tag:theconversation.com,2011:/global/topics/childhood-vaccination-9607/articlesChildhood vaccination – The Conversation2024-03-11T12:28:43Ztag:theconversation.com,2011:article/2174332024-03-11T12:28:43Z2024-03-11T12:28:43ZVaccine-skeptical mothers say bad health care experiences made them distrust the medical system<figure><img src="https://images.theconversation.com/files/580008/original/file-20240305-18-5fkuf2.jpg?ixlib=rb-1.1.0&rect=86%2C28%2C4623%2C3168&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women's own negative medical experiences influence their vaccine decisions for their kids.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakPediatricVaccines/9249589410f742d586eeff3122190438/photo?boardId=71cbe30c136941ba87c7b57dabd12ef2&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=2&currentItemNo=0">AP Photo/Ted S. Warren</a></span></figcaption></figure><p>Why would a mother reject safe, potentially lifesaving vaccines for her child?</p>
<p><a href="https://www.salon.com/2019/02/10/the-unsubtle-sexism-of-the-anti-vax-mom-meme/">Popular writing on vaccine skepticism</a> often denigrates white and middle-class mothers who reject some or all recommended vaccines <a href="https://www.washingtonpost.com/opinions/2021/07/08/right-wing-anti-vaccine-hysteria-is-increasing-well-all-pay-price/">as hysterical</a>, <a href="https://doi.org/10.1080/09589236.2022.2069088">misinformed, zealous</a> <a href="https://www.canberra.edu.au/uncover/news-archive/2022/april/targetting-mothers-anti-vaxxers-insidious-strategies">or ignorant</a>. <a href="https://www.nytimes.com/2022/05/25/magazine/anti-vaccine-movement.html">Mainstream media</a> <a href="https://www.vanityfair.com/news/2021/07/anthony-fauci-coronavirus-vaccine-polio-measles">and medical providers</a> increasingly dismiss vaccine refusal as a hallmark of American fringe ideology, <a href="https://www.nytimes.com/2021/08/31/opinion/anti-vaccine-movement.html">far-right radicalization or anti-intellectualism</a>.</p>
<p>But vaccine skepticism, and the broader medical mistrust and far-reaching anxieties it reflects, is not just a fringe position.</p>
<p>Pediatric vaccination rates had already <a href="https://www.cedars-sinai.org/newsroom/2019-the-year-of-vaccine-preventable-diseases/">fallen sharply before the COVID-19 pandemic</a>, ushering in the return of measles, mumps and chickenpox to the U.S. in 2019. Four years after the pandemic’s onset, a growing number of Americans doubt the safety, efficacy and necessity of routine vaccines. Childhood vaccination rates have declined substantially across the U.S., which public health officials attribute to a <a href="https://apnews.com/article/health-immunizations-children-measles-acba3eb975fdfcd41732ed87511387f2">“spillover” effect</a> from pandemic-related vaccine skepticism and blame for the <a href="https://www.nytimes.com/news-event/measles-outbreak">recent measles outbreak</a>. Almost half of American mothers <a href="https://www.pewresearch.org/science/2023/05/16/americans-largely-positive-views-of-childhood-vaccines-hold-steady/">rated the risk of side effects from the MMR vaccine</a> as medium or high in a 2023 survey by Pew Research. </p>
<p>Recommended vaccines go through rigorous testing and evaluation, and the most infamous charges of vaccine-induced injury <a href="https://www.jstor.org/stable/25766651">have been thoroughly debunked</a>. How do so many mothers – primary caregivers and health care decision-makers for their families – become wary of U.S. health care and one of its most proven preventive technologies?</p>
<p>I’m a cultural anthropologist who <a href="https://scholar.google.com/citations?user=nzIMuB8AAAAJ&hl=en&oi=ao">studies the ways feelings and beliefs circulate in American society</a>. To investigate what’s behind mothers’ vaccine skepticism, <a href="https://doi.org/10.1111/maq.12764">I interviewed vaccine-skeptical mothers</a> about their perceptions of existing and novel vaccines. What they told me complicates sweeping and overly simplified portrayals of their misgivings by pointing to the U.S. health care system itself. The medical system’s failures and harms against women gave rise to their pervasive vaccine skepticism and generalized medical mistrust.</p>
<h2>The seeds of women’s skepticism</h2>
<p>I conducted <a href="https://doi.org/10.1111/maq.12764">this ethnographic research</a> in Oregon from 2020 to 2021 with predominantly white mothers between the ages of 25 and 60. My findings reveal new insights about the origins of vaccine skepticism among this demographic. These women traced their distrust of vaccines, and of U.S. health care more generally, to ongoing and repeated instances of medical harm they experienced from childhood through childbirth.</p>
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<a href="https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="girl sitting on exam table faces a doctor viewer can see from behind" src="https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580511/original/file-20240307-28-wlrbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A woman’s own childhood mistreatment by a doctor can shape her health care decisions for the next generation.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-girl-at-a-medical-appointment-royalty-free-image/1670275219">FatCamera/E+ via Getty Images</a></span>
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<p>As young girls in medical offices, they were touched without consent, yelled at, disbelieved or threatened. One mother, Susan, recalled her pediatrician abruptly lying her down and performing a rectal exam without her consent at the age of 12. Another mother, Luna, shared how a pediatrician once threatened to have her institutionalized when she voiced anxiety at a routine physical.</p>
<p>As women giving birth, they often felt managed, pressured or discounted. One mother, Meryl, told me, “I felt like I was coerced under distress into Pitocin and induction” during labor. Another mother, Hallie, shared, “I really battled with my provider” throughout the childbirth experience. </p>
<p>Together with the convoluted bureaucracy of for-profit health care, experiences of medical harm contributed to “one million little touch points of information,” in one mother’s phrase, that underscored the untrustworthiness and harmful effects of U.S. health care writ large.</p>
<h2>A system that doesn’t serve them</h2>
<p>Many mothers I interviewed rejected the premise that public health entities such as the Centers for Disease Control and Prevention and the Food and Drug Administration had their children’s best interests at heart. Instead, they tied childhood vaccination and the more recent development of COVID-19 vaccines to a bloated pharmaceutical industry and for-profit health care model. As one mother explained, “The FDA is not looking out for our health. They’re looking out for their wealth.”</p>
<p>After ongoing negative medical encounters, the women I interviewed lost trust not only in providers but the medical system. Frustrating experiences prompted them to “do their own research” in the name of bodily autonomy. Such research often included books, articles and podcasts deeply critical of vaccines, public health care and drug companies.</p>
<p>These materials, which have proliferated since 2020, cast light on past vaccine trials gone awry, broader histories of medical harm and abuse, the rapid growth of the recommended vaccine schedule in the late 20th century and the massive profits reaped from drug development and for-profit health care. They confirmed and hardened women’s suspicions about U.S. health care.</p>
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<a href="https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hands point to a handwritten vaccination record" src="https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=446&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=446&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=446&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580514/original/file-20240307-23-p10d28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The number of recommended childhood vaccines has increased over time.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/tom-lyons-dir-of-communications-of-the-boston-public-health-news-photo/1340505911">Mike Adaskaveg/MediaNews Group/Boston Herald via Getty Images</a></span>
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<p>The stories these women told me add nuance to existing academic research into vaccine skepticism. Most studies have considered vaccine skepticism among <a href="https://doi.org/10.1111/maq.12214">primarily white and middle-class parents</a> to be <a href="https://doi.org/10.1177/0891243214532711">an outgrowth of today’s neoliberal parenting</a> and <a href="https://nyupress.org/9781479874835/calling-the-shots/">intensive mothering</a>. Researchers have theorized vaccine skepticism among white and well-off mothers to be an outcome of <a href="https://doi.org/10.1080/14797585.2021.1886425">consumer health care</a> and its emphasis on <a href="https://doi.org/10.1080/01459740.2016.1145219">individual choice</a> and <a href="https://doi.org/10.1016/j.socscimed.2007.04.023">risk reduction</a>. Other researchers highlight vaccine skepticism as a collective identity that can provide mothers with a <a href="https://doi.org/10.14506/ca31.3.04">sense of belonging</a>.</p>
<h2>Seeing medical care as a threat to health</h2>
<p>The perceptions mothers shared are far from isolated or fringe, and they are not unreasonable. Rather, they represent a growing population of Americans who hold the pervasive belief that U.S. health care harms more than it helps.</p>
<p>Data suggests that the number of Americans harmed in the course of treatment remains high, with <a href="https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#patient-safety">incidents of medical error in the U.S.</a> outnumbering those in peer countries, despite more money being spent per capita on health care. <a href="https://www.hopkinsmedicine.org/news/newsroom/news-releases/2023/07/report-highlights-public-health-impact-of-serious-harms-from-diagnostic-error-in-us#:%7E:text=The%20overall%20average%20error%20rate,missed%20in%2017.5%25%20of%20cases.">One 2023 study</a> found that diagnostic error, one kind of medical error, accounted for 371,000 deaths and 424,000 permanent disabilities among Americans every year. </p>
<p>Studies reveal particularly high rates of medical error in the treatment of <a href="https://www.bu.edu/bulawreview/files/2022/03/JEAN-PIERRE.pdf">vulnerable communities</a>, including <a href="https://doi.org/10.1186/s12939-018-0828-7">women, people of color</a>, <a href="https://doi.org/10.1377/hlthaff.2020.01452">disabled</a>, <a href="https://doi.org/10.1371/journal.pone.0166762">poor</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861755/">LGBTQ+ and gender-nonconforming individuals</a> and <a href="https://doi.org/10.3111/13696998.2013.848210">the elderly</a>. The number of U.S. women who have <a href="https://doi.org/10.1001/jama.2023.9043">died because of pregnancy-related causes</a> has increased substantially in recent years, with maternal death rates doubling between 1999 and 2019.</p>
<p>The prevalence of medical harm points to the relevance of <a href="https://www.britannica.com/biography/Ivan-Illich">philosopher Ivan Illich</a>’s manifesto against the “disease of medical progress.” In his 1982 book “<a href="https://search.worldcat.org/title/8493694">Medical Nemesis</a>,” he insisted that rather than being incidental, harm flows inevitably from the structure of institutionalized and for-profit health care itself. Illich wrote, “The medical establishment has become a major threat to health,” and has created its own “epidemic” of iatrogenic illness – that is, illness caused by a physician or the health care system itself.</p>
<p>Four decades later, <a href="https://doi.org/10.1056/NEJMp1407373">medical mistrust among Americans</a> remains alarmingly high. Only 23% of Americans express high confidence in the medical system. The United States ranks 24th out of 29 peer high-income countries for the level of public trust in medical providers.</p>
<p>For people like the mothers I interviewed, who have experienced real or perceived harm at the hands of medical providers; have felt belittled, dismissed or disbelieved in a doctor’s office; or spent countless hours fighting to pay for, understand or use health benefits, skepticism and distrust are rational responses to lived experience. These attitudes do not emerge solely from ignorance, conspiracy thinking, far-right extremism or hysteria, but rather the historical and ongoing harms endemic to the U.S. health care system itself.</p><img src="https://counter.theconversation.com/content/217433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Johanna Richlin does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccine skepticism, and the broader medical mistrust and far-reaching anxieties it reflects, is not just a fringe position in the 21st century.Johanna Richlin, Assistant Professor of Anthropology, University of MaineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2178742023-11-17T17:18:19Z2023-11-17T17:18:19ZChickenpox vaccine recommended for NHS – here’s why a jab is better than getting the disease<figure><img src="https://images.theconversation.com/files/560163/original/file-20231117-15-13qh08.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C3264%2C2438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If the vaccine is offered, children would be given two doses.
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-giving-child-injection-26170495">sergei telegin/ Shutterstock</a></span></figcaption></figure><p>The <a href="https://www.gov.uk/government/publications/childhood-varicella-vaccination-programme-jcvi-advice-14-november-2023/jcvi-statement-on-a-childhood-varicella-chickenpox-vaccination-programme">chickenpox vaccine</a> is already offered as part of childhood immunisation programmes in <a href="https://www.gov.uk/government/news/jcvi-recommends-chickenpox-vaccine-in-childhood-immunisation-programme#:%7E:text=If%20approved%2C%20it%20would%20bring,programme%20in%20place%20since%201995.">several countries</a>, including Canada, the US, Australia and New Zealand. Now the UK government’s Joint Committee on Vaccination and Immunisation (JCVI) has recommended it be included as part of the routine immunisations children receive in the UK.</p>
<p>Not only does evidence from these countries show us the chickenpox vaccine is safe, it also shows us just how effective the vaccine can be – and why it should be introduced in the UK. </p>
<p>In the US for example, where the vaccine was introduced as a routine childhood immunisation in 1995, <a href="https://www.idsociety.org/news--publications-new/articles/2022/chickenpox-now-rare-in-u.s.-due-to-routine-vaccination/">cases have fallen by 97%</a>. Indeed, the chickenpox vaccine prevents almost four million cases, 10,500 hospitalisations and 100 deaths from chickenpox there every year. </p>
<p>Vaccinating kids against chickenpox would not only protect them against mild cases of the virus, but it would also prevent more severe cases and the rare complications that can sometimes happen. This move could be especially beneficial now, given immunity to chickenpox is significantly lower than normal <a href="https://www.gov.uk/government/publications/childhood-varicella-vaccination-programme-jcvi-advice-14-november-2023/jcvi-statement-on-a-childhood-varicella-chickenpox-vaccination-programme">due to the pandemic</a>. </p>
<p>If rolled out soon, it would protect more children from contracting chickenpox, improve immunity within the population and lower case numbers – which may also protect adults who haven’t been exposed before from contracting the virus. </p>
<p>And not only would it protect children and their health now, it would also have many knock-on benefits for their health in the future.</p>
<h2>Offering protection</h2>
<p>Chickenpox is a highly infectious disease caused by the <a href="https://www.cdc.gov/chickenpox/hcp/index.html#:%7E:text=Varicella%20(chickenpox)%20is%20an%20acute,ganglia">varicella zoster virus</a>.</p>
<p>The chickenpox vaccine protects against the varicella virus. If it was included as part of routine childhood vaccination programmes, children would be given two doses when they’re aged 12 months and 18 months. The JCVI has also recommended that older children be offered the vaccine as part of a catch-up programme. </p>
<p>While chickenpox is mostly contracted by young children, the virus can infect anyone of any age. Most cases in children are mild, causing extremely itchy fluid-filled blisters, along with a fever and generally feeling unwell. The infection typically lasts four to seven days.</p>
<p>But some children will develop complications that require hospitalisation – such as inflammation in the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox">lungs or the brain</a>. While these complications can occur in any child, the risk of <a href="https://www.clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/infectious-disease/varicella-zoster-infection-chickenpox-management-in-children/">severe infection</a> is higher in children who are immunocompromised or have underlying medical conditions. </p>
<p>Along with the risk of complications, being infected with chickenpox can increase a person’s risk of developing shingles later in life. Approximately <a href="https://www.gov.uk/government/publications/shingles-vaccination-for-adults-aged-70-or-79-years-of-age-a5-leaflet/vaccination-against-shingles-guide-from-september-2023">one in five people</a> who have had chickenpox will develop shingles later in life.</p>
<figure class="align-center ">
<img alt="Patches of the shingles rash on a woman's arm." src="https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560164/original/file-20231117-15-m7yjxy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The chickenpox vaccine may also protect against developing shingles later in life.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-shingles-on-skin-she-feels-2344606969">aslysun/ Shutterstock</a></span>
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<p>This is due to the fact that <a href="https://www.cdc.gov/shingles/hcp/clinical-overview.html">following infection</a>, the virus travels to the sensory nerve ganglia, where it remains quiet and doesn’t cause any infection for decades. But it can reactivate as shingles later in life – normally when a person is older and their immune system is weakened. This results in a rash that can cause significant pain. In around 10-18% of cases, this rash can remain for the <a href="https://www.cdc.gov/shingles/about/complications.html">rest of their life</a>.</p>
<h2>Why vaccination is better</h2>
<p>The chickenpox vaccine is a live vaccine. This means it contains a small amount of weakened varicella virus, which is administered by injection into the upper arm.</p>
<p>This switches on your immune system to produce antibodies to the virus, which prevents the virus from being able to establish an infection when you’re exposed to the real thing. </p>
<p>The vaccine is <a href="https://www.cdc.gov/vaccines/vpd/varicella/hcp/about-vaccine.html">around 90% effective</a> in protecting against infection. It’s most protective when children are given two doses of the vaccine. </p>
<p>Some may wonder whether immunity from the vaccine is better than immunity from the infection itself. It’s important to point out that in both instances, the immune system is activated by the virus and will generate specific antibodies to protect against it in the future. This means the next time a person is exposed to the chickenpox virus, their antibodies will block it, preventing an infection.</p>
<p>While the vaccine contains only a small amount of weakened virus (which is not capable of causing infection), your immune system still sees it in the same way as it would if you caught the virus from someone else. You still generate an immune response, and you still get protection.</p>
<p>The significant advantage of generating immunity using the vaccine is that you don’t have to get sick with chickenpox, which could have serious side effects. And, the virus doesn’t stay in your body for decades with the risk of being <a href="https://www.cdc.gov/shingles/hcp/clinical-overview.html">activated as shingles</a> later in life.</p>
<p>Apart from the health benefits of vaccinating children, it may also have other benefits – such as preventing time out of school, which will be good for the child’s education.</p>
<p>If this new recommendation comes into force, it will be the beginning of an era where chickenpox infections in children will become the exception rather than the norm. We have a safe vaccine that can prevent a childhood illness which, in some, can cause severe complications. It makes sense that we should be using it.</p><img src="https://counter.theconversation.com/content/217874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Loscher does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In one country where the chickenpox vaccine is already routine, cases have fallen by 97% since it was first introduced.Christine Loscher, Professor of Immunology, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2055152023-06-15T06:09:04Z2023-06-15T06:09:04ZMeasles and whooping cough outbreaks in South Africa: a sign of low vaccination coverage, experts warn<figure><img src="https://images.theconversation.com/files/530906/original/file-20230608-12385-a4sqhf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregivers are conflicted about vaccinating their children. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>The concentrated global effort to use vaccination as a public health intervention began in <a href="https://www.who.int/news-room/fact-sheets/detail/immunization-coverage">1974</a>. Since then, vaccination has changed our lives. Worldwide, in the decades 2000-2020, childhood vaccination led to the reduction of deaths in children under 5 by 50% to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31891-9/fulltext">5.4 million deaths</a> per year. Vaccination currently averts more than <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32657-X/fulltext">5 million deaths</a> each year <a href="https://www.youtube.com/watch?app=desktop&v=vfAcG_ur27g">worldwide</a>. These are deaths that would have been caused by measles, whooping cough, tetanus, polio, diphtheria, pneumonia, rotavirus diarrhoea, and other <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32657-X/fulltext">vaccine-preventable diseases</a>. But in recent months there have been numerous outbreaks of these diseases. Scientists from the South African Medical Research Council explain why these diseases continue to threaten children’s health in the country.</em></p>
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<h2>The country currently has outbreaks of several diseases. What are they?</h2>
<p>There is an increased spread of <a href="https://www.nicd.ac.za/south-african-measles-outbreak-update-2023-9-june-2023/">measles</a> in South Africa now.</p>
<p>Measles is a highly infectious disease that spreads through droplets. It is the second most frequently reported disease outbreak in Africa after cholera. It accounts for 11.5% of all reported disease <a href="https://www.cambridge.org/core/journals/epidemiology-and-infection/article/infectious-disease-outbreaks-in-the-african-region-overview-of-events-reported-to-the-world-health-organization-in-2018/A504999B25CBA5E179B951FABB8CFE53">epidemics on the continent</a>.</p>
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Read more:
<a href="https://theconversation.com/explainer-a-history-of-the-measles-virus-and-why-its-so-tenacious-130262">Explainer: a history of the measles virus and why it's so tenacious</a>
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<p>Children who have not been vaccinated against measles are at high risk of the disease and its complications. These include pneumonia, brain damage, and death. Measles is one of the most dangerous but preventable childhood diseases. Up to <a href="http://www.samj.org.za/index.php/samj/article/view/6196/4933">10% of children</a> under five years of age who develop measles die from complications of the disease. </p>
<p>An effective vaccine against measles has been available for decades. A child requires two doses of the measles vaccine to develop protective immunity against the disease. The two doses of the measles vaccine are given at 6 and 12 months of age in South Africa. At least 95% coverage of 2 doses of the measles vaccine is required for herd immunity against <a href="https://www.who.int/news-room/fact-sheets/detail/measles">measles</a> and protect those who aren’t able to get vaccinated.</p>
<p>Another highly infectious disease that has recently seen an increase in cases in South Africa is pertussis, also referred to as <a href="https://www.nicd.ac.za/an-increase-in-pertussis-cases-13-dec-2022/">whooping cough</a>. Pertussis spreads easily from person to person through droplets produced by coughing or sneezing. Complications of whooping cough include pneumonia, seizures, brain damage, and death. The best way to prevent pertussis is through <a href="https://www.who.int/health-topics/pertussis#tab=tab_2">vaccination</a>. </p>
<h2>These diseases are preventable. What’s behind the spread?</h2>
<p>The resurgence of vaccine-preventable diseases in South Africa is due to immunity gaps caused by low vaccination coverage. A <a href="https://www.health.gov.za/wp-content/uploads/2022/03/National-EPI-Coverage-Survey_Final-full-report-Dec-2020.pdf">national survey</a> conducted from July to December 2019 found that only 81% of children had received all their vaccine doses scheduled up to 12 months of age in South Africa. This percentage has increased only slightly to <a href="https://www.who.int/data/gho/data/themes/topics/immunization-coverage">82%</a> since then, according to estimates from the World Health Organization (WHO) and the United Nations Children Fund (UNICEF).</p>
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Read more:
<a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">South Africa's immunisation record risks being dented by anti-vaccination views</a>
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<h2>What’s the cause of the gaps in immunisation?</h2>
<p>Over the last two years, routine immunisation services and coverage of essential childhood vaccines have been disrupted. And many <a href="https://www.who.int/news/item/24-04-2023-global-partners-announce-a-new-effort-the-big-catch-up-to-vaccinate-millions-of-children-and-restore-immunization-progress-lost-during-the-pandemic">catch-up vaccination efforts</a> have been postponed due to the COVID-19 pandemic. This has led to an increase in the number of children who are unvaccinated or under-vaccinated. </p>
<p>The country’s low vaccination coverage is due to both <a href="https://doi.org/10.1002/14651858.CD013265.pub2">supply and demand issues</a>. These relate to the provision of vaccines and the population’s decision to vaccinate. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6378923/pdf/CD013265.pdf">Structural barriers</a> such as vaccine availability and access to health facilities are well known to reduce vaccination coverage. </p>
<p>Research also <a href="https://www.tandfonline.com/doi/pdf/10.1080/21645515.2018.1460987?needAccess=true&role=button">suggests</a> that social and psychological factors, such as concerns about the safety and efficacy of vaccines, influence decisions around vaccination. Some caregivers are conflicted about vaccinating their children. </p>
