In Clark County, Washington, the fifth most populous county in the state that borders Portland, Oregon, a hotspot for anti-vaxx sentiment, a measles outbreak that began in January led health officials to declare a medical emergency. There have been over 70 confirmed cases, the majority of which are unvaccinated children under the age of ten.
The flare-up was just part of a wider trend. The United States officially declared that measles was eliminated in 2000, but cases of the disease have steadily been increasing since 2011.
The World Health Organization (WHO) declared vaccine hesitancy as one of the 10 biggest threats to global health in 2019. But while the zealous “anti-vaxx” movement sucks up media attention, the failure to vaccinate is connected to a much wider set of cultural issues.
The WHO attributed hesitancy to not only a lack of confidence in vaccines, but complacency and inconvenience in accessing them.
Now, Washington State Secretary of Health John Wiesman has told Apolitical that government and health officials are operating on crisis mode rather than enacting policies that focus on prevention.
Working with communities to address hesitancy and understand their concerns should be the first step to increasing coverage, but without policies that target complacency and confront the lack of access to health services, operating on crisis mode may become the norm.
Misinformation not the only culprit
In 2017, the WHO estimated that 92% of American children age 12 – 23 months were vaccinated with the measles, mumps, and rubella vaccine (MMR), while Washington’s Clark County was below average at 78% vaccinated.
Washington is currently one of the 16 states that allow a vaccination exemption on not only religions and medical grounds, but philosophical. Although legislation recently passed in April to remove the philosophical exemption.
But when the public was told about the new spate of confirmed measles cases by the media, 3,500 kids in Clark County got vaccinated that were not previously scheduled to. MMR vaccine rates went up from 200 kids a week to over 1,000 in the early stages of the outbreak.
Wiesman, who is overseeing the response to the outbreak in the state, said that the rush to get vaccines reveals that the majority of people trust vaccines and want their children to get them, but it wasn’t a high priority until an outbreak occurred.
“Young parents have not lived in an age where outbreaks like this are common,” he said. “Before vaccines, people saw the negative implications whether that is a baby being born with a birth defect because the mom was not able to get vaccinated or a child getting a brain infection or pneumonia or even dying as a result of these diseases.”
Without a reminder of how horrific these diseases can be, often people don’t feel the same sense of urgency that they did when these diseases were prevalent, particularly if there is an opt-out exemption for parents.
A study by CDC and American Pediatrics shows that some parents don’t think it’s necesscary to vaccinate because preventable diseases are less prevalent in society
In testimony to the Senate, Wiesman urged Congress to create a coordinated national media campaign with the CDC to raise the importance of vaccines and provide factual information that can help dispel myths pushed by anti-vaxx groups. The campaign should not only counter misinformation but should also be used to reduce complacency.
His vision is to create a campaign similar to the CDC advertisements for quitting smoking advertisements broadcast on American television in 2014. The ads featured graphic images of former smokers while they talked about cigarette smoking-related illness and the damage that it caused.
CDC research on the outcome of the campaign in 2016, revealed that over 100,000 Americans quit smoking and 1.8 million people tried to quit as a result.
As more parents are working, another challenge in addressing complacency may be the lack of access to a health clinic that is open outside of working hours or easily accessible to their work or home. Healthcare costs can also be a barrier, particularly for low-income families that may not be covered by health insurance.
A survey conducted by the Royal Society for Public Health (RSPH), an English health charity, found that the most common barriers to vaccinations were timing of appointments at 49% and availability of appointments at 46%.
In Washington State, health officials also expanded Medicaid insurance coverage, so low-income families could have inexpensive options for healthcare services. Vaccines are also free of charge to anyone under the age of 19.
Similar to Washington State, countries around the world are enacting policies and using innovative solutions to ensure that children are being vaccinated.
In an effort to make vaccines more accessible in Quebec, Canada, nurses can administer vaccines in grades four of primary school and in high school free of charge. Also, anyone over the age of 14 can get a vaccine without consent.
In Kenya, Zimbabwe, Senegal, and Nigeria health organisations send SMS nudges that remind parents about vaccine schedules, stress the importance of vaccines, and relay facility closures or long wait times, to increase vaccine coverage. For example, in Zimbabwe coverage increased 20% in ten weeks after the SMS’ were sent, according to a study.
“We are happy to fund healthcare and treatments and intervention, but it’s prevention that’s not getting the attention it deserves,” said Wiesman. – Amelia Axelsen
(Picture credit: Pixnio)