy in the Era of COVID-19

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Vaccine hesitancy, more commonly referred to as anti-vax, is a term you mostly likely have heard of before. It refers to the reluctance or refusal of the vaccination of oneself or one’s children. Although anti-vaxxers justify their decisions with ethical, religious and medical reasons, it is undeniable that refusing vaccination contributes to renewed risks and outbreaks of preventable diseases. Despite the improving quality of vaccines, confidence in them is trending downwards globally, with the WHO recently including vaccine hesitancy as a top ten public health threat. In the midst of a pandemic, where recovery seems to hinge on the vaccination of billions, this is very worrying.


Vaccination in the Netherlands

But how is vaccine confidence and coverage in the Netherlands? Surely it must be better than that in the rest of the world? Put shortly, the Netherlands is faring better than most other countries, but not without signs of trouble. The Netherlands has a National Immunization Program (NIP) aimed at protecting children up to 14 years old against infectious diseases. Vaccines are free of charge and are given in two steps: between the ages of 0 and 4, six vaccines are given; at the age of 9, the DTP (diphtheria, tetanus, and polio) and MMR (measles, mumps, and rubella) vaccines are repeated; and girls are given the HPV vaccine when they turn 13.

The coverage rate across the NIP vaccines in young children is around 90%, higher than the WHO global coverage (which ranges from 71% to 86%, depending on the vaccine). However, the Netherlands’ coverage has fallen by 2-3% since 2014. As the NIP is not compulsory, people are able to opt out without legal consequences.

So who are the people that refuse vaccination? Traditionally, one could point to specific religious and ideological groups in the Netherlands, but in recent decades, the anti-vax community has become harder to pin down. The volatile nature of the patterns in vaccine confidence almost resembles that seen in political opinion polling, which makes sense as vaccination has become highly politicized.


Implications for COVID

Dealing with vaccine hesitancy has become all the more important as we try to get a handle on the global pandemic that has claimed so many lives and debilitated the economy. There are currently more than 100 vaccines being tested, with a handful of them in clinical trials. Notably, in November, Pfizer released promising results for its vaccine, claiming 90% effectiveness. While this result should be taken with cautious optimism, it could mean that we have a working vaccine by late 2020 or early 2021. This vaccine will probably soon be joined by others as soon as other pharmaceutical companies conclude their trials.

The roll-out of these vaccines could be hampered, however, by anti-vax sentiments that are more pervasive than ever. In the US, polls revealed that only 50% of Americans would definitely or probably receive a vaccine for COVID-19 once it became available. From microchip conspiracy theories to concerns about safety, there is much hesitancy going around, amplified by social media. One common concern is that the typically 10 to 15-year-long vaccine development process has been condensed into a few months. This may appear troubling at first, but no steps are being left out. The quicker progress can be attributed to new technologies and robust funding mechanisms created after previous epidemics. Furthermore, the vaccines are rigorously tested (Phase I to III trials) and reviewed by regulatory agencies. Once available in the market, they will be monitored by various bodies and governments (Phase IV trials).


Turning Hesitancy into Confidence

Combatting vaccine hesitancy remains a challenge to be tackled over the coming decades. An often-suggested solution is to make vaccination compulsory; in most cases, however, the benefits are minimal and one risks further marginalizing certain groups. An alternative would be to inform everyone, but facts alone are not enough to convert doubters. What seems to be clear is that building trust with patients and showing empathy, rather than focusing on population-level data, will be key in turning hesitancy into confidence.