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Read more:
<a href="https://theconversation.com/unpacking-parents-reasons-for-not-vaccinating-their-children-why-it-matters-171527">Unpacking parents' reasons for not vaccinating their children: why it matters</a>
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<p><a href="https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/mhst1-1201.pdf">Vaccine hesitancy</a> represents a motivational state of being conflicted about or opposed to vaccination. Evidence from several studies conducted in South Africa has shown a significant <a href="https://www.tandfonline.com/doi/pdf/10.1080/14760584.2021.1949291">increase in vaccine hesitancy</a>. This has had a dramatic impact on routine immunisation services and ultimately reduced vaccine coverage over the years.</p>
<h2>What steps can be taken to close these gaps?</h2>
<p>Globally, many initiatives exist to improve childhood immunization, especially in low- and middle-income countries. Within the context of the Immunization Agenda 2030 (IA2030) programme, WHO, UNICEF and Gavi, are launching the <a href="https://www.who.int/news/item/24-04-2023-global-partners-announce-a-new-effort-the-big-catch-up-to-vaccinate-millions-of-children-and-restore-immunization-progress-lost-during-the-pandemic">“Big Catch-Up”</a> initiative. This initiative aims to support countries like South Africa to plan and implement intensified efforts to bolster immunisation. It has three main objectives: </p>
<ul>
<li><p>to reach children who missed vaccination during 2020-2022 for catch-up vaccination</p></li>
<li><p>to restore vaccination coverage to the last best coverage in 2019 </p></li>
<li><p>to strengthen immunisation programmes to reach the under-vaccinated and unvaccinated children. </p></li>
</ul>
<p><a href="https://bmjopen.bmj.com/content/bmjopen/12/11/e058258.full.pdf">Interventions</a> that are focused on improving the healthcare system include cold-chain infrastructure improvements to ensure availability and access to vaccines. Some other <a href="https://www.tandfonline.com/doi/epdf/10.1080/21645515.2016.1221553?needAccess=true&role=button">interventions</a> that can improve uptake of vaccines include using motivational posters or flyers, sending reminders (messages or letters), and material or monetary incentives to caregivers or pay-for-performance schemes for healthcare workers providing vaccinations to children. </p>
<p>Informing and providing education to caregivers and healthcare workers has also been <a href="https://bmjopen.bmj.com/content/bmjopen/12/11/e058258.full.pdf">effective</a> increasing vaccination in children in cases where parents were hesitant. However, not enough research is done on interventions to dispel misinformation and misconception regarding immunisation, which is one of the leading causes of vaccine hesitancy.</p><img src="https://counter.theconversation.com/content/205515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duduzile Ndwandwe receives funding from the South African Medical Research Council. She is affiliated with Eh! Woza, a non-profit Organization for public engagement. </span></em></p><p class="fine-print"><em><span>Charles Shey Wiysonge and Lindi Mathebula do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Over the last two years, routine immunisation services and coverage of essential childhood vaccines have been disrupted.Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilDuduzile Ndwandwe, Deputy Director and Specialist Scientist , South African Medical Research CouncilLindi Mathebula, Project Manager, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2029452023-03-30T07:08:42Z2023-03-30T07:08:42ZMeasles has been identified in NSW, Qld and SA. 5 things to know about the virus<figure><img src="https://images.theconversation.com/files/518957/original/file-20230403-20-itefrs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> </figcaption></figure><p>New South Wales health authorities have issued a <a href="https://twitter.com/NSWHealth/status/1640875391685656576/photo/1">measles alert</a> after a baby who recently returned from overseas, and subsequently visited several sites in Western Sydney, tested positive to the virus. </p>
<p>This follows <a href="https://www.sunshinecoast.health.qld.gov.au/about-us/news/public-health-alert-measles-venue-of-concern">two cases of measles</a> in a family on Queensland’s Sunshine Coast who returned from overseas on March 13, and a case in South Australia which was also <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/public+health/alerts/health+alerts/measles+case+in+south+australia">acquired overseas</a>.</p>
<p>Measles is an extremely contagious disease but, thanks to immunisation, is now rare in Australia. Here are five things you need to know about the virus – and why it’s important to get vaccinated. </p>
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<h2>1. Measles can cause severe illness and death</h2>
<p>Measles is a viral infection that can cause a variety of complications, including encephalitis, or inflammation of the brain. </p>
<p>Before the development of effective vaccines, children’s author Roald Dahl gave a harrowing <a href="https://theconversation.com/how-roald-dahl-became-a-passionate-vaccine-advocate-155725">account</a> of the death of his daughter Olivia from measles encephalitis. </p>
<p>A feared complication is a type of progressive encephalitis that can occur many years after infection called <a href="https://www.ninds.nih.gov/health-information/disorders/subacute-sclerosing-panencephalitis">subacute sclerosing encephalitis</a>. </p>
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Read more:
<a href="https://theconversation.com/how-roald-dahl-became-a-passionate-vaccine-advocate-155725">How Roald Dahl became a passionate vaccine advocate</a>
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<p>Deaths from measles are much more <a href="https://academic.oup.com/ije/article/38/1/192/696766">common</a> in developing countries, where up to one in six infants with measles die from the infection. However, deaths are <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/8FA6078276359430CA257BF0001A4C42/$File/australian_vaccine_preventable_disease_epidemiological_review_series_measles_2012_2019.pdf">still reported</a> in Australia. </p>
<p>Although deaths due to measles globally have fallen sharply since 2000, in 2018 the World Health Organization <a href="https://www.who.int/news-room/fact-sheets/detail/measles">estimated</a> there were more than 140,000 deaths due to measles, mostly in children aged under five. </p>
<p>Measles can also have <a href="https://pubmed.ncbi.nlm.nih.gov/28646947/">indirect impacts</a> on the immune system, with children being more susceptible to other bacterial and viral infections following measles. </p>
<h2>2. Measles is highly infectious</h2>
<p>Measles can spread quickly though susceptible populations. In unvaccinated people, a single case <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30307-9/fulltext">can result in</a> more than 12 to 18 secondary cases. </p>
<p>After exposure, around <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/meas.html">nine out of ten</a> people who are not protected by vaccination or past infection will become infected. </p>
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<img alt="Doctor puts a stethoscope on the chest of a child with measles" src="https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518325/original/file-20230330-28-xpnj00.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Measles spreads quickly in unvaccinated populations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/viral-disease-measles-rash-concept-doctor-1323694004">Shutterstock</a></span>
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<p>A person with measles is infectious even before symptoms develop – from <a href="https://www.who.int/news-room/fact-sheets/detail/measles">four days before</a> the appearance of a rash to four days after.</p>
<p>The measles virus remains infectious in air or on surfaces for <a href="https://www.ecdc.europa.eu/en/measles/facts#:%7E:text=Virus%2Dcontaining%20droplets%20can%20remain,rash%20to%20four%20days%20afterwards.">up to two hours</a>. This means transmission can occur in a hospital waiting room even after the person with measles has left.</p>
<h2>3. The measles vaccine is very effective (though not perfect)</h2>
<p>The measles vaccine has been <a href="https://www.who.int/news-room/fact-sheets/detail/measles">estimated</a> to have averted more than 23 million deaths between 2000 and 2018. </p>
<p>At a <a href="https://www.unicef.org/supply/documents/measles-vaccine-price-data">cost</a> of less than US$2 per dose, it is thought to be one of the most cost-effective health interventions available. </p>
<p>It is highly effective. An Australian <a href="https://pubmed.ncbi.nlm.nih.gov/26668766/">study</a> estimated one dose of vaccine reduced the risk of measles by 96.7%, and two doses by 99.7%. </p>
<p>However, there are some limitations. The vaccine is less effective if given under the age of 12 months due to the baby’s immature immune system. (In outbreak situations, or when an infant is travelling to a country where measles is common, it is sometimes given from <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/measles#recommendations">six months of age</a>).</p>
<p>Another limitation is the measles vaccine is “live” (meaning it contains a very small amount of <a href="https://www.health.gov.au/are-vaccines-safe">live – but weakened – virus</a>), so pregnant women and some people with weakened immune systems cannot receive it.</p>
<p>In Australia, anyone born during or after 1966 <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/measles#recommendations">should check</a> they have had two doses of measles-containing vaccine, and if not, see their doctor to discuss vaccination. </p>
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Read more:
<a href="https://theconversation.com/5-virus-families-that-could-cause-the-next-pandemic-according-to-the-experts-189622">5 virus families that could cause the next pandemic, according to the experts</a>
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<h2>4. Vaccinating children can also protect those who aren’t vaccinated</h2>
<p>“Herd immunity” occurs where high vaccination coverage stops a disease from spreading far in a population.</p>
<p>Because measles is so infectious, the vaccination threshold for herd immunity is high, and is the rationale for Australia’s <a href="https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage">target to vaccinate</a> 95% of children against measles and other vaccine-preventable diseases.</p>
<p>Encouragingly, in 2022, <a href="https://www.health.gov.au/topics/immunisation/immunisation-data/childhood-immunisation-coverage/current-coverage-data-tables-for-all-children">93% of two-year-old Australian children</a> had received their first dose of the measles-mumps-rubella vaccine. </p>
<p>This high vaccination rate led to Australia being declared <a href="https://www.lowyinstitute.org/the-interpreter/measles-outbreaks-are-rising-across-world-what-can-australia-do#:%7E:text=Australia%20was%20declared%20free%20of,resurgence%20in%20the%20developed%20world.">free from measles</a> in 2014, reflecting an absence of ongoing local transmission of measles. </p>
<p>Maintaining Australia’s measles elimination status requires ongoing high vaccination rates, an effective surveillance system to detect imported and locally acquired cases, and a rapid public health response to cases. </p>
<p>The World Health Organization can withdraw the <a href="https://www1.racgp.org.au/ajgp/2020/march/measles-elimination-in-australia">measles elimination</a> status of a country or region if local transmission is re-established, as happened to the United Kingdom in 2019.</p>
<figure class="align-center ">
<img alt="Health worker puts bandaid on child's arm after vaccination" src="https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518324/original/file-20230329-23-wu22mb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Countries must maintain high rates of vaccination to hold their elimination status.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-vaccination-concept-immunity-health-covid19-2011400480">Shutterstock</a></span>
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<p>However, even where herd immunity is not achieved, high vaccine coverage tends to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596463/pdf/yjbm00110-0184.pdf">increase</a> the average age that unvaccinated children get infected. This is important, as the chance of a baby being exposed to measles virus before they have an opportunity to be vaccinated is reduced. </p>
<h2>5. COVID led to a resurgence of infection in many countries</h2>
<p>The COVID pandemic has disrupted many health services, including immunisation programs. This has disproportionately affected countries where systems were under strain prior to the pandemic. One <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9403570/">systematic review</a> identified several countries where the number of vaccines given fell by more than 50%. </p>
<p>Before the COVID pandemic, global coverage of measles-containing vaccines was increasing. The <a href="https://www.who.int/news-room/fact-sheets/detail/measles">proportion</a> of children who received one dose of measles vaccine by their first birthday went from 72% in 2000 to 86% in 2018. </p>
<p>While these previous gains in coverage have provided some ongoing protection, as the number of unvaccinated younger children accumulate globally, the risk of measles outbreaks increases. </p>
<p>Many countries are now <a href="https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html">reporting</a> outbreaks, including India, Yemen, Somalia, Ethiopia, Indonesia, Zimbabwe and Pakistan. </p>
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Read more:
<a href="https://theconversation.com/measles-global-increase-in-cases-likely-driven-by-covid-pandemic-182250">Measles: global increase in cases likely driven by COVID pandemic</a>
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<p>In theory, measles could be a candidate for eradication, like was achieved for <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-smallpox-vaccination#:%7E:text=Thanks%20to%20the%20combined%20efforts,1975%20and%20Africa%20in%201977.">smallpox</a> in the 1970s. </p>
<p>In addition to the benefits of eliminating deaths from measles, there is a <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30052-9/fulltext">compelling</a> economic argument to eradicate measles, as vaccination would no longer be required. However, this goal seems to be slipping out of reach, and the longer we leave it the harder it will be.</p>
<p><em>Rob Hall, former senior lecturer of public health at Monash University, co-authored this article. Rob previously received research funding from the World Health Organization. He was previously a member of the Technical Advisory Group on Immunization and Vaccine-Preventable Diseases for the Western Pacific Region of the World Health Organization.</em></p><img src="https://counter.theconversation.com/content/202945/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Gibney receives funding from the Medical Research Future Foundation and the National Health and Medical Research Council. She is a member of the Australian Technical Advisory Group on Immunisation.</span></em></p><p class="fine-print"><em><span>Allen Cheng receives funding from the Australian Department of Health and the National Health and Medical Research Council. He is a member of the Australian Technical Advisory Group on Immunisation and the Communicable Diseases Network of Australia, advising governments on communicable diseases control </span></em></p>Measles is an extremely contagious disease but, thanks to immunisation, is now rare in Australia.Katherine Gibney, Senior research fellow, The Peter Doherty Institute for Infection and ImmunityAllen Cheng, Professor in Infectious Diseases Epidemiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995952023-03-08T00:19:08Z2023-03-08T00:19:08ZMy kids are behind with their vaccines. How do they catch up?<figure><img src="https://images.theconversation.com/files/511564/original/file-20230222-20-7ndkjm.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C1000%2C657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/father-baby-girl-home-sleeping-1069794509">Shutterstock</a></span></figcaption></figure><p>The vast majority of Australian children are up-to-date with their vaccines. But vaccination rates have <a href="https://ncirs.org.au/sites/default/files/2022-12/Coverage%20report%202021%20SUMMARY%20FINAL.pdf">dipped slightly</a> over the past few years.</p>
<p>Fewer health checks, reduced access to routine health care during lockdowns, and fear of COVID have been the <a href="https://www.tandfonline.com/doi/full/10.1080/07853890.2021.2009128">main reasons</a>.</p>
<p>If that’s been the situation for your family, you can still catch up. Here’s how to check which vaccines are due for your children and how to organise appointments.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needles-are-nothing-to-fear-5-steps-to-make-vaccinations-easier-on-your-kids-153639">Needles are nothing to fear: 5 steps to make vaccinations easier on your kids</a>
</strong>
</em>
</p>
<hr>
<h2>Which shots are due?</h2>
<p>If you are unsure which vaccines are given at different ages:</p>
<ul>
<li><p><strong>look up the vaccine schedule</strong>, officially called the National Immunisation Program Schedule. <a href="https://www.health.gov.au/resources/publications/national-immunisation-program-schedule?language=en">This lists</a> the recommended free vaccines at various ages</p></li>
<li><p><strong>download a vaccine scheduling app</strong>. Some states <a href="https://www.health.nsw.gov.au/immunisation/app/Pages/default.aspx">have an app</a> you can download to create a personal vaccine schedule for your children, with reminders of what’s due and when</p></li>
<li><p><strong>chat to your GP</strong>. The next time you see a GP (for any reason), you can ask about vaccines and which ones are due.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-up-to-date-with-your-vaccinations-116510">Health Check: are you up to date with your vaccinations?</a>
</strong>
</em>
</p>
<hr>
<h2>I think we’re behind. How do I check?</h2>
<p>If you think your child has missed a shot but want to check, obtain your child’s <a href="https://www.servicesaustralia.gov.au/how-to-get-immunisation-history-statement?context=22436">immunisation history statement</a> using:</p>
<ul>
<li><p>your Medicare online account through myGov or</p></li>
<li><p>the Medicare app.</p></li>
</ul>
<p>You can also call the <a href="https://www.health.gov.au/contacts/australian-immunisation-register-contact">Australian Immunisation Register</a> (1800 653 809) and ask for your child’s immunisation history statement to be sent to you. This can take up to 14 days to arrive in the post. </p>
<p>If your child is over the age of 14, they can get their immunisation history statements themselves.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Teenager sitting in front of laptop" src="https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511607/original/file-20230222-24-mgzkrt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some teenagers can access their own immunisation records.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-girls-sitting-stressed-studying-online-2007572123">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you’re not eligible for Medicare, you can still get your immunisation history statement online <a href="https://www.servicesaustralia.gov.au/how-to-get-immunisation-history-statement?context=22436#a2">through myGov</a>. </p>
<p>In very rare cases, a vaccine may have been given but not recorded on the Australian Immunisation Register. </p>
<p>If you think this may be the case, check your child’s baby health book, as information may have been recorded there. You may also need to check with the GP who gave the vaccine. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/getting-vaccinated-at-the-pharmacy-make-sure-its-recorded-properly-140070">Getting vaccinated at the pharmacy? Make sure it's recorded properly</a>
</strong>
</em>
</p>
<hr>
<h2>OK, we are behind. What now?</h2>
<p>If there are no written records available of past vaccination, your child will be offered catch-up vaccines appropriate for their age.</p>
<p>But children who missed their recommended vaccines in childhood can also still receive them free <a href="https://www.health.gov.au/topics/immunisation/immunisation-information-for-health-professionals/catch-up-immunisations#who-can-get-free-catchup-immunisations">before they turn 20</a>. </p>
<p>Depending on the child’s age, you can go to your local doctor, pharmacy, hospital immunisation clinic, local council or see a community health nurse. </p>
<p>Find your local health service <a href="https://www.healthdirect.gov.au/australian-health-services">using this search engine</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-combination-vaccines-dont-overwhelm-kids-immune-systems-82377">No, combination vaccines don't overwhelm kids' immune systems</a>
</strong>
</em>
</p>
<hr>
<h2>I may need an interpreter</h2>
<p>Catch-up vaccinations are free. But we understand that families who speak a language other than English can face challenges navigating the health system, including <a href="https://www.publish.csiro.au/PY/PY10065">accessing vaccines</a>. </p>
<p>If this applies to your family, or someone you know, you or they can use an interpreter to talk to the GP about catch-up vaccinations. </p>
<p>This is a <a href="https://www.tisnational.gov.au/en/Non-English-speakers/Frequently-Asked-Questions">free phone service</a>, covering more than 150 different languages. Call 131 450.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nearly-1-in-4-of-us-arent-native-english-speakers-in-a-health-care-setting-interpreters-are-essential-115125">Nearly 1 in 4 of us aren't native English speakers. In a health-care setting, interpreters are essential</a>
</strong>
</em>
</p>
<hr>
<h2>I have a large family. Any tips?</h2>
<p>If you have multiple children, the GP or practice nurse will tell you how many appointments you will need to ensure your children are up-to-date with their vaccines.</p>
<p>Here are some tips to help things run smoothly:</p>
<ul>
<li><p><strong>bring an extra adult</strong> (if possible) to sit outside the clinic with children not being immunised. This reduces the risk of distractions in the clinic</p></li>
<li><p><strong>try to ring ahead</strong> to let the GP surgery know they need catch-up vaccines. This allows the team time to work out a catch-up schedule</p></li>
<li><p>if you have records of vaccines given overseas speak to the surgery about <strong>dropping records in before</strong> the appointment. Again, this will allow the nurse to work out the catch-up schedule before you arrive</p></li>
<li><p>in some situations, you may be able to have <strong>slightly longer gaps between vaccines</strong> to reduce the number of visits needed. This will depend on the situation. The GP or practice nurse will be able to determine if this is possible based on what vaccines are needed.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Family with 4 children sitting on sofa" src="https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/511611/original/file-20230222-20-ecgesk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Large family? Ring ahead.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-photo-arab-muslim-family-sitting-2075149054">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How about flu or COVID shots?</h2>
<p>Beyond the vaccines on the National Immunisation Program, some children are also recommended a flu and COVID shot, depending on their age.</p>
<p>Children aged 6 months and older are also recommended to receive a yearly influenza vaccine (free for kids <a href="https://www.health.gov.au/campaigns/influenza-vaccination-for-children-under-5">6 months to under 5 years</a>). If they are <a href="https://www.health.nsw.gov.au/news/Pages/20200316_01.aspx">older than 10 years</a>, they can get this flu vaccine at either a GP clinic or pharmacy. </p>
<p>COVID vaccination is currently recommended for children aged 6 months up to 5 years only if children have <a href="https://www.health.gov.au/news/atagi-recommendations-on-covid-19-vaccine-use-in-children-aged-6-months-to">special medical or other needs</a>, including a very weak immune system, disability, or complex or multiple health conditions. </p>
<p>Most children aged 5-17 years are recommended to have <a href="https://www.health.gov.au/our-work/covid-19-vaccines/who-can-get-vaccinated/children#who-is-eligible">two doses</a> of a COVID vaccine. </p>
<p>If your child has not received a COVID vaccine and you want some help deciding, there’s <a href="https://www.ncirs.org.au/covid-19-decision-aids">online help</a> depending on the age of your child.</p>
<hr>
<p><em>For more information about vaccines and catch-up vaccination, call the <a href="https://www.health.gov.au/contacts/national-immunisation-information-line">National Immunisation Information Line</a> on 1800 671 811. For specific medical advice, see your health-care provider.</em></p><img src="https://counter.theconversation.com/content/199595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on research studies funded by NHMRC and has previously received funding for investigator driven research from NHMRC and NSW Ministry of Health, as well as from Sanofi Pasteur, Moderna and Seqirus.</span></em></p><p class="fine-print"><em><span>Abela Mahimbo has previously received funding from GSK for investigator driven research.</span></em></p><p class="fine-print"><em><span>Jane E Frawley does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Catch-up vaccinations are free. These hints and tips will help you get started.Holly Seale, Associate professor, UNSW SydneyAbela Mahimbo, Lecturer in Public Health, University of Technology SydneyJane E Frawley, NHMRC Research Fellow, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1963932022-12-14T06:15:17Z2022-12-14T06:15:17ZWhat is meningococcal disease? What symptoms should I look out for? And how can I prevent it?<figure><img src="https://images.theconversation.com/files/500634/original/file-20221213-1960-92q4xe.jpg?ixlib=rb-1.1.0&rect=301%2C684%2C6408%2C3782&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/unhappy-young-adolescent-12s-kid-girl-1971214970">Shutterstock</a></span></figcaption></figure><p>Parents and doctors alike fear meningococcal infection, which has been <a href="https://www.abc.net.au/news/2022-12-06/nsw-meningococcal-disease-kills-young-woman-third-death-this-yea/101736686">in the news</a> again. Doctors never want to miss a diagnosis, as early treatment with antibiotics may be life-saving. Parents fear the disease because <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">up to 10%</a> of children who become infected die from the disease and its complications.</p>
<p>Another <a href="https://doi.org/10.1097/INF.0000000000000043">40% of children</a> will have ongoing disability from one or more complications. These include deafness, blindness, skin scarring, or surgical amputation of limbs that may be required to save the child’s life in some situations. </p>
<p>In other cases, children will initially be acutely unwell but then recover within a few days of starting antibiotics. Many, though, will have ongoing fatigue, forgetfulness and difficulty concentrating. For most, it’s a life-changing illness.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-expect-more-colds-and-flu-as-covid-restrictions-lift-5-germs-to-look-out-for-170263">We can expect more colds and flu as COVID restrictions lift. 5 germs to look out for</a>
