Roots of Vaccine Hesitancy Run Deep

Vaccines reduce the incidence of vaccine-preventable disease (VPDs) within a population.¹

Vaccination delay or refusal when vaccines are available undermines individual and public health initiatives and can lead to VPD outbreaks.^1-4 Although pharmacy staff members may think about vaccine acceptance in black and white—individuals who accept vaccines and those who do not—it is not that simple.^5-7 Vaccine hesitancy exists on a continuum.⁸

Vaccine hesitancy is a global issue.9 Some individuals refuse all vaccines, whereas others schedule recommended vaccines without any concern. In between are those who receive vaccines but remain skeptical and those who refuse some vaccines.⁵ The World Health Organization indicates that complacency, confidence, and convenience influence vaccine hesitancy.⁹ Identifying factors that influence an individual’s behavior (Table 1⁸) are essential to understanding vaccine hesitancy. Knowing the specifics also helps determine the most appropriate intervention.^3,7,8

Pharmacy staff members can and should address the most significant concerns related to misinformation.

Hot Lots

Uneducated individuals have advanced the “hot lot” vaccine theory based on faulty application of Vaccine Adverse Event Reporting System (VAERS) data.^10,11 They broadcast that vaccine hot lots are responsible for more serifous adverse outcomes. The fact is that VAERS reports adverse events (AEs) that occur after vaccination; reported events are not definitively related to the vaccines.^10,11

Antigenic Overload

Some individuals think that children’s immune systems cannot manage the number of antigens that vaccines introduce, creating what they dub, “antigenic overload.”¹ They suggest antigenic overload predisposes children to AEs and vaccine-induced complications. However, no scientific evidence supports this claim. The birth process exposes babies to significantly more antigens than vaccines do.¹ Additionally, vaccines use 305 antigens to protect against 14 diseases by aged 2 years. Thirty years ago, vaccines contained 3000 antigens to protect against 8 diseases by age 2 years.¹² That is progress.

Natural Immunity's Superiority

Pharmacy staff members may hear vaccine-hesitant individuals say that natural immunity from an infection is safer than vaccine-induced immunity.¹ That may be true for some VPDs. However, the complications and risks of VPDs are significantly greater than those of vaccines.¹

Autoimmune Diseases Connections

Another myth is that vaccines cause autoimmune diseases such as diabetes, Guillain-Barré syndrome, and multiple sclerosis.^1,7

Kitchen table scientists base this argument on the erroneous theory that the immune system cannot discriminate between intrinsic antigens and the vaccine’s antigens, causing antibodies to bind intrinsic antigens and eliciting an autoimmune response.^1,7

What To Do

If patients express concerns that refer to vaccine misinformation, immunizers can use approaches that communica- tion experts call “debiasing” techniques.¹³ After eliciting an accurate understanding of the patient’s beliefs, the immunizer can use debiasing techniques to help, provided the patient is receptive to the proposed correction.¹³ Table 2^13,14 defines the potential impact of misinformation and associated intervention strategies. However, clinicians should avoid debiasing strategies for individuals who are adamant about misinformation.¹³

Conclusion

Individuals may be unresponsive to vaccine-promoting interventions. When they refuse vaccination, it is most important to acknowledge and honor the right to decline.^15,16 Immunizers should not label their efforts as failures but consider them an opportunity to try again later. Providers should encourage future contact if patients have more questions or if they change their minds regarding vaccination.^16,17

About The Author

Jeannette Y. Wick, MBA, RPH, FASCP, is the director of pharmacy professional development at the University of Connecticut in Storrs.

References

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2. Taddio A, McMurtry CM, Shah V, et al; HELPinKids&Adults. Reducing pain during vaccine injections: clinical practice guideline. CMAJ. 2015;187(13):975-982. doi:10.1503/cmaj.150391

3. Omer SB, Orenstein WA, Koplan JP. Go big and go fast--vaccine refusal and disease eradication. N Engl J Med. 2013;368(15):1374-1376. doi:10.1056/NEJMp1300765

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7. Nour R. A systematic review of methods to improve attitudes towards childhood vaccinations. Cureus. 2019;11(7):e5067. doi:10.7759/cureus.5067

8. Butler R, MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Diagnosing the determinants of vaccine hesitancy in specific subgroups: the Guide to Tailoring Immunization Programmes (TIP). Vaccine. 2015;33(34):4176-4179. doi:10.1016/j.vaccine.2015.04.038

9. World Health Organization. Report of the SAGE Working Group on Vaccine Hesitancy. November 12, 2014. Accessed May 23, 2022. https://www.asset-scienceinsociety.eu/sites/default/files/sage_working_group_revised_report_vaccine_hesitancy.pdf

10. Six common misconceptions about vaccination--and how to respond to them. Int J Trauma Nurs. 1998;4(3):109-112. doi:10.1016/s1075-4210(98)90079-7

11. Zimmerman RK, Wolfe RM, Fox DE, et al. Vaccine criticism on the world wide web. J Med Internet Res. 2005;7(2):e17. doi:10.2196/jmir.7.2.e17

12. How vaccines strengthen your baby’s immune system infographic. CDC. Updated July 17, 2017. Accessed May 23, 2022.https://www.cdc.gov/vaccines/parents/infographics/strengthen-baby-immune-system.html

13. MacDonald NE, Butler R, Dubé E. Addressing barriers to vaccine acceptance: an overview. Hum Vaccin Immunother. 2018;14(1):218-224. doi:10.1080/21645515.2017.1394533

14. Lewandowsky S, Ecker UK, Seifert CM, Schwarz N, Cook J. Misinformation and its correction: continued influence and successful debiasing. Psychol Sci Public Interest. 2012;13(3):106-131. doi:10.1177/1529100612451018

15. MacDonald NE, Dubé E. Promoting immunization resiliency in the digital information age. Can Commun Dis Rep. 2020;46(1):20-24. doi:10.14745/ccdr.v46i01a04

16. Fogarty CT, Crues L. How to talk to reluctant patients about the flu shot. Fam Pract Manag. 2017;24(5):6-8.

17. Dubé E, Gagnon D, Vivion M. Optimizing communication material to address vaccine hesitancy. Can Commun Dis Rep. 2020;46(2-3):48-52. doi:10.14745/ccdr.v46i23a05