“There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise,” says Emilie Karafillakis, a Research Fellow for the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, quoting Albert Camus from his book “The Plague”.
She was discussing the growing trend of vaccine hesitancy. Karafillakis says that since the 1918 flu pandemic there have been a wealth of developments in vaccines to prevent such outbreaks.
“Yet we’re facing the challenge that when a new pandemic comes - and we know that a new one will come - we’re going to face a problem of people not being willing to prevent this new infection. We have all these tools, all these amazing vaccines and people are not willing to take them.”
Karafillakis explained that although vaccine hesitancy itself is nothing new, with people questioning side effects since the first vaccine against smallpox, the situation has recently changed.
There has been a notable rise in the number of concerns around vaccines and the manner in which these concerns are shared. “The WHO recognising that this [vaccine hesitancy] is an issue is something really important and it’s going to help us address the issues that are at stake. The problem is how to define it.”
“While the WHO refers to it as ‘vaccine hesitancy’, many journals and media channels refer to ‘anti-vaxxers.' This group is now polarised into these extreme beliefs and they’re really trying to put these views online everywhere they can.”
Karafillakis pointed out, however, that this highly vocal group are in the minority. “It’s important that when we try to address loss of vaccine confidence, that we think about how people within this group differ."
"The majority of vaccine-hesitant people are normal parents who just want to do what’s best for their children. That’s their primary objective; they want to understand how they can keep their children safe."
"The problem that they’re facing is misinformation, conflicting information, too much information. And they don’t know who to turn to any more and they don’t know which information to believe and trust.”
“When you look at a population, the majority of people accept vaccination; they don’t question it, they just go and get their kids vaccinated and they do what their doctors tell them to do. We need to keep that in mind – in the end, most people vaccinate.”
“But we have a tiny, tiny group of people that refuse all vaccines, they’re really the minority; just 1-2 percent in every country.”
“What we’re dealing with are the people in the middle – the people that are still questioning it, who might delay one vaccine because they think there are too many vaccines given at the same time, or might refuse one particular vaccine because they think it might have side effects.”
“It’s people that are still uncertain, that are just trying to navigate this new world of information that is very unclear for them.”
“These are the people that we really want to target: they can be parents, but they can also be healthcare workers –a lot of whom are starting to question why we have so many vaccines.”
Annabel Seebohm, Secretary General of CPME, the Standing Committee of European Doctors, said that European doctors reaffirm that the prevention of communicable diseases through vaccination is safe.
“We’re facing the hallenge that when a new pandemic comes - and we know that a new one will come - we’re going to face a problem of people not being willing to prevent this new infection” Emilie Karafillakis
“There is no doubt– immunisation through vaccination is the best protection against serious diseases and we also advocate that doctors and other healthcare professionals should ensure that they themselves are vaccinated. They need to be role models and clearly have a responsibility.”
Seebohm said that healthcare professionals in general are increasingly equipped to address the decreasing confidence in vaccination, but added, “We need further support and training to raise awareness and to build trust in vaccines.”
“Moreover, we need further education so that healthcare professionals know how to address the issue of vaccine-related concerns with their patients.”
As for confidence in vaccines among healthcare professionals themselves, Seebohm said that overall, healthcare professionals in Europe are confident of the safety of vaccines and that only a minority have concerns.
According to the 2016 Vaccine Confidence Index, Europe had the lowest confidence in the safety of vaccines of any region, with seven of the ten least vaccine-confident countries. Globally, France was the country with the lowest level of confidence.
A subsequent 2018 survey, solely focused on the EU, found that Portugal, Spain and Denmark have the highest level of confidence, while France and Poland are the least.
Karafillakis explains, “Vaccine hesitancy is not static; it changes over time and it depends on the country. Part of this can be explained by anti-vaccine groups online, which have a lot more impact on social media, lots of talking about it in politics as well.”
“There was a study done that took some of our data on vaccine confidence and tried to link it with people’s votes for populist parties. They found that people that had less confidence in vaccines tended to vote more for populist parties” Emilie Karafillakis
She added, “This is really important. It’s what can really create a crisis in a country. There are specific rumours that can spread– in some countries they’re just buried and nothing ever happens, but in others, because of the context, they get picked up and become something much bigger."
"This can be the political environment, and we’ve seen that in Italy and the election, how it [the anti-vaccination movement] has been taken as a political argument."
On social media’s role in vaccine hesitancy, Karafillakis said, “This is a big one that we have to talk about.”
“Hesitancy and questioning about vaccination have been there since vaccines were created; what’s changed is the way these issues are spread now and the way that certain messages and rumours can really become amplified.”
She went on to describe a case where concerns over the HPV vaccination – originating in Japan - led some girls who felt that they were having symptoms linked to the vaccine (a subsequent investigation found this to be untrue) to share videos online of themselves having seizures, spasms, and paralysis; “really impactful videos; I’ve seen some of them, they’re really hard to watch”.
Karafillakis explained that these videos ended up spreading all over Japan. “It took just one person to add Danish subtitles for it to spread to Denmark and have people in there creating their own videos and believing that they had been impacted as well. It took one other person to translate it into English and it spread to Ireland.”
“The majority of vaccine-hesitant people are normal parents who just want to do what’s best for their children… The problem that they’re facing is misinformation” Emilie Karafillakis
“That’s what we’re facing today – we’re facing the same concerns – ‘are vaccines safe?’ ‘are vaccines effective?’, but they are now amplified by social media, creating a rapid spread of concerns that can create problems in any country. Even a country with the highest [vaccine] coverage is at risk of having something coming up from the ground, from the public.”
Asked if there was any connection between people who vote for populist parties and vaccine hesitancy, Karafillakis said, “There was a study done that took some of our data on vaccine confidence and tried to link it with people’s votes for populist parties. They found that people that had less confidence in vaccines tended to vote more for populist parties.”
“There’s a lot of that ‘putting the masses against the elite’ and a lot of that is taken back by the populist parties, whether in France or in Italy. There’s that whole concept of, you’re there as a population, you know better than them, the experts, they’re just the minority. It feeds into that discussion.”
Karafillakis explained that there are key things that can be done to tackle this growing problem. “The first is to listen. We need to keep a constant ear on the ground to detect possible changes in confidence and possible signals that could lead to crises.”
“That can be done through surveys and monitoring of media and discussions that are happening online to see when there’s a change. Another one is engagement - a big part of the issue with vaccine confidence is mistrust – it’s not enough to just give people information; it’s important but it’s not going to solve the problem.”
“We need to think about how we can engage the public from the outset, as soon as we’re thinking about doing a trial, how we can work on this together.”