</strong>
</em>
</p>
<hr>
<h2>What causes it and who most at risk?</h2>
<p>Meningococcal disease is caused by the meningococcus bacteria, also known as <em>Neisseria meningitidis</em>. The bacterial infection causes meningitis (infection of the lining around the brain) and/or sepsis (blood poisoning).</p>
<p>The <a href="https://doi.org/10.33321/cdi.2022.46.46">highest risk</a> of disease is in children under four years, and adolescents and young adults aged 15-24. </p>
<figure class="align-center ">
<img alt="Teens in a school corridor" src="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500871/original/file-20221213-20493-98k2cy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Australian adolescents are now offered a vaccine to protect against four types of the disease.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/students-in-the-school-hallway-8419516/">Rodnae Productions/Pexels</a></span>
</figcaption>
</figure>
<p>Aboriginal infants and young people are at <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4001e.htm">higher risk</a> of meningococcal disease than non-Indigenous children.</p>
<h2>What are the symptoms?</h2>
<p>Young infants who become unwell with this infection usually develop symptoms such as a fever, irritability, vomiting and poor feeding.</p>
<p>Young people who develop the infection may complain of a headache, neck stiffness, fever, vomiting or feeling generally tired and unwell with “flu-like” symptoms.</p>
<p>Unfortunately, these symptoms are fairly general and occur with many other infections, making this disease hard to diagnose. This may result in delayed diagnosis and treatment.</p>
<p>A more unusual symptom children or young people may experience is feeling they have cold hands and feet. </p>
<p>The classic <a href="https://www.doctorsofsouthmelbourne.com.au/meningococcal-rash/#:%7E:text=A%20meningococcal%20rash%20is%20caused,bleeding%20occurs%20(i.e.%20haemorrhages).">dark red-purple rash</a> associated with the infection is often a later sign of the disease. Ideally, antibiotic treatment should be started before the rash appears, to combat the infection as early as possible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-meningococcal-meningitis-and-what-are-the-signs-64170">Explainer: what's meningococcal meningitis and what are the signs?</a>
</strong>
</em>
</p>
<hr>
<h2>How does it spread?</h2>
<p>The meningococcus bacteria usually enter the bloodstream through the throat.</p>
<p>The bacteria live quite happily <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/meningococcal-disease">in the throat</a> of around 10% of the population, without causing any symptoms. Young people in particular have a higher chance of having the bacteria in their throat and passing it to each other through air droplets from coughing or through kissing.</p>
<figure class="align-right ">
<img alt="Teens legs in photo booth" src="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500644/original/file-20221213-1960-zinfze.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Young people pass it to each other through coughing or kissing.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/person-in-blue-denim-jeans-and-white-sneakers-4858872/">Cottonbro studio/Pexels</a></span>
</figcaption>
</figure>
<p><em>N. meningitidis</em> is often referred to as an “accidental pathogen” because it prefers to live at the back of the throat, with no intent to cause meningitis or sepsis. It can invade the lining of the throat during a throat infection, which disrupts the barrier in the throat and allows the bacteria to enter the bloodstream.</p>
<p>It may also be more likely to invade the bloodstream and multiply if the person has a problem with their immune system.</p>
<p>Once in the bloodstream, the bacteria multiply very quickly and the body reacts with a very robust immune response, which unfortunately can contribute to some of the complications.</p>
<p>The bacteria primarily damage the walls of the blood vessels in the body and the blood vessels become leaky. This results in bleeding into the skin, which causes a rash, and lack of blood supply to the limbs, resulting in breakdown of the tissues in the limb. Sometimes this requires surgical amputation of the limb or multiple limbs to save the child’s life.</p>
<h2>What are the different types of meningococcal disease?</h2>
<p>There are <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal-disease">13 different types</a> of meningococcus, however almost all disease in humans is caused by six groups: A, B, C, W, Y and X.</p>
<p>Group W is <a href="https://doi.org/10.1016/j.vaccine.2019.04.020">associated with</a> a higher risk of dying from the infection (around 10-15%), whereas with group B there is a lower risk of dying (around 5-10%).</p>
<p>In Australia, group B causes the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/australian_meningococcal_surveillance_programme_annual_report_2021.pdf">highest number</a>, however there are significant differences between different states. Most cases in temperate climates occur in winter and early spring. Viral infections, in particular influenza, <a href="https://doi.org/10.1016/j.cmi.2020.01.004">increase the risk</a> of meningococcal infection. </p>
<h2>How can you protect against it?</h2>
<p>The best way to protect against meningococcal disease is through vaccination.</p>
<p>From 2003 to 2013 in Australia, there was a <a href="https://doi.org/10.5694/mja2.51463">decrease</a> in meningococcal disease cases, following the introduction of the free meningococcal C vaccine onto the National Immunisation Program for children aged 12 months.</p>
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<img alt="Baby's leg after a vaccination" src="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500635/original/file-20221213-1960-saad3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Babies are routinely vaccinated against four types.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bandaid-after-vaccination-needle-sore-261449495">Shutterstock</a></span>
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<p>A free, combined meningococcal ACWY vaccine is now available on the National Immunisation Program for all children at 12 months of age (this replaced the meningococcal C vaccine) and for adolescents aged 14-16 years through a school-based program from April 2019. </p>
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Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
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<p>A meningococcal B vaccine has been more difficult to produce and requires a different vaccine manufacturing approach. Two meningococcal B vaccines are available and licensed in Australia.</p>
<p>One of these meningococcal B vaccines is now provided on the National Immunisation Program for Aboriginal and Torres Strait Islander infants due to their higher risk of meningococcal B than non-Indigenous infants.</p>
<p>In South Australia, where historically most cases have been caused by group B, the meningococcal B vaccine is <a href="https://doi.org/10.1016/S1473-3099(21)00754-4">provided free</a> through a state-funded program for infants from six weeks of age and for Year 10 students through the school immunisation program.</p>
<p>This followed a large study I led in South Australia of 35,000 senior school students across SA. It <a href="https://doi.org/10.1056/nejmoa1900236">showed</a> the meningococcal B vaccine was highly effective in preventing meningococcal B disease but not in reducing the number of young people carrying the disease-causing bacteria in their throat. So the vaccine needs to be given to age groups at highest risk of disease rather than expecting a herd immunity effect by reducing the number of young people carrying the disease causing bacteria in their throats.</p>
<p>In other states, the meningococcal B vaccine <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/meningococcal">can be purchased</a> for around A$120-$140 per dose and is provided through a script from a GP.</p><img src="https://counter.theconversation.com/content/196393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Marshall receives funding from the National Health and Medical Research Council. Her institution receives funding from GSK, Sanofi-Pasteur and Pfizer for clinical vaccine trials of which Helen Marshall is an investigator. The herd immunity study in South Australia was sponsored by The University of Adelaide and funded by GSK.</span></em></p>Early treatment with antibiotics can be life-saving.Professor Helen Marshall, Professor in Vaccinology, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1899342022-09-21T12:35:27Z2022-09-21T12:35:27ZPolio vaccination rates in some areas of the US hover dangerously close to the threshold required for herd immunity – here’s why that matters<figure><img src="https://images.theconversation.com/files/484423/original/file-20220913-3906-gl2l50.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C4102%2C2990&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In 1956, during the height of the polio epidemic in the U.S., health officials in Chicago offer polio shots at a public school.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/free-chicago-illinois-mrs-rose-stamler-uses-microphone-to-news-photo/514975204?adppopup=true">Bettmann via Getty Images</a></span></figcaption></figure><p>Given recent headlines, you may be wondering why polio is even an issue in 2022. For more than 60 years, vaccines against the poliovirus <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/polio.html#">have protected virtually everyone</a> in the United States from the disease. Due to an enormously successful polio vaccination campaign beginning in the 1950s when the <a href="https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-polio-vaccination">first polio vaccines became available</a>, by 1979 polio was <a href="https://www.cdc.gov/polio/why-are-we-involved/index.htm#">considered eliminated in the U.S.</a> </p>
<p>Unfortunately, even today, there are communities in the U.S. that have lower-than-necessary polio vaccination rates. Because many people have not been vaccinated, there is now a real <a href="https://theconversation.com/fears-of-a-polio-resurgence-in-the-us-have-health-officials-on-high-alert-a-virologist-explains-the-history-of-this-dreaded-disease-189107">possibility of a resurgence of polio in the U.S</a>. </p>
<p>As a <a href="https://scholar.google.com/citations?user=G2EkJJ0AAAAJ&hl=en">clinical professor of pharmacy</a>, I train future pharmacists about how vaccines work, their importance and how they prevent diseases. </p>
<p>Public health experts’ longstanding concerns over falling vaccination rates rose to the surface when, in July 2022, a man from Rockland County, New York, <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm">was diagnosed with polio</a>, the first such diagnosis in the U.S. <a href="https://www.nytimes.com/2022/07/21/nyregion/polio-case-new-york.html">in nearly a decade</a>. The patient – who developed the severe, paralytic form of the disease – had been exposed to an <a href="https://theconversation.com/polio-in-new-york-an-infectious-disease-doctor-explains-this-exceedingly-rare-occurrence-187518">altered live vaccine strain from overseas</a>.</p>
<p>Then on Sept. 9, 2022, New York declared a <a href="https://www.governor.ny.gov/executive-order/no-21-declaring-disaster-state-new-york">state of emergency</a> due to ongoing poliovirus transmission. As of that date, using wastewater surveillance, officials had identified <a href="https://health.ny.gov/diseases/communicable/polio/wastewater.htm">57 samples of poliovirus in wastewater</a> from four New York counties. More than half of those were detected in the same county where the adult patient is from, just outside New York City.</p>
<p>As a result of the continued poliovirus detection in wastewater, the Centers for Disease Control and Prevention declared that the U.S. now meets the World Health Organization’s criteria for “a <a href="https://www.cdc.gov/media/releases/2022/s0913-polio.html">country with circulating vaccine-derived poliovirus</a>.”</p>
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<figcaption><span class="caption">The U.S. has recorded its first case of polio in the U.S. in nearly a decade.</span></figcaption>
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<h2>Two main poliovirus vaccine types</h2>
<p>There are two key types of polio vaccine <a href="https://www.cdc.gov/cpr/polioviruscontainment/diseaseandvirus.htm">in use around the world today</a>. The <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/ipv/">inactivated poliovirus vaccine</a> is given as a shot, and the <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/">oral attenuated (or weakened) poliovirus vaccine</a> is administered as oral drops, sometimes on a sugar cube.</p>
<p>Since 2000, the U.S. has exclusively used the inactivated poliovirus vaccine, which cannot cause disease since it does not contain live virus. But in countries where the poliovirus continues to circulate, <a href="https://polioeradication.org/where-we-work/polio-endemic-countries/">such as Pakistan and Afghanistan</a>, the <a href="https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/">oral attenuated poliovirus vaccine</a> is still used. </p>
<p>In <a href="https://polioeradication.org/wp-content/uploads/2016/09/Position-statement_OPVsafety.pdf">extremely rare cases</a>, the weakened live vaccine used in other countries can mutate back into its virulent form and lead to paralysis. This is how the adult in New York is believed to have come into contact with the virus.</p>
<h2>How ‘herd immunity’ for polio is determined</h2>
<p>The degree to which a community is protected from a pathogen like poliovirus comes down to <a href="https://doi.org/10.1001/jama.2020.20895">herd immunity</a>. When a community – the so-called herd – reaches a threshold of immunity, it can prevent the transmission of a pathogen from person to person, thereby quelling the pathogen. </p>
<p>The herd immunity threshold for a given disease is calculated based upon the expected number of individuals who an infected person would spread it to if they were susceptible. The higher the number of individuals who would become infected, the higher the percentage of the community or population that <a href="https://doi.org/10.1093/cid/cir007">needs to be vaccinated</a> to avoid continued spread of the disease. </p>
<p>For poliovirus, researchers estimate that between five and seven individuals would be infected for each case <a href="https://doi.org/10.4161/hv.18444">if those people were susceptible</a>. Based upon these calculations, experts determined that at least 80% of a community or population should be vaccinated against poliovirus to prevent its spread. </p>
<h2>Falling vaccination rates</h2>
<p>Throughout the U.S., vaccination rates for polio vary significantly. </p>
<p>The CDC recommends that infants and young children receive a <a href="https://www.cdc.gov/vaccines/vpd/polio/public/index.html#">four-dose schedule of the inactivated poliovirus vaccine</a> at 2 months, 4 months, 6 to 18 months and 4 to 6 years. For those who begin vaccination later – as older children, teens or adults – three doses is considered to be complete vaccination. This is because three doses of inactivated poliovirus vaccination have been shown to provide <a href="https://www.cdc.gov/vaccines/vpd/polio/hcp/effectiveness-duration-protection.html#">between 99% and 100% protection against severe disease</a>. </p>
<p>Although all U.S. states are currently above the 80% herd immunity threshold for poliovirus, there are areas within the country that include many pockets of unvaccinated or undervaccinated individuals – those who have not received a total of three lifetime doses of the inactivated vaccine.</p>
<p>New York state, for example, holds one of the highest kindergarten polio vaccination rates in the country, <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html">with 97.9%</a> of kindergartners vaccinated in the 2020-2021 school year. But current estimates by the New York State Department of Public Health suggest that only <a href="https://health.ny.gov/diseases/communicable/polio/county_vaccination_rates.htm">79% of 2-year-olds in that state</a> have received three doses of the polio vaccine. </p>
<p>Further, in certain pockets and counties of New York, such as Rockland, Orange and Sullivan, three-dose vaccination rates may be far lower based on the 2-year-old age group, which is the only data that is available by county: Rockland 60%, Orange 59% and Sullivan 62%. In fact, 46% of counties in New York are below the three-dose poliovirus vaccination <a href="https://health.ny.gov/diseases/communicable/polio/county_vaccination_rates.htm">herd immunity threshold for 2-years-olds</a>. </p>
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<figcaption><span class="caption">Most people today don’t remember the polio outbreak that terrorized Americans during the first half of the 20th century.</span></figcaption>
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<h2>Vaccine recommendations</h2>
<p>When children fall more than one month behind on recommended polio vaccination, doctors recommend routine catch-up throughout adolescence. </p>
<p>Because most adults in the U.S. today were vaccinated as children and the <a href="https://www.cdc.gov/polio/why-are-we-involved/index.htm#">U.S. had eliminated polio as of 1979</a>, there was little reason for health experts to believe an adult would come into contact with poliovirus in the U.S. For that reason, catch-up vaccination for adults has not been included on the routine adult vaccination schedule. </p>
<p>But in August 2022, the CDC updated its guidance. In light of the fact that there are communities where poliovirus vaccination rates have fallen below the 80% threshold needed for herd immunity, coupled with the ongoing circulation of poliovirus in New York, the CDC now recommends that all unvaccinated or undervaccinated adults in these communities <a href="https://www.cdc.gov/vaccines/vpd/polio/public/index.html#">receive a poliovirus vaccination</a>. </p>
<p>Additionally, the CDC suggests that some fully vaccinated adults who are at increased risk of exposure may benefit from a single lifetime poliovirus booster dose. This includes health care providers who care for those with poliovirus, or people traveling to areas where poliovirus has not been eliminated.</p>
<p>If you are unsure if you need vaccination or what steps you should take, talk to your pharmacist or primary care physician.</p><img src="https://counter.theconversation.com/content/189934/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Girotto consults for Lexi-Comp. She has received grant funds from Pfizer to support independent quality improvement specific to outpatient antimicrobial stewardship. </span></em></p>With poliovirus circulating in New York, health authorities worry that pockets of the county with low polio vaccination rates could give the virus a foothold.Jennifer Girotto, Clinical Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863482022-07-05T04:23:39Z2022-07-05T04:23:39ZDiphtheria is back in Australia, here’s why – and how vaccines can prevent its spread<figure><img src="https://images.theconversation.com/files/472429/original/file-20220705-22-eqv0xf.jpg?ixlib=rb-1.1.0&rect=221%2C13%2C8453%2C4864&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-home-quarantine-looking-out-window-1682659129">Shutterstock</a></span></figcaption></figure><p>An unvaccinated toddler from the far north coast of New South Wales is in <a href="https://www.abc.net.au/news/2022-07-03/diphtheria-cases-nsw-australia-unvaccinated-toddler-child/101204572">intensive care</a> after catching respiratory diphtheria (diphtheria of the throat). A six-year-old close family contact is also infected. </p>
<p>These are the first cases of respiratory diphtheria in children seen in Australia <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2406-cdi2406f.htm#:%7E:text=Diphtheria%20in%20Australia%20(1991%2D1998)&text=Since%20the%20establishment%20of%20the,female%20ratio%201.1%3A1">since 1992</a>. </p>
<h2>What is diphtheria and how is it spread?</h2>
<p>Diphtheria is a potentially deadly infection caused by toxins produced by certain strains of <em>Corynebacterium</em> bacteria. </p>
<p>Respiratory diphtheria causes <a href="https://www.cdc.gov/diphtheria/about/symptoms.html">severe swelling</a> of the throat and neck, which can block the airway and cause breathing problems.</p>
<p>The bacterial toxin can also damage the heart, kidneys, brain and nerves. The bacteria can also cause <a href="https://www.nejm.org/doi/full/10.1056/NEJMicm1701825">skin sores</a>, which are not as serious as respiratory diphtheria.</p>
<p>The diphtheria bacteria spread through respiratory droplets, for example, from coughing or sneezing. They can also spread through touching skin sores.</p>
<h2>How is it prevented?</h2>
<p>In Australia, vaccines containing diphtheria toxoid (an inactivated form of the toxin) are provided free on the <a href="https://www.health.gov.au/health-topics/immunisation/when-to-get-vaccinated/national-immunisation-program-schedule">National Immunisation Program</a> (NIP), with three doses initially at two, four and six months of age. </p>
<p>These are six-in-one combination vaccines which also provide protection against pertussis (whooping cough), tetanus, polio, hepatitis B and <a href="https://www.health.gov.au/health-topics/hib-haemophilus-influenzae-type-b">Haemophilus influenzae type b</a> (Hib) infection, which causes meningitis (inflammation of the lining of the brain) and septicaemia (blood poisoning). </p>
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Read more:
<a href="https://theconversation.com/have-you-had-your-diphtheria-vaccines-heres-why-it-matters-98174">Have you had your diphtheria vaccines? Here's why it matters</a>
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<p>Booster doses for diphtheria, tetanus and pertussis are provided under the National Immunisation Program at 18 months, four years and at around 12 years of age (through school-based immunisation programs). It’s important to get all these booster doses as immunity tends to decrease over time. </p>
<p>Adult boosters are also recommended but not funded by the National Immunisation Program. </p>
<h2>How is it treated?</h2>
<p>Antibiotics are given to people with diphtheria but may not have much impact on the disease once established. </p>
<p>Specialised treatment with diphtheria antitoxin (DAT) is often required to counteract the effects of the toxin. DAT needs to be given early in the illness (within 48 hours).</p>
<p>However there are <a href="https://www.ijidonline.com/article/S1201-9712(18)34410-2/fulltext">global shortages</a> of DAT due to decreased production over recent decades.</p>
<h2>It was once a big killer</h2>
<p>Diphtheria was once among the top-ten causes of <a href="https://historyofvaccines.org/history/diphtheria/overview">child death</a>. There were <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-pubs-cdi-2000-cdi2406-cdi2406f.htm">more than 4,000 deaths</a> from diphtheria in Australia between 1926 and 1935. </p>
<p>Diphtheria cases fell dramatically following the introduction of vaccines in the 1940s.</p>
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<img alt="Child touches their sore neck" src="https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472426/original/file-20220705-18-72tsd3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Diphtheria respiratory infection causes swelling of the throat and neck.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-have-sore-throat-sick-diphtheria-796122484">Shutterstock</a></span>
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<p>Diphtheria is now rare. Prior to the two recent cases in NSW, there had been no cases of respiratory diphtheria in children in Australia since 1992. There were <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/2A15CD097063EF40CA2587CE008354F1/$File/australian_vaccine_preventable_disease_epidemiological_review_series_diphtheria_1999_2019.pdf">38 cases</a> of skin diphtheria reported between 2011 and 2019, affecting both children and adults. Over the same period, there were seven cases of respiratory diphtheria, all of which were in adults. Two unvaccinated adults died from respiratory diphtheria in <a href="https://www.smh.com.au/national/diphtheria-death-in-brisbane-shocks-ama-20110503-1e64k.html">2011</a> and <a href="https://www.sbs.com.au/news/article/qld-diphtheria-patient-dies-in-hospital/f20q9r1jf">2018</a>. </p>
<h2>Why are we seeing diphtheria now? What role does travel play?</h2>
<p>Anyone unvaccinated against diphtheria is at risk of disease. Diphtheria vaccination rates in Australian children have been high at over 90% since 2000 and are <a href="https://ncirs.org.au/sites/default/files/2021-11/NCIRS%20Annual%20Immunisation%20Coverage%20report%202020.pdf">currently around 95%</a>. </p>
<p>People born before 2000 are more likely to be under-vaccinated, as vaccination rates were lower when they were growing up.</p>
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<p>There is also a particular risk from travel to countries where diphtheria remains more common, including Southeast Asia, Papua New Guinea, states of the former Soviet Union and eastern European countries. </p>
<p>Diphtheria vaccination prevents disease but doesn’t fully prevent people carrying the bacteria in the back of their throat without symptoms. It is possible for fully vaccinated people to spread the bacteria to unvaccinated contacts, including when they return from overseas travel.</p>
<p>Increases in diphtheria are a now a real risk as vaccination rates have <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00512-X/fulltext">declined globally</a>. </p>
<p>We are also at increased risk of other diseases, such as measles, now international travel has restarted. Measles cases have surged globally in part due to <a href="https://theconversation.com/measles-global-increase-in-cases-likely-driven-by-covid-pandemic-182250">COVID pandemic-related disruption</a> to routine immunisation programs in many parts of the world. UNICEF and the World Health Organization <a href="https://www.who.int/news/item/27-04-2022-unicef-and-who-warn-of--perfect-storm--of-conditions-for-measles-outbreaks--affecting-children">have warned</a> of a perfect storm of conditions for measles outbreaks.</p>
<p>A <a href="https://www.health.vic.gov.au/health-alerts/new-measles-case-in-victoria-3">recent measles case</a> in a traveller was the first in Australia since March 2020.</p>
<h2>What can you do?</h2>
<p>Ensuring people of all ages are up-to-date with their vaccines is key.</p>
<p>Parents should ensure children get all their routine vaccinations on time – this will provide strong protection against serious diseases like diphtheria and measles.</p>
<figure class="align-center ">
<img alt="Nurse vaccinates toddler" src="https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472427/original/file-20220705-16-30vr42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines provide strong protection against diphtheria.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-pediatric-holds-injection-vaccination-child-645639754">Shutterstock</a></span>
</figcaption>
</figure>
<p>People of all ages should also be up-to-date for vaccines, particularly if travelling overseas. Beyond childhood, the <a href="https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/diphtheria">Australian Immunisation Handbook</a> recommends a diphtheria vaccine booster dose for:</p>
<ul>
<li><p>adults at 50 and 65 years of age</p></li>
<li><p>people of any age who are more than ten years since their last dose and travelling to a country where health services are difficult to access. </p></li>
<li><p>people travelling to high-risk countries if it has been more than five years since the last dose.</p></li>
</ul>
<p>Ensuring support to low- and middle-income countries, particularly those in our region, to strengthen their immunisation programs, including via catch-up campaigns for measles and other vaccines, is also key to protecting us all.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diphtheria-could-become-a-problem-again-thanks-to-new-variants-and-antimicrobial-resistance-156973">Diphtheria could become a problem again thanks to new variants and antimicrobial resistance</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/186348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristine Macartney is the Director of the National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS receives funding from the Australian Government Departments of Health and Foreign Affairs and Trade, the NSW Health Department and other state/territory health departments . We also receive funding from the NHMRC, MRFF, the World Health Organisation, Gavi the Vaccine Alliance and other non-pharmaceutical sources.</span></em></p><p class="fine-print"><em><span>Frank Beard and Noni Winkler do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Australia currently has its first cases of childhood respiratory diphtheria since 1992. So why are we seeing diphtheria now? And what role does travel play in its spread?Frank Beard, Associate Professor, University of SydneyKristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of SydneyNoni Winkler, Senior Research Officer at the National Centre for Immunisation Research and Surveillance, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1726252021-11-30T04:42:27Z2021-11-30T04:42:27ZWe shouldn’t lift all COVID public health measures until kids are vaccinated. Here’s why<figure><img src="https://images.theconversation.com/files/434355/original/file-20211129-21-100ukyv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-doctor-putting-medical-plaster-girl-1921268393">Shutterstock</a></span></figcaption></figure><p>Australia’s vaccination rollout got off to a slow start, but we’ve since become one of the most vaccinated countries in the world. More than <a href="https://www.health.gov.au/sites/default/files/documents/2021/11/covid-19-vaccine-rollout-update-28-november-2021.pdf">86% of Australians aged over 16</a> have received two doses, and 75% of adolescents have had their first dose. This is a fantastic achievement, but younger children are missing from this picture.</p>
<p>The majority of parents <a href="https://www.theage.com.au/politics/federal/two-thirds-of-australians-want-all-kids-aged-5-11-to-have-the-jab-but-parents-more-cautious-20211125-p59c51.html">want to vaccinate their children</a>. But kids aren’t yet eligible for vaccination in Australia, despite vaccines being <a href="https://www.cbc.ca/news/canada/ottawa/what-to-know-about-childern-vaccine-1.6262471">approved for children</a> overseas.</p>
<p>It’s therefore not surprising schools have become a major driver of community transmission, with unvaccinated children making up <a href="https://www.smh.com.au/national/nsw/crunch-time-what-do-expect-from-sydney-s-delta-wave-over-summer-20211122-p59b4w.html">about one-third of recent cases</a> in New South Wales. </p>
<p>Despite this, some state governments plan to further dismantle public health measures keeping the virus in check. In NSW, this will include <a href="https://www.abc.net.au/news/2021-11-25/nsw-updates-roadmap-95-percent-double-dose-vaccination/100649860">scrapping mandatory mask rules</a>. </p>
<p>It’s not the right time to do this while our children remain unprotected. </p>
<p>Additionally, the emergence of the <a href="https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern">Omicron variant</a>, which might be more transmissible and reduce the effectiveness of our vaccines, shows Australia needs to take a much more <a href="https://ozsage.org/media_releases/reduce-the-risk-of-lockdowns-during-the-holiday-season/">cautious approach</a> to easing restrictions.</p>
<h2>COVID is not always a mild illness for kids</h2>
<p>Adults are much more likely to experience serious illness than children, but kids are still at risk.</p>
<p>During the first year of the pandemic, it’s estimated that approximately <a href="https://www.science.org/action/downloadSupplement?doi=10.1126%2Fscitranslmed.abg4262&file=abg4262_sm.pdf">one in every 400 children</a> in the United Kingdom who got infected became sick enough to need to go to hospital, and between <a href="https://www.nature.com/articles/s41591-021-01578-1">one in 20,000</a> and <a href="https://link.springer.com/article/10.1007/s10654-020-00698-1">one in 50,000</a> infections were fatal.</p>
<figure class="align-center ">
<img alt="Hospital emergency department entrance." src="https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434569/original/file-20211129-21-bbsu3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A small proportion of kids with COVID need to be treated in hospital.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/main-entrance-modern-hospital-building-signs-361382480">Shutterstock.</a></span>
</figcaption>
</figure>
<p>These figures represent the <em>infection hospitalisation rate</em> and the <em>infection fatality rate</em>, and they capture the full toll of the virus, because they are based on all infections, including the asymptomatic ones that don’t get detected.</p>
<p>However, these estimates pre-date the emergence of the Delta variant, which <a href="https://www1.racgp.org.au/newsgp/clinical/study-suggests-delta-more-than-doubles-death-risk">causes more severe illness</a>. Preliminary evidence from Canada suggests the Delta variant is <a href="https://www.medrxiv.org/content/10.1101/2021.09.25.21264097v1">2.5 times more likely</a> to lead to hospitalisation in children.</p>
<p>This year in Australia, <a href="https://doi.org/10.33321/cdi.2021.45.62">2% of detected cases</a> in children aged 5-11 years resulted in hospitalisation, although some of these were for social reasons. These include cases in which parents were hospitalised with COVID and were temporarily unable to care for their children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-we-cant-treat-covid-19-like-the-flu-we-have-to-consider-the-lasting-health-problems-it-causes-164072">No, we can’t treat COVID-19 like the flu. We have to consider the lasting health problems it causes</a>
</strong>
</em>
</p>
<hr>
<p>Kids can also be left with persistent symptoms (long COVID) after infection. It’s unclear how often this occurs, but in the UK, <a href="https://www.ons.gov.uk/releases/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk4november2021">an estimated 3,000 children</a> have been living with self-reported long COVID for at least one year.</p>
<h2>How many children are at risk in Australia?</h2>
<p>Because the virus that causes COVID is so contagious, almost everyone will get infected eventually if they aren’t vaccinated. </p>
<p>Even though only a small proportion of cases in children are severe, we can still expect a large number of children to get seriously unwell because there will be so many infections.</p>
<figure class="align-center ">
<img alt="Mother takes her sick child's temperature." src="https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=413&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=413&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=413&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=519&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=519&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434570/original/file-20211129-15-1koone6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=519&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More infections means more kids will become severely unwell.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-checking-temperature-sick-daughter-250485763">Shutterstock</a></span>
</figcaption>
</figure>
<p>There are 3.8 million children in Australia. If we didn’t offer them a chance to get vaccinated, based on the estimated severity of the original strain, we could eventually expect around 9,000 children to be hospitalised and 76 to 191 deaths. If we do these same calculations for the Delta variant, there could be approximately 22,000 hospitalisations in children.</p>
<p>The period over which this occurred would depend on the number of public health measures kept in place. COVID spread rapidly through schools in England after restrictions were lifted. By mid-October, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/22october2021">8% of high school students and 4% of younger children</a> were testing positive.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-cases-rise-when-schools-open-but-more-so-when-teachers-and-students-dont-wear-masks-169928">COVID-19 cases rise when schools open – but more so when teachers and students don't wear masks</a>
</strong>
</em>
</p>
<hr>
<p>This year in Australia, <a href="https://doi.org/10.33321/cdi.2021.45.62">13 children and 22 adolescents</a> have been admitted to an intensive care unit for COVID (and many more to a general hospital ward), and <a href="https://www.sbs.com.au/news/a-victorian-child-under-10-has-become-australia-s-youngest-person-to-die-with-covid-19/90af458d-1f32-45de-bdfb-9e9a6d750598">one child</a> and <a href="https://www.abc.net.au/news/2021-10-16/victoria-covid-cases-deaths-lockdown-saturday/100544548">one teenager</a> died.</p>
<p>It’s unclear how many children could develop long COVID, but England’s National Health Service has had to open <a href="https://www.england.nhs.uk/2021/06/nhs-sets-up-specialist-young-peoples-services-in-100-million-long-covid-care-expansion/">15 long COVID clinics for children</a>.</p>
<h2>How does COVID compare to other diseases?</h2>
<p>COVID is more risky for children than some other diseases that we already vaccinate against. </p>
<p>Today, children are routinely vaccinated against varicella (chickenpox) in Australia. Prior to the introduction of the vaccine, there were around <a href="https://www.ombo.nsw.gov.au/__data/assets/pdf_file/0019/39412/NCIRS-child-deaths-from-infectious-diseases-report-2016-NSW-Ombudsman-final-1.pdf">five to eight deaths per year</a> from this disease.</p>
<p>COVID also <a href="https://www.thelancet.com/article/S2213-2600(20)30527-0/fulltext">poses a bigger risk to children than influenza</a>. During the 2009 <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2010.01912.x">H1N1 (swine flu) influenza pandemic</a>, more than 1,000 children were hospitalised and 11 died.</p>
<p>It’s statistics like these that were behind the United States’ Centers for Disease Control and Prevention’s decision to <a href="https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2021-11-2-3/08-COVID-Oliver-508.pdf">recommend COVID vaccination for children</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434264/original/file-20211128-27-hxrrz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID is more dangerous for children than some diseases we already vaccinate against.</span>
<span class="attribution"><span class="source">CDC</span></span>
</figcaption>
</figure>
<h2>How can we keep children safe?</h2>
<p>Australia should follow the lead of countries that have already started to vaccinate children against COVID, such as the United States and Canada. However this is unlikely to happen <a href="https://www.smh.com.au/politics/federal/jabs-for-under-12s-won-t-start-until-january-covid-commander-says-20211112-p598do.html">until mid-to-late January next year</a>.</p>
<p>This delay means public health measures will be vital to keep COVID under control in the community. As the experience of England has shown, <a href="https://www.gov.uk/government/news/four-in-five-people-aged-16-and-over-vaccinated-with-both-doses">high adult vaccination levels</a> aren’t sufficient to protect children and prevent the virus from spreading in schools.</p>
<p>States that have planned to <a href="https://www.nsw.gov.au/covid-19/easing-covid-19-restrictions/opening-in-dec">further ease restrictions</a> should pause those plans until children have had the chance to be vaccinated.</p>
<p>We also need to do more to protect our schools. COVID is an <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51131">airborne disease</a>, meaning the virus drifts through the air like cigarette smoke. Masks and ventilation can help protect us, but ventilation involves much more than just opening a window.</p>
<figure class="align-center ">
<img alt="Children wearing masks in a classroom with their teacher." src="https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434568/original/file-20211129-59485-v3z6mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Masks and ventilation can help protect children now.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-international-caucasian-asian-students-teacher-1814892260">Shutterstock</a></span>
</figcaption>
</figure>
<p>As the OzSAGE independent scientific advisory group explains, we need a <a href="https://ozsage.org/media_releases/protecting-children-from-covid-19-and-making-schools-and-childcare-safer/">comprehensive package of measures</a>, including the use of HEPA air cleaners, to keep our schools safe.</p>
<p>Even after all of Australia’s children have had the chance to be vaccinated, we’ll <a href="https://theconversation.com/covid-doesnt-need-to-run-rampant-here-are-6-ways-to-keep-cases-low-in-the-next-year-170207">need to keep</a> some basic public health measures, such as improved ventilation, in place.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-doesnt-need-to-run-rampant-here-are-6-ways-to-keep-cases-low-in-the-next-year-170207">COVID doesn't need to run rampant. Here are 6 ways to keep cases low in the next year</a>
</strong>
</em>
</p>
<hr>
<p>COVID vaccines are very effective at preventing severe disease, but they’re not perfect and don’t completely prevent transmission. Their effectiveness may also diminish in the face of new variants of the virus.</p>
<p>As the sudden emergence of the <a href="https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern">Omicron variant</a> has shown, the pandemic won’t end until global vaccination levels are much higher. Australia can do our bit by vaccinating as much of our population as possible, while also <a href="https://endcovidforall.com/">donating vaccines and manufacturing technology</a> to developing countries in the region.</p><img src="https://counter.theconversation.com/content/172625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Zoë Hyde is a member of the OzSAGE independent scientific advisory group.</span></em></p>The delay in vaccinating children means public health measures will be vital in keeping COVID under control in the community.Zoë Hyde, Research Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1715272021-11-16T14:40:00Z2021-11-16T14:40:00ZUnpacking parents’ reasons for not vaccinating their children: why it matters<figure><img src="https://images.theconversation.com/files/431240/original/file-20211110-17-q187wf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Through their vaccination choices, parents are often communicating not just what they think, but also who they are.</span> <span class="attribution"><span class="source">Spencer Platt/Getty Images</span></span></figcaption></figure><p>For many of us, the case for childhood vaccination seems self-evident. Every year, this powerful public health intervention <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5402432/">protects</a> billions of children from deadly and debilitating infections like polio and measles. Yet worldwide, many parents are <a href="https://www.who.int/immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf">reluctant</a> – if not outright refusing – to vaccinate their children. This <a href="https://www.timeshighereducation.com/books/review-calling-the-shots-why-parents-reject-vaccines-jennifer-reich-new-york-university-press">includes</a> parents who have access to vaccines, are well-educated, and have enjoyed the benefits of having their children grow up in a world free of many vaccine-preventable diseases.</p>
<p>This phenomenon is now referred to as <a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">vaccine hesitancy</a>. It’s not new. Public concerns about vaccination, and controversies surrounding it, <a href="https://www.oah.org/tah/issues/2015/august/vaccination-resistance/">are as old</a> as vaccines themselves. Yet with the recent <a href="https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fglobalhealth%2Fmeasles%2Fglobalmeaslesoutbreaks.htm">global outbreaks</a> of diseases such as measles and diphtheria, and more recently <a href="https://www.nature.com/articles/s41591-021-01459-7">COVID-19</a>, vaccine hesitancy has been placed firmly on the global public health <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">agenda</a>.</p>
<p>In a recently conducted <a href="https://doi.org/10.1002/14651858.CD013265.pub2">Cochrane review</a> we analysed qualitative studies of parents’ views, experiences, and practices around routine childhood vaccination. </p>
<p>We included 27 studies in our analysis. Studies were conducted in Africa, the Americas, South-East Asia, Europe, and the Western Pacific, and included urban and rural settings, as well as high-, middle-, and low-income settings.</p>
<p>We found that vaccination uptake, as with so many health interventions, is influenced by many factors and carries a variety of meanings – social, political, economic, ideological, moral as well as biological. Through their vaccination choices, parents are often communicating not just what they think about vaccines, but also who they are, what they value and with whom they identify. </p>
<p>We found that parents’ vaccination views and practices are shaped by factors like: </p>
<ul>
<li><p>their broader worldviews surrounding health and illness </p></li>
<li><p>the vaccination ideas and practices of their social networks</p></li>
<li><p>wider political issues and relations of power and particularly the impact these have on parents’ trust (or distrust) in those associated with vaccination programmes </p></li>
<li><p>access to and experiences of vaccination services and their frontline healthcare workers.</p></li>
</ul>
<p>Our findings suggest that childhood vaccination, whatever stance is taken, is a complex social process. It is deeply embedded in the wider social worlds in which people live. Understanding these social worlds, and placing them at the centre of public health interventions, is critical. </p>
<h2>Reasons for vaccine hesitancy</h2>
<p>Vaccine hesitancy is not a single problem. The way it manifests and why it occurs <a href="https://www.sciencedirect.com/science/article/pii/S0264410X15005009?via%3Dihub">varies</a> considerably across place, time, and even vaccines. Local contexts and framing matter. Yet we found certain overarching patterns across the studies that help to explain why parents may be hesitant about routine vaccines for their children.</p>
<p>The first reason relates to the view that healthcare is a matter of personal risk, choice, and responsibility. Many parents, across the spectrum of vaccination attitudes, hold this worldview. Yet some parents see this worldview as being in conflict with vaccination promotion messages. These messages emphasise population-level risk and community health. This perceived tension may lead some parents to be hesitant about vaccination for their children.</p>
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Read more:
<a href="https://theconversation.com/low-trust-in-authorities-affects-vaccine-uptake-evidence-from-22-african-countries-161045">Low trust in authorities affects vaccine uptake: evidence from 22 African countries</a>
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<p>The second reason relates to the impact of social exclusion. Exclusion can take many different forms: economic, political, and cultural. All these forms can lay the foundation for distrust, alienation, resentment, and demotivation. Parents who are socially excluded may be hesitant about vaccination because they distrust vaccines and those delivering them. Or it may be a form of resistance or a mechanism to bring about change. It may be that vaccination takes time and comes with opportunity costs for these parents.</p>
<h2>An alternative approach</h2>
<p>Parents who resist vaccines for their children are commonly <a href="https://blogs.scientificamerican.com/observations/opting-out-of-vaccines-should-opt-you-out-of-american-society/">portrayed</a> as ‘ignorant’, ‘misinformed’ or ‘irrational’ – or selfish or evil. It is often <a href="https://www.gavi.org/vaccineswork/understanding-vaccine-hesitancy">assumed</a> that the attitudes of these parents can be corrected with biomedical education and advanced risk communication strategies. The findings from our review suggest that a more nuanced and less clinically oriented approach may be needed.</p>
<p>Such an approach involves taking seriously, on their own terms, the complex factors and meanings shaping parents’ vaccination choices. It means recognising that parents’ values and priorities, and their responses to these, do not always align with the goals of vaccination programmes. </p>
<p>“Hesitancy” does not only have negative connotations, as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649487/">seminal work</a> published over two decades ago demonstrated. In fact, for many parents, “hesitancy” may also be about a striving for or desiring something: to protect their child’s health, to be part of healthcare decision-making, to belong and feel included among peers, to feel confident that expert systems have their best interests at heart, to have their own priorities recognised and basic needs met.</p>
<p>Approaching hesitancy with this understanding is unlikely to translate into one-dimensional and “quick-fix” interventions. Yet we believe it could provide avenues for the development of more sensitive and effective strategies for engaging with parents who decide against vaccination for their children.</p><img src="https://counter.theconversation.com/content/171527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccination uptake is influenced by many factors and carries a variety of meanings – social, political, economic, ideological, moral as well as biological.Sara Cooper, Senior Scientist, Cochrane South Africa, South African Medical Research Council (SAMRC) and Honorary researcher, Division of Social & Behavioural Sciences, School of Public Health, UCT, South African Medical Research CouncilAlison Swartz, Senior Lecturer, University of Cape TownBey-Marrié Schmidt, Senior Lecturer, University of the Western CapeCharles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilChristopher J Colvin, Associate Professor, University of Cape TownEvanson Z Sambala, Research Fellow, School of Public Health, University of the WitwatersrandNatalie Leon, Specialist Scientist Researcher, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1687082021-11-03T11:23:09Z2021-11-03T11:23:09ZWhy vaccine doses differ for babies, kids, teens and adults – an immunologist explains how your immune system changes as you mature<figure><img src="https://images.theconversation.com/files/429805/original/file-20211102-19-1cqiw40.jpg?ixlib=rb-1.1.0&rect=0%2C896%2C5503%2C4032&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many vaccine formulations are tweaked for patients of different ages.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/student-andy-melgar-checks-in-with-emt-alfonso-deza-after-news-photo/1327357664">Mario Tama via Getty Images</a></span></figcaption></figure><p>Human beings are born pretty helpless, with a lot of developing to do. And just as you must learn such skills as how to walk, so must your immune system learn to defend against infections. As time passes, your immune system matures through different stages, much the way you advanced from crawling to standing, walking and running.</p>
<p>This process is one of the reasons scientists study the immune response to a vaccine in different age groups, and why, for example, the COVID-19 vaccines need to be tested separately in children ages 5-11 and those 12-16. Doctors want to use the vaccine dose that provides the best protection with the fewest side effects. And that’s going to depend on how the immune system is working based on how developed it is – something you can’t really tell from the outside.</p>
<p><a href="https://directory.hsc.wvu.edu/Profile/56680">I’m an immunologist</a>, and here’s the way I explain to my pediatric and adult patients how vaccines work in people of all different ages. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="baby at mother's breast" src="https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=571&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=571&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429806/original/file-20211102-29191-vtodoe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=571&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A newborn’s immune system still has a lot to learn and relies on supports from mom.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-mother-breastfeeding-baby-boy-while-royalty-free-image/1203911366?adppopup=true">Paulo Sousa/EyeEm via Getty Images</a></span>
</figcaption>
</figure>
<h2>Two halves of the immune system</h2>
<p>The immune maturing process starts shortly after birth.</p>
<p>When you’re born, your main immune protection comes via antibodies your mother shared through the placenta and breast milk. They provide what’s called passive immunity. <a href="https://doi.org/10.3389/fimmu.2020.595297">Newborns’ adaptive immune system</a> – the part of your immune system that will make your own antibodies – isn’t really up and running yet. The process gets started right away, but it can take years for the adaptive immune system to reach full maturity.</p>
<p>Luckily you’re also born with what’s called the <a href="https://www.ncbi.nlm.nih.gov/books/NBK279396/">innate immune system</a> – and it lasts throughout your life. It doesn’t need to learn in order to fight off infections and promote health as the adaptive immune system does. Without the innate immune system people would get sick a lot faster and more often.</p>
<p>The innate immune system starts with your skin and mucous membranes. Should any germs get past those physical barriers, it has enzymes just waiting to break down foreign organisms. Beyond that there are specialized cells looking for anything that is not you in order to kill intruders, while other cells called phagocytes gobble up invaders.</p>
<p>So the innate immune system is <a href="https://www.forbes.com/sites/fionamcmillan/2019/02/26/the-immune-systems-first-responders-are-smarter-than-we-thought/?sh=5fdc40261d82">your body’s first responder</a>. It buys you a bit of time. Then your adaptive immune system comes in and joins the fight.</p>
<p>When you become immunized via a vaccine or infection, your adaptive immune system starts actively making antibodies of your own. They’re proteins that act like suction cups and stick to viruses or bacteria to help the body get rid of the germs faster and prevent the infection from spreading. Antibodies are specialized to recognize and take down a particular intruder.</p>
<p>The adaptive immune system can learn a new infection or recall one that it has not seen in a long time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="frozen vaccine vials" src="https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429808/original/file-20211102-29670-eqps6i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The dose that works for adults might not be appropriate for youngsters of different ages.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakBiden/d89b46b600de4f7d9f834aa4901fb24c/photo?boardId=d7f2514f50804466b15dfb81ed00d9cd&st=boards&mediaType=audio,photo,video,graphic&sortBy=&dateRange=Anytime&totalCount=52&currentItemNo=0">AP Photo/Francisco Seco</a></span>
</figcaption>
</figure>
<h2>Vaccines account for immune development</h2>
<p>In the same way an infant will learn to walk even if you don’t secure the stairways and pool areas for them, your immune system can learn to squelch an invading virus without a vaccine – but the chance of injury is much greater. </p>
<p>Vaccines work by triggering the creation of antibodies that will recognize a specific germ and work to fight it off in a safer manner than getting the infection for the first time without it. How well a vaccine works is a combination of how many antibodies you produce in response to it, how effective they are and the safety of the vaccine.</p>
<p>When researchers work to fine-tune the dosage of a vaccine for different age groups, they need to be aware of what parts of the immune system are online and what parts aren’t fully active in people at each developmental stage. This is part of the reason some vaccines – <a href="https://theconversation.com/kids-arent-just-littler-adults-heres-why-they-need-their-own-clinical-trials-for-a-covid-19-vaccine-162821">such as for COVID-19</a> – <a href="https://theconversation.com/the-fda-authorizes-pfizers-covid-19-vaccine-for-children-ages-5-to-11-a-pediatrician-explains-how-the-drug-was-tested-for-safety-and-efficacy-169907">get tested and approved on different schedules</a> for adults, teens, kids and babies.</p>
<p>A number of vaccines for infants are given as a series – meaning they get the same kind of shot several times over the course of a few months. A baby’s adaptive immune system is prone to being forgetful or not listening at this age – the same way a baby falters as it tries to stand and walk. With each exposure, every aspect of the immune system <a href="https://doi.org/10.1038/cr.2009.139">gets stronger and better</a> at defending against the would-be infection.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chart listing vaccination schedule for young children" src="https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=369&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=369&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429732/original/file-20211102-54176-3uy4s0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=369&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some vaccines need to be given multiple times.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/vaccines/schedules/easy-to-read/child-easyread.html">CDC National Center for Immunization and Respiratory Diseases</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>After 4 years of age and through younger adult life, your immune system tends to be <a href="https://doi.org/10.1016/j.jaci.2018.02.017">more responsive and less prone to forgetting</a>. It’s not a coincidence that this is when people tend to <a href="https://www.uhhospitals.org/Healthy-at-UH/articles/2018/04/allergies-and-age">gain most of their allergies</a>. For the COVID-19 Pfizer vaccine, researchers found that kids ages 5 to 11 had a similar immune and safety response at <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">one-third the dose</a> used for those ages 12 and up.</p>
<p>Scientists tend to start with patients between ages 18 and 55 years old when studying vaccines. Their adult immune systems have matured and they can be counted on to reliably report any adverse reactions. Seeing what happens in the adult age group also helps physicians predict what might occur when a vaccine is administered to others and be on the lookout for these side effects in the younger age groups.</p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Around age 55 or so, the adaptive immune system <a href="https://doi.org/10.1098/rspb.2014.3085">starts to become weaker again and forgetful</a>, in some ways more like the infant’s developing system. Luckily vaccine boosters can provide a quick refresher for these older patients – like helping protect them from accidental falls after a lifetime having mastered walking and running.</p>
<p>In the end, vaccines provide the safest environment for the immune system to learn, and tweaking the dosages for different age groups helps ensure that each patient gets just what’s necessary to get the job done.</p><img src="https://counter.theconversation.com/content/168708/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Peppers does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>First CDC signed off on a COVID-19 vaccine for adults, then teens. Now US children ages 5 to 11 are officially eligible for shots. Here’s the science on why each group needs to be considered separately.Brian Peppers, Assistant Professor of Pediatric and Adult Allergy/Immunology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688992021-10-22T12:39:13Z2021-10-22T12:39:13ZParents were fine with sweeping school vaccination mandates five decades ago – but COVID-19 may be a different story<figure><img src="https://images.theconversation.com/files/427788/original/file-20211021-14-cn140n.jpg?ixlib=rb-1.1.0&rect=197%2C8%2C2645%2C1814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children and parents lined up for polio vaccines outside a Syracuse, New York school in 1961.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/LinedUpForPolioVaccine1961/4da7b3b42ecd4a68a089a5985f951f32/photo?Query=school%20vaccine&mediaType=photo&sortBy=arrivaldatetime:asc&dateRange=Anytime&totalCount=1077&currentItemNo=9">AP Photo</a></span></figcaption></figure><p>The ongoing battles over COVID-19 vaccination in the U.S. are likely to get more heated when the Food and Drug Administration authorizes emergency use of a vaccine for children ages 5 to 11, expected later this fall.</p>
<p>California <a href="https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/">has announced</a> it will require the vaccine for elementary school attendance once it receives full FDA approval after emergency use authorization, and other states may follow suit. COVID-19 vaccination mandates in workplaces and colleges have sparked controversy, and the possibility that a mandate might extend to younger children is <a href="https://www.kff.org/coronavirus-covid-19/press-release/most-parents-dont-want-their-schools-to-require-covid-19-vaccination-but-most-favor-requiring-masks-for-unvaccinated-children-and-staff/">even more contentious</a>.</p>
<p>Kids are already required to get a host of other vaccines to attend school. School vaccination mandates have been around since the 19th century, and they became a fixture in all 50 states in the 1970s. Vaccine requirements are among the <a href="https://pubmed.ncbi.nlm.nih.gov/12508514/">most effective means of controlling infectious diseases</a>, but they’re currently under attack by small but vocal minorities of parents who consider them unacceptable intrusions on parental rights.</p>
<p>As a public health historian who studies the <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">evolution of vaccination policies</a>, I see stark differences between the current debates over COVID-19 vaccination and the public response to previous mandates.</p>
<h2>Compulsory vaccination in the past</h2>
<p>The <a href="https://doi.org/10.1353/bhm.2004.0062">first legal requirements for vaccination</a> date to the early 1800s, when gruesome and deadly diseases routinely terrorized communities. A loose patchwork of local and state laws were enacted to stop epidemics of smallpox, the era’s only vaccine-preventable disease. </p>
<p>Vaccine mandates initially applied to the general population. But in the 1850s, as universal public education became more common, people recognized that schoolhouses were likely sites for the spread of disease. Some states and localities began enacting <a href="https://doi.org/10.1093/jhmas/XXXIII.3.344">laws tying school attendance to vaccination</a>. The smallpox vaccine was crude by today’s standards, and concerns about its safety led to numerous lawsuits over mandates.</p>
<p>The U.S. Supreme Court upheld compulsory vaccination in two decisions. The first, in 1905, <a href="https://supreme.justia.com/cases/federal/us/197/11/">affirmed that mandates are constitutional</a>. The second, in 1922, <a href="https://supreme.justia.com/cases/federal/us/260/174/">specifically upheld school-based requirements</a>. In spite of these rulings, many states lacked a smallpox vaccination law, and some states that did have one failed to enforce it consistently. Few states updated their laws as new vaccines became available.</p>
<p>School vaccination laws underwent a major overhaul beginning in the 1960s, when health officials grew frustrated that <a href="https://doi.org/10.1177/0033354919826558">outbreaks of measles were continuing to occur in schools</a> even though a safe and effective vaccine had recently been licensed.</p>
<p>Many parents mistakenly believed that measles was an annoying but mild disease from which most kids quickly recovered. In fact, it often caused <a href="https://www.cdc.gov/measles/symptoms/complications.html">serious complications</a>, including potentially fatal pneumonia and swelling of the brain.</p>
<p>With encouragement from the Centers for Disease Control and Prevention, all states updated old laws or enacted new ones, which generally covered all seven childhood vaccines that had been developed by that time: diphtheria, pertussis, tetanus, polio, measles, mumps and rubella. In 1968, just half the states <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">had school vaccination requirements; by 1981, all states did</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Smiling boy rolls up his sleeve to get a shot from a nurse" src="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, students even received vaccinations from nurses at school.</span>
<span class="attribution"><a class="source" href="http://resource.nlm.nih.gov/101447463">NIH U.S. National Library of Medicine</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Expanding requirements, mid-20th century</h2>
<p>What is most surprising about this major expansion of vaccination mandates is how little controversy it provoked.</p>
<p>The laws did draw scattered court challenges, usually over the question of exemptions – which children, if any, should be allowed to opt out. These lawsuits were often brought by chiropractors and other adherents of alternative medicine. <a href="https://pubmed.ncbi.nlm.nih.gov/15868682/">In most instances, courts turned away these challenges</a>.</p>
<p>There was scant public protest. In contrast to today’s vocal and well-networked anti-vaccination activists, organized resistance to vaccination remained on the fringes in the 1970s, the period when these school vaccine mandates were largely passed. Unlike today, when <a href="https://www.cdc.gov/vaccinesafety/concerns/index.html">fraudulent theories of vaccine-related harm</a> – such as the discredited notion that vaccines cause autism – <a href="https://theconversation.com/anti-vaccination-mothers-have-outsized-voice-on-social-media-pro-vaccination-parents-could-make-a-difference-120572">circulate endlessly on social media</a>, public discussion of the alleged or actual risks of vaccines was largely absent.</p>
<p>Through most of the 20th century, <a href="https://doi.org/10.1353/bhm.2013.0047">parents were less likely to question</a> pediatricians’ recommendations than they are today. In contrast to the empowered “patient/consumer” of today, an attitude of “doctor knows best” prevailed. All these factors contributed to overwhelmingly positive views of vaccination, with more than 90% of parents in a 1978 poll reporting that <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">they would vaccinate their children even if</a> there were no law requiring them to do so.</p>
<p>Widespread public support for vaccination enabled the laws to be passed easily – but it took more than placing a law on the books to control disease. Vaccination rates <a href="https://doi.org/10.1177/0033354919826558">continued to lag in the 1970s</a>, not because of opposition, but because of complacency.</p>
<p>Thanks to the success of earlier vaccination programs, most parents of young children lacked firsthand experience with the suffering and death that diseases like polio or whooping cough had caused in previous eras. But public health officials recognized that those diseases were far from eradicated and would continue to threaten children unless higher rates of vaccination were reached. Vaccines were already becoming a victim of their success. The better they worked, the more people thought they were no longer needed.</p>
<p>In response to this lack of urgency, <a href="https://press.uchicago.edu/ucp/books/book/chicago/V/bo14237741.html">the CDC launched a nationwide push in 1977</a> to help states enforce the laws they had recently enacted. Around the country, health officials partnered with school districts to audit student records and provide on-site vaccination programs. When push came to shove, they would exclude unvaccinated children from school until they completed the necessary shots.</p>
<p>The lesson learned was that making a law successful requires ongoing effort and commitment – and continually reminding parents about the value of vaccines in keeping schools and entire communities healthy.</p>
<h2>Add COVID-19 to vaccine list for school?</h2>
<p>Five decades after school mandates became universal in the U.S., <a href="https://www.pewresearch.org/science/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/">support for them remains strong overall</a>. But misinformation spread over the internet and social media has weakened the public consensus about the value of vaccination that allowed these laws to be enacted.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="adults and kids with signs protesting COVID-19 vaccines" src="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some anti-vaccination activists are vocal opponents of vaccine mandates for kids.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/with-her-daughter-ella-baindourov-nara-varderesyan-leads-news-photo/1235967787?adppopup=true">Sarah Reingewirtz/MediaNews Group/Los Angeles Daily News via Getty Images</a></span>
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</figure>
<p>COVID-19 vaccination has become politicized in a way that is unprecedented, with sharp partisan divides over whether <a href="https://www.pewresearch.org/fact-tank/2020/07/22/republicans-remain-far-less-likely-than-democrats-to-view-covid-19-as-a-major-threat-to-public-health/">COVID-19 is really a threat</a>, and whether the <a href="https://news.gallup.com/poll/352397/democratic-republican-confidence-science-diverges.aspx">guidance of scientific experts can be trusted</a>. The attention focused on COVID-19 vaccines has given new opportunities for anti-vaccination conspiracy theories to reach wide audiences. </p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.] </p>
<p>Fierce opposition to COVID-19 vaccination, powered by <a href="https://www.npr.org/2021/10/17/1046598351/the-political-fight-over-vaccine-mandates-deepens-despite-their-effectiveness">anti-government sentiment and misguided notions of freedom</a>, could undermine support for time-tested school requirements that have protected communities for decades. Although vaccinating school-aged children will be critical to controlling COVID-19, lawmakers will need to proceed with caution.</p><img src="https://counter.theconversation.com/content/168899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Colgrove has received funding from the National Library of Medicine, the Greenwall Foundation, the Milbank Memorial Fund, and the William T. Grant Foundation. </span></em></p>Public health experts know that schools are likely sites for the spread of disease, and laws tying school attendance to vaccination go back to the 1800s.James Colgrove, Professor of Sociomedical Sciences, Mailman School of Public Health; Dean of the Postbaccalaureate Premedical Program, Columbia School of General Studies, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1666252021-08-25T15:11:11Z2021-08-25T15:11:11ZIt’s been a year since Africa was declared polio free. But a threat remains<figure><img src="https://images.theconversation.com/files/417566/original/file-20210824-13-18fxv99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A child gets a dose of the oral polio vaccine.</span> <span class="attribution"><span class="source">Simon Maina/AFP via Getty Images</span></span></figcaption></figure><p>The <a href="https://www.who.int/news/item/25-08-2020-global-polio-eradication-initiative-applauds-who-african-region-for-wild-polio-free-certification">25th of August marks</a> the first anniversary of a milestone that took over 30 years to achieve. Africa being free from polio – a disease that has caused death and paralysis throughout recorded history.</p>
<p>Polio is a viral illness that can cause sudden weakness, permanent paralysis, or death in people who were previously healthy and had no risk factors or comorbidities. It usually affects children. The virus is spread by faecally contaminated food and water or close contact.</p>
<p>But the outbreaks of this fearful disease have become a thing of the past, told to us by our grandparents. The reason for the disappearance? Vaccination.</p>
<p>The <a href="https://polioeradication.org/">Global Polio Eradication Initiative</a> was launched in 1988. In that year, more than 350,000 people were paralysed. Polio cases were reported from at least 125 countries.</p>
<p>The initiative set an original target of the year 2000 for polio eradication. It introduced polio vaccines into health programmes around the globe and ensured birth cohorts of children were routinely vaccinated. This drive reduced the number of polio cases to only 22 in 2017. </p>
<p>Only <a href="https://polioeradication.org/polio-today/polio-now/wild-poliovirus-list/">two cases</a> of polio from paralysed individuals have been recorded so far in 2021. This is the lowest number ever. But an additional 62 detections of polio have been identified in wastewater treatment plants or surface water downstream of large populations in Pakistan and Afghanistan. So the case number may be artificially low due to poor surveillance or weak health systems.</p>
<p>Despite the efforts of health programmes around the world, there is still a threat that polio could spread again. Even one case would constitute an international event.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-eradicating-polio-everywhere-has-been-so-hard-to-crack-105405">Why eradicating polio everywhere has been so hard to crack</a>
</strong>
</em>
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<p>Africa has had a long history with polio. <a href="https://www.news24.com/news24/analysis/barry-d-schoub-africa-is-now-polio-free-with-south-africa-playing-a-pivotal-role-20200831">South Africa</a> used crowd-funding in the <a href="https://www.africakicksoutwildpolio.com/timeline/">1960s</a> to raise funds for a research facility to develop a polio vaccine, <a href="https://www.news24.com/news24/analysis/barry-d-schoub-africa-is-now-polio-free-with-south-africa-playing-a-pivotal-role-20200831">in collaboration with international researchers</a>. The facility originated as the Poliomyelitis Research Foundation and developed into the <a href="https://www.nicd.ac.za/">National Institute for Communicable Diseases</a>, which has more recently played a leading role in the fight against COVID-19, listeria, and other pathogens. </p>
<p>Polio is still a large part of <a href="https://www.gov.za/faq/health/why-should-i-have-my-child-vaccinated">routine childhood vaccinations</a> in South Africa. </p>
<p>No wild polio, that is polio cases caused by the natural ‘wild type’ form of the virus, has been detected in Africa since 2016. On 25 August 2020, the continent was declared free of wild poliovirus. This leaves only two countries on the globe – Pakistan and Afghanistan – where wild polio is found. A weak healthcare system and vaccine hesitancy have allowed the sustained transmission of polioviruses, and the unfortunate consequence: paralysis or death. </p>
<h2>Poliovirus biology and vaccines</h2>
<p>Polioviruses occur in three serotypes (types 1, 2 and 3). It is <a href="https://www.who.int/news-room/fact-sheets/detail/poliomyelitis">estimated</a> that less than one in 100 infected individuals become paralysed. Others may be asymptomatic or have varying degrees of flu-like illness. Thus, when one paralysed case has been detected, there are likely 99 other asymptomatically infected individuals, making it challenging to control the spread. </p>
<p>There have been two vaccines used since the 1960s to prevent polio: the Salk vaccine, which is an inactivated vaccine, and the Sabin vaccine, which is a live attenuated vaccine. A live vaccine contains a weakened version of the natural ‘wild type’ virus. </p>
<p>Both vaccines are excellent at preventing paralysis. The two vaccines differ, however, in their ability to control asymptomatic poliovirus transmission. </p>
<p>The inactivated polio vaccine is an injectable vaccine that induces antibodies in the blood that prevent paralysis should the person later come into contact with wild polio. If a person later encounters wild poliovirus, the wild virus may still replicate in the person’s gastrointestinal tract and shed in their stool, potentially transmitting asymptomatically to others in the community. The inactivated polio vaccine is excellent for personal protection against paralysis. But it’s not effective at controlling outbreaks, as it does not effectively prevent asymptomatic polio transmission. </p>
<p>The Sabin vaccine is a live, orally-administered, weakened vaccine strain given as drops. It produces good intestinal immunity. This means that, should the vaccinated individual come into contact years later with wild poliovirus, the wild poliovirus won’t be shed in the person’s faeces. Thus, in addition to preventing paralysis, the oral polio vaccine can prevent shedding of wild poliovirus in stool. It is therefore very effective at controlling polio outbreaks. This benefit has been instrumental in decreasing polio transmission and bringing polio to the brink of eradication.</p>
<p>The oral polio vaccine is very effective. But if the population vaccination coverage is low, then people who get the live vaccine can transmit this virus to those who are not immunised. Over weeks to months, this transmission among the community has the benefit of immunising susceptible people. Yet, over a long period of more than six months to years, mutations can arise in the virus genome that can turn it back into a disease-causing virus. This is called a vaccine-derived poliovirus. </p>
<p>Vaccine-derived polio is extremely rare. But it has arisen in multiple <a href="https://www.africanews.com/2021/08/17/uganda-confirms-polio-outbreak//">countries</a> over the past decades. </p>
<p>To combat this phenomenon, a new live vaccine has just been developed. This vaccine is called the novel oral polio vaccine, serotype 2 (nOPV2). This vaccine received <a href="https://www.who.int/news/item/13-11-2020-first-ever-vaccine-listed-under-who-emergency-use">emergency use listing</a> in November 2020, just before the SARS-CoV-2 vaccines, and has already been used in seven African countries. Novel oral polio vaccines against serotypes 1 and 3 are currently in development.</p>
<h2>Maintaining efforts</h2>
<p>The development of nOPV2 is a game-changer in the war against polio. The current target for polio eradication has been <a href="https://polioeradication.org/wp-content/uploads/2021/06/polio-eradication-new-Strategy-2022-26-Executive-Summary.pdf">extended to 2026</a>. </p>
<p>To meet this deadline, three things must happen. </p>
<ul>
<li><p>Health systems around the world need to keep vigilant; </p></li>
<li><p>vaccination coverage need to be kept high; and </p></li>
<li><p>we need to keep developing new vaccines to counteract evolving viruses.</p></li>
</ul><img src="https://counter.theconversation.com/content/166625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melinda Suchard has received speaker honoraria from Sanofi Pasteur. She manages grants from the World Health Organisation for polio surveillance.</span></em></p><p class="fine-print"><em><span>Wayne Howard does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Outbreaks of polio have become a thing of the past, told to us by our grandparents, only because of vaccination.Wayne Howard, Medical Scientist, National Institute for Communicable DiseasesMelinda Suchard, Head, Centre for Vaccines and Immunology, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1605892021-05-13T21:52:38Z2021-05-13T21:52:38Z3 reasons for making COVID-19 vaccination mandatory for children<figure><img src="https://images.theconversation.com/files/400655/original/file-20210513-21-11s7fpr.jpg?ixlib=rb-1.1.0&rect=12%2C62%2C4181%2C2867&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children wearing masks sit behind screened-in cubicles in their classroom at a Toronto school during the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>On May 5, Health Canada <a href="https://ottawacitizen.com/news/local-news/covid-19-vaccine-for-children-aged-12-to-15-approved-by-health-canada">approved a COVID-19 vaccine for use in children aged 12-15 years</a>. The United States Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use">quickly followed suit</a>, and <a href="https://www.timesofisrael.com/israel-ready-to-vaccinate-adolescents-as-soon-as-fda-approves/">other countries</a> are likely to do the same. Similar approvals <a href="https://www.propublica.org/article/fauci-vaccines-kids">for younger children are on the horizon</a>.</p>
<p>This is very welcome news. It will not be possible to achieve full protection against COVID-19 at the population level unless most adolescents and children are vaccinated. However, factors such as <a href="https://theconversation.com/how-better-conversations-can-help-reduce-vaccine-hesitancy-for-covid-19-and-other-shots-159321">vaccine hesitancy</a> and mistaken beliefs about the <a href="https://www.cbc.ca/news/health/covid-19-kids-risk-pandemic-1.6006172">risks COVID-19 poses to children</a> may make this a challenging goal. </p>
<p>One tool that <em>may</em> serve to encourage vaccination uptake is vaccine mandates.</p>
<p>As philosophical researchers, we offer three ethical arguments in favour of making COVID-19 vaccination mandatory for children, <a href="https://philpapers.org/rec/SKEMV">based on our research</a>. We contend it would be ethically permissible for governments to impose a sanction (such as a fine or exclusion from social environments or activities) on those who fail to vaccinate their children.</p>
<h2>Risk of harm to children</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child receiving an injection in his arm from a health-care worker" src="https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400659/original/file-20210513-19-x99zry.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Julian Boyce, 14, receives his first Pfizer COVID-19 vaccination at NYC Health + Hospitals/Harlem, from nurse Kenia Georges in New York on May 13.</span>
<span class="attribution"><span class="source">(AP Photo/Richard Drew)</span></span>
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</figure>
<p><strong>Argument one</strong>: if there is an easy, low-cost way for parents or guardians to avoid exposing <em>children in their care</em> to substantial risk of harm and death, they ought to do so. </p>
<p>COVID-19 presents <a href="https://www.cbsnews.com/amp/news/covid-michigan-cases-spike-kids/">a substantial risk of harm</a> — including long-term health complications such as organ damage, <a href="https://theconversation.com/long-covid-in-children-what-parents-and-teachers-need-to-know-156185">long COVID</a>, or <a href="https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html">multisystem inflammatory syndrome</a> (MIS-C) and <a href="https://toronto.citynews.ca/2021/04/26/13-year-old-brampton-girl-dies-after-contracting-covid-19/">death</a> — to at least <a href="https://www.cbc.ca/news/canada/montreal/montreal-teenager-covid-19-1.5978231">some</a> <a href="https://globalnews.ca/news/7771954/bc-2-year-old-dies-covid-19/">proportion</a> of children. We have limited knowledge about how large the at-risk group is and who is in it, and about the extent to which these conditions will be treatable. </p>
<p>If the COVID-19 vaccine is as safe and effective as other standard childhood vaccinations (or similarly safe as, <a href="https://www.washingtonpost.com/health/2021/05/10/coronavirus-vaccine-for-kids/">it seems</a>, most COVID-19 vaccines are for adults), it would provide parents and guardians with an easy, low-cost way to avoid exposing their children to an infection that may cause them serious harm or death.</p>
<p>Governments have an obligation to protect children from parents or guardians who might expose children in their care to easily avoidable risk of harm and death. Therefore, the state ought, in principle and in the absence of decisive countervailing reasons, to mandate that parents vaccinate their children against COVID-19. </p>
<p>We accept that the state protects children in other contexts by imposing obligations on adults to adopt easy, low-cost ways of avoiding significant harm and death, for example, by using car seats and seat belts for their children when driving.</p>
<h2>Risk of harm to others</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Young people waiting outdoors in a socially distanced lineup" src="https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400658/original/file-20210513-17-1u50xgr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children aged 12 to 15 wait to get vaccinated at Relapse Pediatric Center in Decatur, Ga. Hundreds of U.S. children received the Pfizer vaccine just days after it was approved for use within their age group.</span>
<span class="attribution"><span class="source">(AP Photo/Ravi Nessman)</span></span>
</figcaption>
</figure>
<p><strong>Argument two</strong>: If, by vaccinating their children, parents and guardians can avoid imposing a significant risk of harm and death <em>on others</em> in an easy, low-cost way, they ought to vaccinate their children. </p>
<p>The threat to all of us from COVID-19 is significant. The risk unvaccinated children pose is especially great. <a href="https://www.scientificamerican.com/article/when-will-kids-get-covid-vaccines/">Children contribute to the spread of the virus</a> through social mixing, often in large groups (for example, <a href="https://abc7.com/covid-chidlren-variant-coroanvirus-coronavirus-vaccine/10486843/">in classrooms</a>). Moreover, the longer children remain unvaccinated, <a href="https://www.nytimes.com/2021/03/29/opinion/covid-vaccines-kids.html?smid=tw-share">the more opportunity exists for a new, more potent variant of COVID-19</a> to emerge and threaten us all. </p>
<p>A safe, effective COVID-19 vaccine would provide parents and guardians with an easy, low-cost way to avoid imposing the significant risk of harm or death associated with COVID-19 on others.</p>
<p>The state is required to adopt measures to protect populations from exposure to risk of harm and death that might be avoided easily and at low cost. Therefore, the state ought (again in principle and in the absence of decisive countervailing reasons) to mandate that parents vaccinate their children. </p>
<p>We accept that the state protects populations with low-cost and easy avoidance of risk of harm and death in other contexts by, for example, imposing speed limits, limits on alcohol consumption and vision requirements for driving. </p>
<p>We also already accept that the state imposes obligations on parents to take measures to prevent their children from posing risks to others in many contexts. Childhood vaccinations are already <a href="https://doi.org/10.1016/j.vaccine.2020.09.063">mandatory in some liberal democracies</a>, and most liberal democracies mandate that children attend school to provide them with a civic education, and prohibit children from carrying weapons, for similar reasons.</p>
<h2>Children’s well-being</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Empty classroom with chairs up on student desks" src="https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400656/original/file-20210513-18-tmzaw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pandemic restrictions such as school closures may be detrimental to children’s well-being.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p><strong>Argument three</strong>: One very compelling reason we have to end the pandemic and to mandate vaccination relates to children’s well-being. We must protect children from the mental and physical effects of lockdown and other restrictions, or effects of insufficient restrictions, such as school closures due to infection spread. </p>
<p>Restrictions and the effects of spreading infection lead to decreased opportunities for the pursuit of well-being. Impacts on education alone are considerable, especially amongst the least well off.</p>
<p>But most important of all we want children to thrive. The third argument for mandating the vaccination of children turns on <a href="https://philpapers.org/rec/TOMSOC-3">unique</a> features of <a href="https://philpapers.org/rec/SKECAP">children’s</a> <a href="https://philpapers.org/rec/SKEUWC">well-being</a>. Children’s well-being may have different elements than adults’. For example, adults may be focused on values like authentic happiness and rational desires. This may not be true of (especially young) children. </p>
<p>While happiness and the satisfaction of desires matter to children’s well-being, these might not be all that matters. Other <a href="https://guyfletcherphilosophy.files.wordpress.com/2016/02/fletcher-g-objective-list-theories-copy.pdf">so-called “objective goods</a>” may play a significant role in children’s well-being. These include loving and supportive relationships, various forms of play, learning and intellectual development.</p>
<p>Ending the pandemic is essential to enabling children to enjoy the so-called “<a href="https://www.academia.edu/5725780/The_Goods_of_Childhood_Childrens_Rights_and_the_Role_of_Parents_as_Advocates_and_Interpreters">goods</a> of <a href="https://philarchive.org/archive/GHETIGv4">childhood</a>,” including valuable relationships with friends and extended family (especially older adults), various forms of unstructured play, exploration and intellectual development, and to pursue them in a carefree way in the absence of unavoidable worries about risk.</p>
<p>Childhood is a relatively short period in an individual’s life. It is important for preparing children to meet the challenges of adulthood. But it is also a time in which to savour particular kinds of goods in a unique way. An effective way to secure this for all children is to mandate their vaccination.</p>
<p>We believe these three arguments are compelling reasons for vaccinating children. We hold that they offer a strong case for considering mandating vaccination for children. However, even if there are decisive counter-arguments for not mandating vaccination in some contexts, we maintain that our arguments provide parents or guardians with conclusive reasons to vaccinate their children.</p><img src="https://counter.theconversation.com/content/160589/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Forsberg receives funding from the British Academy. </span></em></p><p class="fine-print"><em><span>Anthony Skelton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Full population-level protection against COVID-19 will require most adolescents and children to be vaccinated. There are ethical arguments for encouraging vaccination uptake through vaccine mandates.Anthony Skelton, Associate professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western UniversityLisa Forsberg, British Academy Postdoctoral Fellow, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1569732021-03-12T16:49:58Z2021-03-12T16:49:58ZDiphtheria could become a problem again thanks to new variants and antimicrobial resistance<figure><img src="https://images.theconversation.com/files/389294/original/file-20210312-15-ixpsu2.jpg?ixlib=rb-1.1.0&rect=51%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The diphtheria vaccine ensures the disease is no longer the threat it once was.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pediatrician-makes-vaccination-small-boy-542046412">adriaticfoto/ Shutterstock</a></span></figcaption></figure><p>Diphtheria is a respiratory disease that was a <a href="https://www.microbiologyresearch.org/content/journal/micro/10.1099/mic.0.000627#tab2">leading cause of death in children</a> worldwide in the early 20th Century. Thanks to a successful vaccine introduced during the 1940s and 50s, diphtheria is a disease of the past for many people – though it still remains a threat in some parts of the world, including in south Asia and Africa.</p>
<p>Our team of researchers wanted to determine how the disease has changed over the past century to understand what sort of threat it carries today. We found numerous genetic variations in the bacteria that causes diphtheria, alongside a build up of antibiotic resistance. Both of these changes could pose major challenges for <a href="https://www.nature.com/articles/s41467-021-21870-5">future treatment and control</a>.</p>
<p>Diphtheria is caused by the bacterium <em>Corynebacterium diphtheriae</em>, and is spread through droplets in the air. It causes a white-grey build-up in the back of the throat, releasing a toxin that kills the cells in your body. This leads to fever, swollen glands, difficulty breathing, and death within days if left untreated. Symptoms can also be very similar to flu initially, making it difficult to diagnose in areas where it is not common. </p>
<p>While the vaccine offers high levels of protection against the diphtheria toxin, those who haven’t been vaccinated and catch the disease require antitoxin treatment and antibiotics. Despite this, not only are fewer doses of antitoxin being produced worldwide, reports are also beginning to suggest some <em>C. diphtheriae</em> strains are <a href="https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-020-00805-7">becoming resistant to antibiotics</a>. </p>
<p>Antibiotic resistance happens when bacteria acquire the ability to destroy or avoid the effects of an antibiotic, often thanks to genetic changes. Over-prescribing antibiotics is one cause of resistance. Resistance can be spread from one bacterium to another, and even between different bacterial species.</p>
<p>Knowing how <em>C. diphtheriae</em> has changed over time globally will allow researchers to know whether the vaccine and treatments remain effective, and understand if antibiotic resistance is increasing.</p>
<h2>Tracking variants</h2>
<p>Cases of diphtheria dropped significantly across the world after the vaccine was developed, and the diseaes had been all but eliminated where vaccine coverage had been high. Spikes have occurred though – such as in the mid-1990s when the Soviet Union dissolved, due to large gaps in vaccine schedules and healthcare systems. </p>
<p>But case numbers are now increasing significantly again globally. The highest number of cases since 1996 were reported in 2019 – 22,986 globally. This increase was driven by a number of major outbreaks, including the ongoing <a href="https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-019-0204-2">crisis in Yemen</a>.</p>
<p>To understand how diphtheria has changed, we set out to analyse the bacteria’s genome (its DNA and genes). Our team collected 502 separate genomes from over 122 years and 16 countries. A computer analysis then helped us create a “family tree” of <em>C. diphtheriae</em>. This allowed us to not only see how one bacterium relates to another, but to get a global picture of the species and see how certain variants had evolved or changed, and if some are potentially becoming deadlier than others.</p>
<figure class="align-center ">
<img alt="Computer image of group of long thin bacteria cells." src="https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389295/original/file-20210312-15-1g2h0p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some of these variants are adapting to the vaccine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteria-corynebacterium-diphtheriae-grampositive-rodshaped-bacterium-1889038198">Kateryna Kon/ Shutterstock</a></span>
</figcaption>
</figure>
<p>We found that there are multiple large groups of specific <em>C. diphtheriae</em> variants circulating within regions across the world that are distantly related – like cousins, but tens or hundreds of times removed. Some of these variant groups have remained relatively unchanged over large periods of time – three decades, in some cases – re-emerging sporadically, with few or no changes to their structures or genomes.</p>
<p>We determined that the toxin upon which the vaccine and antitoxin is based is only one of 18 <em>C. diphtheriae</em> variants we found. Six of these variants carried mutations that impact the toxin’s shape, which could be changing how it interacts with your body’s cells. Future research is needed to determine the real effect of these changes, and soon.</p>
<p>Additionally, bacteria that do not have the toxin but still cause disease have been found more often in recent years, and typically in high-income countries where vaccine coverage is high. This suggests the bacterium may be adapting to the vaccine – in this case by causing disease in a different way than with the toxin.</p>
<p>Most significant is that antibiotic resistance is present in large amounts of the bacteria responsible for more recent cases, with those from the 2010s having on average almost two resistance genes per genome. Crucially, most of the resistance is not for drugs used to treat diphtheria. But it demonstrates <em>C. diphtheriae</em>‘s ability to acquire resistance. If it were to develop resistance to the drugs used to treat it, diphtheria could quickly become very difficult to treat. </p>
<h2>Global spread</h2>
<p>To the best of our knowledge, diphtheria does not survive regularly outside of humans – reports of animals infected without prior human contact are <a href="https://link.springer.com/article/10.1007/s15010-015-0846-y">incredibly rare</a>. We think that the bacteria remains in a population by spreading through people who carry the bacteria, but don’t develop the disease or exhibit symptoms. </p>
<p>This is further supported by the antibiotic resistance genes we found, suggesting these bacteria are being exposed to excess antibiotics – and inside humans is the most likely place that’s happening. Future studies must focus on this potential for asymptomatic spread, which will help determine the danger to vulnerable communities. </p>
<p>With so many variants, it will be important to investigate what impact these mutations have. While circulating <em>C. diphtheriae</em> toxins today are not different enough to stop being effected by the vaccine, the pace at which the toxin’s structure is adapting into different variants is concerning. With COVID-19 interrupting many childhood vaccination programmes globally, it will be important to be prepared for and address these gaps in vaccinations to ensure that incidences of diphtheria and other preventable diseases do not continue to rise.</p><img src="https://counter.theconversation.com/content/156973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert C Will receives funding from the Medical Research Council. </span></em></p><p class="fine-print"><em><span>Ankur Mutreja receives funding from Wellcome, BMGF, UKRI, DBT and Hamied Foundation.</span></em></p>Our study found that the bacteria which causes diphtheria is rapidly changing.Robert C Will, PhD Candidate, Department of Medicine, University of CambridgeAnkur Mutreja, Group Leader, Global Health (Infectious Diseases), University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1535492021-01-21T13:33:53Z2021-01-21T13:33:53ZSouth Africa’s immunisation record risks being dented by anti-vaccination views<figure><img src="https://images.theconversation.com/files/379912/original/file-20210121-19-12dyogd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine hesitancy is a growing public health problem. </span> <span class="attribution"><span class="source">Sharon Seretlo/Gallo Images via Getty Images</span></span></figcaption></figure><p>Vaccination has eradicated smallpox, nearly eradicated polio, and led to major reductions of serious infectious diseases. These include diphtheria, whooping cough, tetanus, and measles.</p>
<p>Yet concerns about vaccination – or what’s known as <a href="https://www.who.int/immunization/sage/meetings/2014/october/SAGE_working_group_revised_report_vaccine_hesitancy.pdf?ua=1">vaccine hesitancy</a> – persist. This isn’t new: people have delayed being vaccinated, or point blank refused, since the first vaccines came off the production line. </p>
<p>In 2019, the World Health Organisation identified <a href="https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019">vaccine hesitancy</a> as one of the ten greatest threats to global health.</p>
<p>This is understandable. Vaccine hesitancy poses significant risks for those refusing to be vaccinated as well as the wider community. For example, delays and refusals of vaccination make communities unable to reach thresholds of coverage necessary for herd immunity. This happens when a large percentage of the inhabitants of an area is vaccinated against a disease, making the spread of the disease from person to person unlikely. As a result, the whole community becomes protected, not just those who were vaccinated. </p>
<p>Herd immunity thresholds vary with each disease. For example, herd immunity against measles requires about 95% of the population to be vaccinated. For COVID-19, data to calculate an accurate herd immunity threshold is limited, but it is currently estimated to be about 67%. </p>
<p>When herd immunity thresholds are not met, the risk of infection increases among susceptible individuals, leading to <a href="https://www.thinkglobalhealth.org/article/vaccine-hesitancy-escalating-danger-africa">outbreaks of vaccine-preventable diseases</a>. </p>
<p>Vaccine hesitancy has resulted in multiple vaccine-preventable disease outbreaks. These include the measles epidemics in Europe and North America between <a href="https://www.cdc.gov/globalhealth/measles/data/global-measles-outbreaks.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fglobalhealth%2Fmeasles%2Fglobalmeaslesoutbreaks.htm">2018 and 2020</a>. The polio vaccine boycott in Nigeria in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1831725/">2003–2004</a> is another striking example.</p>
<p>Research on vaccine hesitancy in South Africa is still limited. But growing evidence <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-578">suggests</a> that <a href="http://www.samj.org.za/index.php/samj/article/view/12516">it is</a> becoming a <a href="https://pubmed.ncbi.nlm.nih.gov/31521412/">problem</a>. </p>
<p>South Africa has made important advances in a number of its immunisation programmes over the past <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279621/">20 years</a>. The danger is that it could begin to fall behind if people increasingly question vaccines, seek alternatives, or decide to <a href="http://www.samj.org.za/index.php/samj/article/view/9654">postpone or reject vaccination</a> – even when vaccination services are available and accessible. </p>
<p>Scientists and policy makers need to know the scale of the problem so that tailored and targeted strategies can be developed to address it.</p>
<h2>A growing trend</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31831547/">In 2019</a>, more than half of vaccinators in selected healthcare facilities in Cape Town reported having encountered vaccine hesitant individuals at some point in their careers. </p>
<p>There were a number of reasons for the reluctance to receive childhood vaccinations. These included the fear of side effects, religious beliefs, and the need for natural immunity. </p>
<p>The healthcare workers said that the internet and social media were significant contributors to vaccine <a href="https://pubmed.ncbi.nlm.nih.gov/31831547/">hesitancy among caregivers</a>. </p>
<p>These findings were backed up by another <a href="https://pubmed.ncbi.nlm.nih.gov/31521412/">study</a> we did in 2019 in which we identified multiple misconceptions, conspiracy theories, and concerns expressed on Facebook about human papillomavirus (HPV) vaccination. HPV vaccination helps prevent cervical cancer and other HPV-associated diseases. At the moment, HPV vaccination is offered free of charge to grade 5 girls over the age of 9 years in public sector schools in South Africa. </p>
<p>Research stretching back over decades shows that there is a trend of a growing tide of misinformation and disinformation about vaccination on the internet. For example, there’s <a href="http://www.samj.org.za/index.php/samj/article/view/9654">evidence</a> that there was an increase in the numbers of anti-vaccination webpages in South Africa between 2011 and 2013. Advertisements appeared on more than half of the web pages. And two-thirds of these were sponsored by or linked to organisations with financial interests in discrediting vaccines. <a href="http://www.samj.org.za/index.php/samj/article/view/9654">Most web pages</a> (93%) claimed that vaccines were not safe. Nearly 80% of the anti-vaccination claims originated from the United States of America. </p>
<p>In a more recent <a href="https://gh.bmj.com/content/5/10/e004206">study</a>, we analysed a wide range of social media posts and found a significant relationship between foreign disinformation campaigns on social media and declining vaccination coverage. The study also shows a significant relationship between organisation on social media and public doubts regarding the safety of vaccines.</p>
<h2>Lots to be done</h2>
<p>Measuring the scale of the problem accurately isn’t easy. Most methods of doing this have been developed for <a href="https://www.tandfonline.com/doi/full/10.1080/21645515.2018.1460987">high-income countries</a>. These might not be appropriate for countries like South Africa. </p>
<p>In 2017, the vaccine implementation research portfolio at the <a href="https://southafrica.cochrane.org/our-work/vaccine-implementation-research">South African Medical Research Council</a> set about developing a vaccine hesitancy instrument. We wanted to develop a tool that would measure vaccine hesitancy in a <a href="https://www.fondation-merieux.org/wp-content/uploads/2017/11/vaccine-acceptance-2018-charles-wiysonge.pdf">South African</a> context. We have refined the instrument and started field-testing among healthcare workers in Cape Town. After this, field-testing will be expanded to other population groups and areas in the country. </p>
<p>It’s still early days but this tool is a key step towards measuring and addressing vaccine hesitancy in the country.</p>
<p>There is, however, a silver lining. There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3838535/">evidence</a> that vaccination decisions of most caregivers are influenced by advice given by their healthcare workers. Most caregivers consider healthcare workers as knowledgeable about the science behind vaccination and the benefits and risks of vaccination. </p>
<p>Nevertheless, vaccine hesitancy poses a serious threat to health efforts, particularly during a pandemic. It is pervasive, misinformed and <a href="https://pubmed.ncbi.nlm.nih.gov/30451037/">contagious</a>. Only a collective effort between parents, paediatricians, family doctors, public health officials, governments, the technology sector, and civil society will allow misinformation to be dispelled and confidence in vaccination to be enhanced.</p><img src="https://counter.theconversation.com/content/153549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccine hesitancy has resulted in multiple vaccine-preventable disease outbreaks. Research on vaccine hesitancy in South Africa is limited. But growing evidence suggests that it’s becoming a problem.Charles Shey Wiysonge, Director, Cochrane South Africa, South African Medical Research CouncilSara Cooper, Senior Scientist in Cochrane South Africa at the South African Medical Research Council (SAMRC) and Honorary researcher in the Division of Social & Behavioural Sciences in the School of Public Health, UCT, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1459862020-09-29T18:55:50Z2020-09-29T18:55:50ZYour child’s vaccines: What you need to know about catching up during the COVID-19 pandemic<figure><img src="https://images.theconversation.com/files/360348/original/file-20200928-18-nteh2q.jpg?ixlib=rb-1.1.0&rect=15%2C15%2C2596%2C1656&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting children vaccinated can protect them and others from potentially deadly diseases.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/photo-essay-in-a-mother-child-care-center-in-the-suburban-news-photo/151061313">BSIP/UIG via Getty Images</a></span></figcaption></figure><p>This spring, after stay-at-home orders were announced and schools shut down across the nation, many families stopped going to their pediatrician. As a result, kids have fallen behind on important childhood vaccinations. </p>
<p>Vaccination rates <a href="https://www.scientificamerican.com/article/vaccinations-have-sharply-declined-nationwide-during-the-covid-19-pandemic/">declined starkly</a> after mid-March, with up to 60% reductions in some areas of the country. Nationwide, vaccination rates dropped <a href="https://www.cms.gov/newsroom/fact-sheets/fact-sheet-service-use-among-medicaid-chip-beneficiaries-age-18-and-under-during-covid-19">by 22%</a> among Medicaid and Children’s Health Insurance Program recipients under 2.</p>
<p>Now that kids are coming back to <a href="https://uvahealth.com/findadoctor/profile/irene-p-mathieu">pediatricians like me</a>, many parents have questions about catching up.</p>
<h2>Why is it a problem that my child is behind on vaccines?</h2>
<p>Vaccines protect your child from serious communicable diseases including brain infections, pneumonia, bloodstream infections and, in the case of the HPV and hepatitis B vaccines, even some types of cancer. The vaccine schedule we use was created to maximize your child’s protection throughout life.</p>
<p>In addition to protecting your child, vaccines protect others by decreasing the circulation of dangerous germs in our communities – we call this “<a href="https://theconversation.com/herd-immunity-wont-solve-americas-covid-19-problem-139724">herd immunity</a>.” </p>
<p>Herd immunity is especially important to protect people who can’t get certain vaccines for medical reasons. When enough people are vaccinated, a disease can disappear altogether. For example, close to 95% of people need to be <a href="https://www.globalhealthnow.org/2019-12/myth-about-herd-immunity">vaccinated against measles</a> to stop transmission of that virus. When the number of people who are adequately vaccinated drops too low, the whole community is at risk of an outbreak. </p>
<p>With the COVID-19 pandemic continuing across the country, the last thing we need is an outbreak of another deadly disease.</p>
<h2>How do I figure out what my child needs to catch up?</h2>
<p>This depends on your child’s age and which vaccines they’ve already received. The best way to figure out what your child needs is to call your pediatrician’s office and ask. There is a clear “<a href="https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html">catch-up schedule</a>” that we use to figure out which vaccines a child needs and when they can be given.</p>
<p>Many parents worry that getting too many shots at once could be dangerous. However, the amount of material contained in each vaccine is very, very small compared with all the different germs and substances our kids breathe in, eat and drink every day, not to mention what they’re exposed to when they scrape a knee or elbow. </p>
<p>There really is <a href="https://media.chop.edu/data/files/pdfs/vaccine-education-center-too-many-vaccines.pdf">no such thing</a> as too many shots at once under current guidelines, although some shots can’t be given together on the same day.</p>
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<h2>What if my child is not feeling well when the pediatrician wants to give the vaccines?</h2>
<p>For most kids, it is <a href="https://www.cdc.gov/vaccines/parents/visit/sick-child.html">perfectly safe</a> to get vaccines when they have a mild illness – including a fever. Also, vaccines are no less effective if given when your child is sick. </p>
<p>It’s understandable that getting a lot of shots at once when your child isn’t feeling well can be upsetting for the child. You can talk to your pediatrician about which shots are most critical and ask that your child get those first and the rest on another day. At the same time, we still want people to stay home as much as possible to keep people safe from COVID, so try to get all of your child’s care done in as few visits as possible.</p>
<h2>Does my child really need the flu shot?</h2>
<p>The effectiveness of the flu shot varies each year. It is not 100% effective, but we still recommend it because this vaccine lowers your child’s risk of dying of the flu if he or she were to get sick. </p>
<p>Unfortunately, <a href="https://www.cdc.gov/flu/spotlights/2019-2020/2019-20-pediatric-flu-deaths.htm#:%7E:text=August%2021%2C%202020%20%E2%80%93%20CDC%20today,for%20last%20season%20to%20188.">188 children died of the flu</a> last year in the U.S. Many of these children were perfectly healthy before they got sick. Most of those who died had not received the flu shot.</p>
<p>Other parents worry that the flu shot itself will make their child sick. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>The injected influenza vaccine is made from dead flu virus, so <a href="https://theconversation.com/why-the-flu-shot-cannot-give-you-the-flu-and-why-you-should-get-one-now-124257">it is not possible to get the flu from the vaccine</a>. However, the shot <a href="https://www.cdc.gov/flu/prevent/keyfacts.htm">may cause</a> a low-grade fever, fatigue or muscle soreness and swelling where the shot was given. These are signs that the body’s immune system is responding to the vaccine, which is exactly what we want! It’s the body’s way of training itself to recognize the flu virus, so when children come into contact with the virus later, their bodies knows how to fight it.</p>
<h2>Should my child get the COVID-19 vaccine when one is available?</h2>
<p>It is too soon to make recommendations about who should get a COVID-19 vaccine. It is highly unlikely that a safe and effective vaccine against COVID-19 will be widely available before 2021.</p>
<p>Because COVID is still circulating in our communities, it’s that much more important that we all work to ensure children are as protected as possible from other deadly diseases.</p><img src="https://counter.theconversation.com/content/145986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Irène Mathieu does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond her academic appointment.</span></em></p>A pediatrician answers parents’ questions about catching up on missed childhood vaccinations and why that’s so important.Irène Mathieu, Pediatrician, Assistant Professor of Pediatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1381062020-06-14T12:29:02Z2020-06-14T12:29:02ZVaccinations skipped during COVID-19 shutdown may lead to outbreaks of other diseases<figure><img src="https://images.theconversation.com/files/341306/original/file-20200611-80789-1p00yas.jpg?ixlib=rb-1.1.0&rect=641%2C0%2C7279%2C5379&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The World Health Organization estimates that 117 million people worldwide may have missed a vaccination during the COVID-19 pandemic.</span> <span class="attribution"><span class="source">(Shutterstock))</span></span></figcaption></figure><p>Although COVID-19 is a new illness caused by a new virus, the fallout from the COVID-19 shutdown may put the world at risk for outbreaks of old illnesses: ones that were practically eradicated through vaccination.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&rect=181%2C0%2C4204%2C2711&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/341120/original/file-20200611-114118-1bpoksw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children may be falling behind on scheduled vaccinations during the COVID-19 shutdown.</span>
<span class="attribution"><span class="source">(Shutterstock))</span></span>
</figcaption>
</figure>
<p>The World Health Organization estimates that <a href="https://www.who.int/immunization/diseases/measles/statement_missing_measles_vaccines_covid-19/en/">117 million people worldwide</a> will miss out on vaccinations for preventable diseases due to COVID-19. Closer to home, the Canadian Paediatric Society is worried that Canadians will <a href="https://www.cbc.ca/news/health/covid-19-child-immunizations-1.5543286">fall behind</a> on their vaccination schedules. Vaccines are one of the most important public health tools at our disposal. Ignoring vaccinations can have dire consequences. </p>
<h2>Lessons from 1918</h2>
<p>I am a historian of medicine. I study the history of infectious diseases and vaccination. In recent months, I have focused my research on the understudied effects of the 1918 flu pandemic on public health in Canada. </p>
<p>The experience of the 1918 influenza should act as a warning for provincial public health programs. My research shows that in the years after the 1918 flu, Canada suffered a series of outbreaks of <a href="https://www.cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf">smallpox and typhoid</a> after vaccination took a backseat to the pandemic.</p>
<p>Provincial governments need to have a plan to get children back on track when COVID-19 subsides, or run the risk of creating an environment ripe for outbreaks of vaccine-preventable diseases such as measles.</p>
<h2>Establishing public health measures</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=498&fit=crop&dpr=1 600w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=498&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=498&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=626&fit=crop&dpr=1 754w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=626&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/339995/original/file-20200605-176564-1gfhlrk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=626&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Walter Reed Hospital flu ward in Washington D.C. during the flu epidemic of 1918-19.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Before the 1918 flu, local public health programs were temporary, and workers were volunteers. In 1923, the Health Board of Québec provided financial support to create <a href="https://utorontopress.com/ca/public-health-in-the-age-of-anxiety-2">permanent public health units</a>. As part of this, it instituted a hygiene week, when the government educated communities about the importance of public health measures, including vaccination. Ontario followed suit, in 1924, when the chief officer of health helped develop full-time public health units for the province. </p>
<p>Though it may seem that the 1918 flu directly spurred the development of permanent public health units and sophisticated routine vaccine programs, the truth is more complicated. My study of public health reports shows that after the 1918 flu, cases of smallpox and other preventable diseases spiked. </p>
<p>In 1920, Canada had 2,553 cases of smallpox, compared to a baseline of a couple hundred a year. Cases continued climbing to a peak of <a href="https://www.museumofhealthcare.ca/explore/exhibits/vaccinations/smallpox.html">3,300 in 1927</a>, before declining to near zero in the 1940s. In 1923, Cochrane, Ont. had an outbreak of typhoid with <a href="https://www.cpha.ca/sites/default/files/assets/history/book/history-book-print_all_e.pdf">800 cases and 50 deaths</a>. With a population of 3,400, cases represented almost a quarter of the population. </p>
<h2>Outbreaks in the wake of 1918 flu</h2>
<p>It is difficult to track vaccination uptake in the early 1900s, because records of vaccination during this period were spotty at best. Nonetheless, these lapses in public health expose failures to maintain adequate vaccination levels in communities across Canada in the wake of the 1918 flu, which interrupted many aspects of life including <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862334/">commerce, religion and vaccination</a>. </p>
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Read more:
<a href="https://theconversation.com/the-taming-of-polio-and-the-challenge-of-the-flu-116100">The taming of polio and the challenge of the flu</a>
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</em>
</p>
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<p>After the 1918 flu, however, public health officers did not take measures necessary to make up for lost time and missed vaccinations. It was not until several outbreaks had occurred, such as the one in Cochrane, that public health authorities regained control over preventable diseases. </p>
<p>Getting infectious diseases under control meant ensuring shots were administered as part of routine vaccination programs. This was a messy process and it did not happen all at once. However, by 1940 Toronto acheived the distinction of being the first city with a population over 500,000 to report <a href="https://utorontopress.com/ca/public-health-in-the-age-of-anxiety-2">no cases of smallpox</a>. Toronto achieved this by tracking vaccinations closely and by advertising smallpox vaccination at the same time every year.</p>
<h2>Vaccine misinformation</h2>
<p>Today, Canadian vaccination programs are threatened by vaccine misinformation, rejection and apathy. At the same time, a growing number of Canadians are <a href="https://www.cfp.ca/content/65/3/175">hesitant to vaccinate</a>. These factors leave Canada with slim margins on maintaining herd immunity, which refers to the point at which the percentage of people immunized ensures protection of the whole community from disease. Even before COVID-19, Canada has had outbreaks of measles in under-vaccinated communities. In 2019, Canada reported <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/measles-rubella-surveillance/2019/week-52.html">113 cases of measles</a>. </p>
<p>The COVID-19 pandemic has created many problems that will need attention. Already provinces are creating step-by-step plans to <a href="https://globalnews.ca/news/6920122/coronavirus-heres-how-provinces-plan-to-emerge-from-covid-19-lockdown/">reopen their economies</a>. What is needed now is for provinces to create step-by-step plans for identifying and contacting those who have fallen behind on their vaccinations.</p><img src="https://counter.theconversation.com/content/138106/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Derek Cameron received funding from the Social Science and Humanities Research Council. </span></em></p>Children may have fallen behind on their vaccination schedules during the pandemic, increasing the risk that COVID-19 may be followed by outbreaks of once-eradicated diseases.Derek Cameron, PhD Candidate in History, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1312322020-02-05T15:57:49Z2020-02-05T15:57:49ZVaccinating children – why peace of mind should not be forgotten when it comes to funding<figure><img src="https://images.theconversation.com/files/313786/original/file-20200205-149747-r9kzrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1385453168?src=jkf9PEdb4d2ziEPJcyShBw-1-85&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>Vaccinating children against serious diseases is a complicated process. Even after all the scientific discoveries and developments, there are important decisions to be made by parents and politicians. </p>
<p>In the UK, government policy on whether to fund new vaccines, or modify their availability, is based on advice from an <a href="https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation">independent scientific advisory group</a>. This involves weighing up the benefits and costs, and then deciding whether a vaccine is value for money. </p>
<p>The idea is to find a balance between the cost of doing something (such as routinely vaccinating all children against a particular disease) and how much benefit you get from doing it (such as health gains by preventing disease and the associated economic savings). </p>
<p>Yet the current approach does not take into account many of the benefits that vaccinations offer and which <a href="https://www.sciencedirect.com/science/article/pii/S1473309908702585">set them apart</a> from other health interventions. The fact that vaccinations are preventative rather than curative, for example, or that they offer long-term protection and increased peace of mind. This, in turn, could mean that vaccines are at a disadvantage compared with other health interventions when it comes to making decisions about funding. </p>
<h2>Vaccination factors</h2>
<p><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-943#Tab1">Previous research</a> suggests that parents make decisions about childhood vaccinations according to a mixture of social and personal factors. Social factors include societal norms and moral beliefs. Personal factors include perceived effectiveness, the risk of infection, side effects, and ease of access. </p>
<p>The peace of mind – a sense of wellbeing and reassurance – that comes from getting a child vaccinated could be another important personal factor. But little research has been done in this area, so the potential benefit is not currently considered by decision makers. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0264410X19316512?via%3Dihub">Our research</a> investigated “vaccine associated peace of mind” by discussing the topic with members of the public to see whether it was a factor in their experiences of vaccination. </p>
<p>We found that peace of mind was dependent on an individual’s knowledge about the benefits of having a specific jab. Feelings of reassurance were linked to knowing that once vaccinated, their child was protected against a disease. But for those few who considered vaccinations a routine health intervention, peace of mind was not mentioned. </p>
<p>Participants in one focus group said that the longer a vaccine had been available, the safer it felt to them. They spoke of being reassured by knowing a vaccination had been used for many years. </p>
<p>There were some exceptions. For example, although the <a href="https://www.nhs.uk/conditions/vaccinations/meningitis-b-vaccine/">MenB vaccine</a> (given to offer protection from life-threatening infections including meningitis and blood poisoning caused by meningococcal group B bacteria) was considered relatively “new” by many participants (it was <a href="https://www.gov.uk/government/publications/menb-vaccination-introduction-from-1-september-2015">introduced in 2015</a>), it brought increased peace of mind because of the severity of the diseases it prevented. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313710/original/file-20200205-149766-dola66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Peace in a bottle?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccine-vial-dose-flu-shot-drug-1046242816">Shutterstock/Numstocker</a></span>
</figcaption>
</figure>
<h2>Parental concerns</h2>
<p>Peace of mind was also found to vary over time. Although it was linked to knowledge about health benefits, or to reassurance received from healthcare providers, it could all be diminished by short-term concerns relating to the pain or distress their child might suffer when receiving an injection. </p>
<p>Also, certain vaccines offered less peace of mind if a parent had only experienced a mild form of the disease as a child, or had no personal experience at all. </p>
<p>Many of the parents we spoke to said that making vaccination decisions was a complex process, with each person choosing to vaccinate (or not) by balancing their beliefs about the benefits versus the potential risks. Some mentioned feelings of anxiety about making the wrong decision.</p>
<p>For most, the amount of peace of mind they reported was linked to their opinions about the severity of a disease and possible susceptibility. But concerns about vaccine-associated side effects were also found to reduce peace of mind. </p>
<p>Overall, the research found that vaccine associated peace of mind – although it varied in magnitude and duration – was a valued benefit for some people when making vaccination decisions for their children. This suggests that the current economic approach used to make funding decisions may not be enough. When it comes to improving public health, peace of mind should be considered in the future.</p><img src="https://counter.theconversation.com/content/131232/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Lasseter is supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions at the University of Bristol in partnership with Public Health England. This work was funded by the Meningitis Research Foundation via a charitable donation from Pfizer Limited. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care or Public Health England.</span></em></p>A sense of wellbeing can have an important affect on parents’ decisions when it comes to health care.Gemma Lasseter, Research Fellow, University of BristolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1226882019-08-30T11:36:08Z2019-08-30T11:36:08ZMeasles epidemic: parents reluctant to vaccinate their children need to hear of the horrors of forgotten diseases<figure><img src="https://images.theconversation.com/files/290185/original/file-20190829-106508-36u29k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-syringe-vaccine-616263095?src=-1-13">Billion Photos/Shutterstock</a></span></figcaption></figure><p>There’s been a surge in measles cases across Europe, putting people’s lives at risk according to new findings from the <a href="http://www.euro.who.int/en/media-centre/sections/press-releases/2019/european-region-loses-ground-in-effort-to-eliminate-measles">World Health Organization</a>. </p>
<p>The official figures show that approximately 90,000 cases have been reported for the first half of 2019. This is already more than the number of cases recorded for the whole of 2018 (84,462). </p>
<p>This has in part been put down to disinformation about the MMR (measles, mumps and rubella) vaccine on social media <a href="https://www.pathologyinpractice.com/story/27090/measles-the-importance-of-vaccination-disease-monitoring-and-surveillance">putting parents off vaccinating </a>their children.</p>
<p>Recent outbreaks of measles, which is much more infectious than mumps and rubella, have been widely <a href="https://www.independent.co.uk/topic/measles">reported</a>. But what is less well known is that there have been a few babies born with congenital rubella syndrome in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5954604/">the UK in the past few years</a>. This is an illness resulting from an infection of the rubella virus during pregnancy.</p>
<h2>Rubella babies</h2>
<p>People under the age of 50 are unlikely to have heard about “Rubella babies”, but in the 1940s, the Australian paediatric ophthalmologist, Norman Gregg, made <a href="https://sydney.edu.au/medicine/museum/mwmuseum/index.php/Gregg,_Sir_Norman_McAlister">the connection</a> between women being infected with German measles (rubella) during pregnancy and their children being born deaf and blind and sometimes with other disabilities.</p>
<p>Many babies infected with the virus while in the womb do not survive, but in the 1960s in the UK about 300 children each year were born with “congenital rubella syndrome” and needed care. By 1970, a safe effective Rubella vaccine was available and the UK began <a href="https://academic.oup.com/cid/article/7/Supplement_1/S11/398615">vaccinating school girls</a>. A screening programme, which involved testing blood samples from women of childbearing age to see whether they had previous immunity to the virus, also began. Those who did not did not have protection were offered the vaccine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290190/original/file-20190829-106480-1a59rmq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rubella is a viral illness that causes a mild fever and a skin rash.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/treatment-rubella-viral-infection-concept-girls-1056168554?src=-1-0">OneSideProFoto/Shutterstock</a></span>
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</figure>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/measles-should-vaccinations-be-compulsory-114481">Measles: should vaccinations be compulsory?</a>
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</em>
</p>
<hr>
<p>Although women starting in particular jobs – such as health care and teaching – were screened, most of the tests were done on pregnant women as part of their 12 week check. In 1988, the Rubella vaccine become the R in the MMR and the strategy changed to vaccinating <a href="https://www.nhs.uk/conditions/vaccinations/mmr-vaccine/">all pre-school children</a>.</p>
<p>The idea was that if all young children were protected, then these infections would eventually not be circulating at all. During 2016 and 2017, routine screening for Rubella antibodies during pregnancy was phased out across the UK. It was considered not cost-effective, since Rubella infection during pregnancy was extremely rare and most people in the UK of child bearing age should have received MMR as children. But the recent outbreaks of measles across the world have illustrated the <a href="https://www.pathologyinpractice.com/story/27090/measles-the-importance-of-vaccination-disease-monitoring-and-surveillance">problems with MMR uptake</a>.</p>
<h2>Misinformation and memory</h2>
<p>Why are people reluctant to have screening tests and vaccinations to prevent diseases? While some of the reasons may include loss of trust in “experts” and people in authority, I wonder if it is also partly because the stories of such diseases have been long forgotten. </p>
<p>When Eva Peron, the First Lady of Argentina, died from cervical cancer at the <a href="https://www.biography.com/political-figure/eva-peron">age of 33 in 1952</a>, for example, early diagnosis was not possible – and chemotherapy treatment was in its infancy. So for women who developed this disease, a distressing illness and painful death were more or less inevitable. </p>
<p>The design of a laboratory method for detecting early changes in the appearance of cells in the cervical region – the “Pap smear” – eventually made regular mass screening possible. Since the introduction of the scheme into the UK in 1988, it has prevented thousands of <a href="https://www.sciencedirect.com/science/article/pii/S0140673604166749">premature deaths in women each year</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=470&fit=crop&dpr=1 600w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=470&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=470&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=590&fit=crop&dpr=1 754w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=590&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/290186/original/file-20190829-106504-1p0ujjn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=590&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">‘Vaccinating the poor of New York City against smallpox in 1872’. In 1863, mass production of smallpox vaccine was developed, allowing for broad immunisation of North American and European populations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/vaccinating-poor-new-york-city-against-242820433?src=-1-2">Everett Historical/Shutterstock</a></span>
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<p>The discovery that most but, crucially, not all cases of cervical cancer are attributable to Human Papillomavirus (HPV) infection led to the development of the HPV vaccine which is now given routinely to <a href="https://www.who.int/immunization/diseases/hpv/en/">teenage girls</a> – and in some countries boys as well. Evidence from the UK programme, which began in 2009, suggests the vaccine is very effective and this should help to further reduce the number of women with cervical cancer among the under 30s. </p>
<p>Yet despite all that’s known about cervical cancer and the importance of going for a regular smear test, many women still appear to be reluctant to go. It’s estimated that about <a href="https://www.bbc.co.uk/news/uk-england-45593583">three million women</a> across England have not had a smear test for at least three-and-a-half years.</p>
<p>In the 20th-century, there were major advances in disease prevention, which improved both life expectancy and quality of life. But it seems these health and societal developments are now being overlooked. Indeed, giving people information and instructions is no longer working. So perhaps it’s time to appeal to people’s hearts by telling the stories of these diseases – and how they have affected real people. </p>
<p><a href="https://www.who.int/bulletin/volumes/87/8/09-069559/en/">Gruesome photos on cigarette packages</a>, for example, massively help to reduce tobacco use, so maybe something similar now needs to happen in terms of vaccinations to tackle the latest epidemic and anti-vaxxer campaigns around the world.</p><img src="https://counter.theconversation.com/content/122688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Pitt does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s not just measles you need to worry about.Sarah Pitt, Principal Lecturer, Microbiology and Biomedical Science Practice, University of BrightonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1192302019-06-25T08:45:13Z2019-06-25T08:45:13ZTo protect us all, babies travelling overseas may need the measles shot at 6 months instead of 12<figure><img src="https://images.theconversation.com/files/280652/original/file-20190621-149839-16frgzw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you're going overseas with your little one, you can vaccinate them against measles early. But they'll still need their regular jab when they turn one.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/778314598?src=Cwbn69UEk_nZGZFSRL2U1Q-1-1&studio=1&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>This year, we’ve seen a <a href="https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/">resurgence of measles</a> around the globe. The World Health Organisation (WHO) recorded more than 230,000 cases in the first five months of 2019, compared to 160,000 in a similar period in 2018.</p>
<p>Australia has had <a href="http://www9.health.gov.au/cda/source/rpt_3.cfm">128 measles cases</a> since the beginning of the year compared to a total of 103 cases for all of 2018.</p>
<p>Measles causes fever, cough and a rash. But it can also cause more serious illness and even death. Babies and people with weakened immune systems are at the greatest risk of complications.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/prepare-for-a-healthy-holiday-with-this-a-to-e-guide-69552">Prepare for a healthy holiday with this A-to-E guide</a>
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<p>The best protection against measles is vaccination. Two doses of a measles-mumps-rubella (MMR) vaccine has a <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/measles">success rate</a> of more than 98%.</p>
<p>Under Australia’s National Immunisation Program, children receive two doses of MMR. The first dose is given at 12 months of age and a second dose at 18 months.</p>
<p>But given the rise of measles cases around the world, doctors are now calling for <a href="https://www.abc.net.au/news/2019-06-21/measles-cases-up-but-young-babies-dont-get-vaccine/11224336">infants travelling overseas</a> to be assessed by their GP to see whether they need the measles vaccine at six months.</p>
<h2>Measles spreads easily</h2>
<p>Many adult Australians may not have received two doses of MMR vaccine, as only one dose was recommended before 1992 (a single dose is <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/measles">around 95% effective</a>).</p>
<p>Unvaccinated travellers to countries with a higher prevalence of measles can unknowingly bring measles back to Australia. Current <a href="https://www.cdc.gov/measles/plan-for-travel.html">measles hot spots</a> include Israel, Thailand, Vietnam, Japan, Ukraine, Philippines and the United States (especially New York). </p>
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<img alt="" src="https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281089/original/file-20190625-81750-1q5sapp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People can catch up on their measles vaccinations at any age.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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</figure>
<p>Measles is highly infectious. Once imported from overseas, it’s adept at seeking out and infecting the unvaccinated in a population. </p>
<p>The recent resurgence of measles has led experts to advise that people ensure they have had <a href="https://www.ausdoc.com.au/news/aussie-travellers-urged-get-vaccinated-ahead-mmr-shortages">two lifetime doses</a> of the MMR vaccine prior to travel.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/six-myths-about-vaccination-and-why-theyre-wrong-13556">Six myths about vaccination – and why they're wrong</a>
</strong>
</em>
</p>
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<h2>Mums protect their babies in the beginning</h2>
<p>As the first MMR vaccine is not given until 12 months of age, infant travellers who are too young to have received their first dose of MMR are particularly at risk of contracting measles.</p>
<p>We don’t routinely recommend MMR immunisation for infants younger than 12 months because of the presence of maternal antibodies. <a href="https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/important-maternal-vaccines.html">During pregnancy</a>, antibodies which protect against many diseases, such as measles, whooping cough and influenza, are actively transferred through the placenta to the baby.</p>
<p>Most mothers have antibodies to protect against measles either from receiving the MMR vaccine themselves during childhood or adolescence, or as a result of prior infection.</p>
<p>But during the first year of life, the antibodies protecting the baby naturally wane. The antibody levels are usually high enough in the first six months of life to protect against measles.</p>
<p>Once an infant reaches 12 months of age, the measles antibodies have usually sufficiently disappeared and can no longer provide protection. For this reason, we give the first dose of MMR vaccine at 12 months old.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-born-between-1966-and-1994-are-at-greater-risk-of-measles-and-what-to-do-about-it-110167">Why people born between 1966 and 1994 are at greater risk of measles – and what to do about it</a>
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</em>
</p>
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<h2>Changing the recommendations</h2>
<p>Maternal antibodies can interfere with and reduce the response to an MMR vaccine given to an infant before 12 months of age.</p>
<p>The WHO Expanded Program on Immunisation recommends the first dose of MMR vaccine be given at <a href="https://www.who.int/wer/2017/wer9217/en/">nine months old</a>. This is because in many countries the rates of measles are higher than in Australia, and the increased risk of infection outweighs any reduced vaccine response because of persisting maternal antibodies. </p>
<p>The WHO recommends that for countries like Australia that have achieved low rates of transmission, it’s better to give the first MMR vaccine at 12 months, because higher protection occurs among older infants as there is less interference from maternal antibodies.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-combination-vaccines-dont-overwhelm-kids-immune-systems-82377">No, combination vaccines don't overwhelm kids' immune systems</a>
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<p>Until recently, our immunisation handbook stated that children as young as nine months could receive the MMR vaccine in certain circumstances, including travel to highly measles-endemic areas and during outbreaks. </p>
<p>But given the rise in measles globally, the recommended age at which Australian infants can receive MMR vaccine in special circumstances <a href="https://immunisationhandbook.health.gov.au/">has been lowered</a> from nine months to <a href="https://www.ausdoc.com.au/news/measles-outbreak-risk-babies-should-have-mmr-six-months">six months</a>.</p>
<p>The <a href="https://www.cdc.gov/vaccines/vpd/mmr/hcp/recommendations.html">US</a> and <a href="https://www.gov.uk/government/publications/measles-the-green-book-chapter-21">England</a> also state vaccination from six months of age can occur for travellers and to help control outbreaks.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/281090/original/file-20190625-81754-v9fqij.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Babies inherit antibodies that protect against measles from their mums while they’re in the womb, but these wane over time.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
</figcaption>
</figure>
<p>While MMR vaccines are normally free, because this early dose is not part of the National Immunisation Program, parents may need to pay an out-of-pocket fee to get it. Check with your GP.</p>
<p>Importantly, if MMR is given before 12 months old, infants still need two further doses of measles-containing vaccine. This is to account for the possibility the early dose may not have been completely effective because of interference from the maternal antibodies. </p>
<p>They should receive the next dose of MMR vaccine at 12 months of age or four weeks after the first dose – whichever is later. They should then receive their final dose of measles-containing vaccine – an MMR and varicella (chickenpox) combination, known as MMRV – at 18 months. Both these vaccine doses are free under the National Immunisation Program.</p>
<h2>MMR is safe and effective for babies</h2>
<p>A <a href="https://www.who.int/immunization/sage/meetings/2015/october/2_MCV1_below_9_months_Effect_safety_28092015.pdf">recent review</a> of MMR vaccines in infants under nine months found the overall effectiveness was 72%. So it’s not quite as effective as the near complete protection afforded by vaccination at 12 months and older, but still has a very strong chance of being effective. </p>
<p>MMR vaccine in infants from six months old was considered safe, with no reports of serious events recorded across seven studies in the review. Fever and rash were the most common adverse reactions, occurring in 5-10% of infants. This is similar to vaccination at 12 months old.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-up-to-date-with-your-vaccinations-116510">Health Check: are you up to date with your vaccinations?</a>
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<p>Parents of young infants planning international travel should talk to their GP. The GP will consider factors including the length of the trip and destination countries when giving advice. </p>
<p>Adult travellers, too, should review their own vaccination record and speak to their GP if they are unsure they are fully protected.</p>
<p><em>This article originally said parents would need to pay approximately A$50 to obtain the MMR vaccine for infants under 12 months. The text has been updated to say they may need to pay an out-of-pocket fee, as this can vary, and the cost of the vaccine may be covered in <a href="https://www.health.nsw.gov.au/immunisation/Documents/gp-measles-update.pdf">some jurisdictions</a>.</em></p><img src="https://counter.theconversation.com/content/119230/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the National Health and Medical Research Council for his Career Development Fellowship.</span></em></p><p class="fine-print"><em><span>Alexis Pillsbury and Jean Li-Kim-Moy do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Babies are normally vaccinated against measles at 12 months old. But doctors are now suggesting having the shot as early as six months might be worthwhile for youngsters traveling overseas.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyAlexis Pillsbury, Senior Research Officer, National Centre for Immunisation Research and Surveillance, University of SydneyJean Li-Kim-Moy, General Paediatrician; Research Fellow, National Centre for Immunisation Research and Surveillance, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1163342019-05-13T21:32:39Z2019-05-13T21:32:39ZMeasles outbreak: Why are anti-vaxxers risking a public health crisis?<figure><img src="https://images.theconversation.com/files/272527/original/file-20190503-103071-v6avgb.jpg?ixlib=rb-1.1.0&rect=188%2C104%2C6591%2C4526&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A risk analysis could offer insight into the anti-vaccination decision of some parents.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The current outbreak of measles has startled public health practitioners, who <a href="https://www.cdc.gov/measles/about/history.html">declared measles controlled over two decades ago</a>. We are now grappling with <a href="https://www.theglobeandmail.com/canada/article-as-us-battles-measles-emergency-patchy-vaccination-rates-raise/">a low-level epidemic</a> that may become endemic. Health professionals, armed with <a href="https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/">the science to back up vaccination,</a> strongly disapprove of parents who do not vaccinate their children. They characterise objections to vaccines as ignorant and <a href="https://blogs.scientificamerican.com/observations/opting-out-of-vaccines-should-opt-you-out-of-american-society/">irresponsible</a>.</p>
<p>Measles caused 110,000 deaths worldwide in 2018, but so far, only 65 occurred in the Americas (mostly in Venezuela and Brazil) and none in <a href="https://www.cdc.gov/measles/cases-outbreaks.html">North America</a>. In Canada, the small but rapidly <a href="https://www.canada.ca/en/public-health/services/diseases/measles/surveillance-measles/measles-rubella-weekly-monitoring-reports.html">trending upward number of cases</a> is far from an epidemic. </p>
<p>However, with over 200,000 unvaccinated children <a href="https://www.ctvnews.ca/health/287-000-young-children-in-canada-don-t-have-the-measles-vaccine-unicef-1.4393929">under the age of five</a> and some areas well below the target immunization rate of <a href="https://www.winnipegfreepress.com/opinion/editorials/low-vaccination-rates-troubling-508967462.html">95 per cent</a>, this may change quickly.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=477&fit=crop&dpr=1 600w, https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=477&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=477&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=599&fit=crop&dpr=1 754w, https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=599&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/272521/original/file-20190503-103085-d6l40z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=599&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines protect children from measles, a highly contagious airborne disease.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Measles is a highly contagious airborne disease with a relatively small rate of serious <a href="https://www.cdc.gov/measles/about/complications.html">complication</a>. With the recommended double dose, the measles, mumps, rubella (MMR) vaccine is <a href="https://www.cdc.gov/measles/vaccination.html">97 per cent effective against measles</a>. </p>
<p>Anti-vaxxers also cite the <a href="https://www.nvic.org/vaccines-and-diseases/measles/measles-vaccine-injury-death.aspx">complications of vaccination</a> as a reason to doubt the value of the MMR vaccine. But these complications are exceedingly rare. </p>
<p>Weighing the decision of not to vaccinate with the probability of falling ill is at the heart of the risk analysis made by all parents.</p>
<h2>Applying risk analysis to a public health crisis</h2>
<p>I am an economist and <a href="https://www.acsh.org/tags/anti-vaxx">the anti-vaxx movement</a> makes me think of how a risk analysis could offer insight into the anti-vaccination decision of some parents.</p>
<p>Risk analysis uses probability to predict the ultimate impact of a <a href="https://www.investopedia.com/terms/r/risk-analysis.asp">decision</a>. We use risk analysis every day from simple problems such as whether to take an umbrella based on a weather forecast, to assessing when it is safe to cross over into oncoming traffic to pass another car. Getting wet because we forget an umbrella has a smaller consequence than making a poor car-passing decision. </p>
<p>Just how do we combine probability of an outcome with the impact of that outcome to make the best decision? </p>
<p>Most commonly, everyday experience is our guide. We get wet once because we leave the umbrella at home, and then we start using the weather forecast and the probability of precipitation as a guide. Those of us who are averse to a bad hair days will pack an umbrella with just a 10 per cent chance of rain. Others will take no preventive action until forecasters set precipitation at 75 per cent. We balance the probability of an occurrence with its perceived cost or benefit if that outcome transpires.</p>
<p>The essential problem with risk analysis regarding vaccines and anti-vaxxers is that parents have increasingly limited time to assess complex medical issues. Risk analysis requires the balancing of probabilities and context and that is hard to do with health related decisions. </p>
<h2>Anti-vaxxers</h2>
<p>Normally for health matters we have relied on experts such as a family physicians or public health information offered by governments and trusted third parties. </p>
<p>But medical advice no longer comes just from family physicians. A growing panoply of wellness practitioners advise the public. While creating a <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.49.6.786">holistic definition of health</a> makes sense, it has also had the unintended consequence of creating an opening for <a href="https://vancouversun.com/opinion/op-ed/timothy-caulfield-are-we-enabling-harmful-wellness-woo">an army of so called “experts” who opine on health matters</a>, often crowding out information from traditional medical sources. </p>
<p>Also, as I recall when a parent of young children, <a href="https://www.parents.com/baby/new-parent/sleep-deprivation/how-to-get-sleep/">many parents are sleep deprived</a>, giving them little time to fact-check so many rely on the advice of friends and doctors. Social media has also created <a href="https://www.theguardian.com/media/2019/feb/01/facebook-youtube-anti-vaccination-misinformation-social-media">echo chambers of misinformation</a> and it is easy to fall into a circle of “virtual” authorities that first create then build on misinformation. </p>
<p>Complicating the assessment of risk from measles is the increasingly <a href="https://vaccinechoicecanada.com/">sophisticated</a> internet-based advocacy against vaccination that sow fear, uncertainty and doubt. </p>
<p>For example, although the direct link between the MMR (measles, mumps, rubella) vaccine and autism has been <a href="https://www.nytimes.com/2019/03/05/health/measles-vaccine-autism.html">laid to rest repeatedly and most recently using big data,</a> anti-vaxxers continue to circulate the weak association between aluminum and autism and the fact that some vaccines contain aluminum salts. This partial information leads to an erroneous inference that measles vaccine can lead to autism. </p>
<p>In fact, the MMR vaccine does not contain aluminum salts. Aluminum is the <a href="https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients/aluminum">third-most-abundant element</a> after oxygen and silicon, and any vaccine is a minor source of this element for all of us. But the lingering and faulty inference is that vaccinating your children against measles exposes them to high levels of aluminum and therefore raises the <a href="https://vaccinechoicecanada.com/in-the-news/measles-how-about-autism/">risk for autism</a>. </p>
<p>Many parents do not have the time or ability to undertake the research to penetrate the misinformation of the anti-vaxxers and therefore can be left with a flawed analysis of the risks associated with not vaccinating their children. </p>
<h2>Combating misinformation</h2>
<p>Let’s try and understand why parents are making these dangerous health decisions. I believe that if parents have more accessible information, they may be more able to undertake a true risk assessment of vaccinations.</p>
<p>Taking on the “myth-information” of anti-vaxxers directly in sharp concise messages and calling them out by name will be more successful than general information on web sites.</p>
<p>Parents need to become better consumers of information: always check the sponsors of websites offering medical advice.</p>
<p>But this may not be enough. I tend to take medical advice on vaccinations. When my physician suggested I was of an age to get the shingles vaccine, I did. But I was ready to do this anyway as I know three people who have had shingles, one mild, the other moderate with lingering pain to this day, and one who had a severely disfiguring case that triggered early retirement. </p>
<p>My direct experience with the disease really prompted my decision to vaccinate.</p>
<p>I fear that only when some children die, or become severely damaged as was common in the pre-vaccination days, will risk become real to vaccine-hesitant parents, and then we will see a stampede to get the shots.</p><img src="https://counter.theconversation.com/content/116334/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gregory C Mason receives funding from the Thorlakson Family Foundation for research in the impact of telemedicine and electronic health records in health outcomes. He has also been funded by Worker's Compensation Board of Manitoba for research into the intangible costs of workplace accidents as well as the Manitoba Government to examine the value for money of cancer screening.</span></em></p>An economics risk analysis offers some insight into the modern anti-vaxx movement.Gregory C Mason, Associate Professor of Economics, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1064792018-12-06T11:42:00Z2018-12-06T11:42:00ZCountering misinformation about flu vaccine is harder than it seems<figure><img src="https://images.theconversation.com/files/249041/original/file-20181205-186070-12am6mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Californians in June 2015 protest a bill that did away with personal belief exemptions for vaccinating children before they enter school.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Vaccines-California/6e30acb541bf49ab89209e7ad3725186/56/0">Rich Pedroncelli/AP Photo</a></span></figcaption></figure><p><a href="https://theconversation.com/desinformacion-y-la-vacuna-contra-la-gripe-3-lecciones-para-combatir-mitos-108862"><em>Leer en español</em></a>.</p>
<p>Many Americans hold beliefs about the flu vaccine that are at odds with the best available scientific evidence. For example, <a href="https://www.sciencedirect.com/science/article/pii/S0264410X14015424">a recent study</a> found that more than two-fifths, or 43 percent, of Americans believe that the seasonal flu vaccine can give us the flu. Scientific research strongly suggests that this is not true. Because most modern flu shots <a href="https://www.cdc.gov/flu/protect/keyfacts.htm">do not contain a live virus</a>, the shot itself simply cannot get us sick with the flu. </p>
<p>Widespread misinformation about flu vaccine safety is an important public health problem, because people who believe that the flu vaccine can make us sick <a href="https://www.sciencedirect.com/science/article/pii/S0264410X14015424">may be less likely</a> to vaccinate themselves. In 2017, and in <a href="https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm">every flu cycle since 2010</a>, <a href="https://www.cnbc.com/2017/09/28/flu-season-fewer-than-half-of-americans-vaccinated.html">less than half</a> of American adults chose to vaccinate themselves against the flu. </p>
<p>Low flu vaccine uptake is especially concerning this year. Recent Centers for Disease Control and Prevention estimates suggest that the most recent flu cycle was one of the deadliest ever – <a href="https://www.nytimes.com/2018/10/01/health/flu-deaths-vaccine.html">as nearly 80,000</a> Americans died from the flu and flu-related complications in 2017. That’s more than double the number of Americans who die in <a href="https://www.vox.com/2018/9/27/17910318/flu-deaths-2018-epidemic-outbreak-shot">traffic collisions</a>, in a typical year.</p>
<p>Consequently, figuring out how public health professionals can most effectively combat misinformation about the flu vaccine is a critically important question for public health research. Looking at the latest research, we review the effectiveness of several communication strategies designed to reduce misinformation about the flu – and childhood – vaccines. </p>
<h2>Strategy No. 1: Just the facts</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249042/original/file-20181205-186064-jxixf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Explaining that vaccines do not cause autism and have few side effects does not seem to matter to those who oppose vaccination.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medication-drug-needle-syringe-drugmedical-vaccine-735830812?src=XniXufeqF_jeY2X3X2kaNA-1-64">Numstocker/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>One way that public health researchers and professionals attempt to correct misinformation about the flu is by attempting to educate people about its causes and severity, and to provide them with information about flu vaccine safety. </p>
<p>In general, the “just the facts” approach has limited effectiveness. For example, <a href="https://www.sciencedirect.com/science/article/pii/S0264410X14015424">a recent study</a> found that providing people with information about the health risks posed by seasonal influenza neither improved their likelihood of getting the flu vaccine nor decreased misinformation about flu vaccine safety. Scholars have found <a href="http://pediatrics.aappublications.org/content/133/4/e835">a similar pattern of results</a> when attempting to provide people with information about the health risks posed by other diseases as well.</p>
<p>Providing people with information about flu vaccine safety specifically may be somewhat more effective – at least at reducing misinformation. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jasp.12453">Recent</a> <a href="https://www.sciencedirect.com/science/article/pii/S0264410X14015424">academic</a> <a href="http://pediatrics.aappublications.org/content/133/4/e835">studies</a> have shown that presenting survey respondents with facts about vaccine safety can decrease the extent to which survey respondents believe that vaccines are unsafe. </p>
<p>But, there’s a catch. People who become less likely to believe misinformation about vaccine safety are not necessarily more likely to get vaccinated, due to something scholars call the “backfire effect.” </p>
<p>The <a href="https://link.springer.com/article/10.1007/s11109-010-9112-2?LI%3Dtrue">backfire</a> <a href="https://journals.sagepub.com/doi/abs/10.1177/2053168017716547">effect</a> occurs when efforts to provide people with information which challenges their prior beliefs can actually make them more resistant to taking action based on that information. For example, <a href="https://www.sciencedirect.com/science/article/pii/S0264410X14015424">one study</a> found that people who were told that the flu vaccine does not contain a live virus – and therefore cannot give one the flu – were more likely to report thinking that vaccines were safe. But they were also less likely to consider getting vaccinated themselves. </p>
<h2>Strategy No. 2: Bust the myths</h2>
<p>A second strategy that public health researchers and professionals use to correct misinformation about the flu involves tackling the myths directly by engaging in “myth busting.” This is closely tied to the first approach, except that it frequently involves exposing people to a piece of misinformation about the flu vaccine in an effort to discredit it. </p>
<p>That of course, is problematic, given that repeating the myth might increase the odds of people believe in it. And correcting misinformation is very difficult task, primarily because misinformation tends to be “<a href="https://journals.sagepub.com/doi/full/10.1177/1529100612451018">sticky</a>.” Therefore, even when “myth busting” works, the effects might not last a very long time. One <a href="https://link.springer.com/article/10.3758%2Fs13423-011-0173-y">study</a>, for example, looked at people’s misperceptions about basic science questions, provided them with corrections, and then reinterviewed them a week later. The result? Even those for whom the correction worked in the beginning returned to hold the initial, misinformed opinion. </p>
<p>While this may sound pretty bleak, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jasp.12453">scholars</a> <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175799">studying</a> this topic did find that certain approaches to “myth busting” might work. A worthwhile approach, for example, avoids repeating misinformation (such as saying that the flu shot includes a live virus) first to then “debunk” it. Instead, the focus should be on presenting people with the myth correcting information prior to the misinformation. </p>
<p>Scholars also <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jasp.12453">suggest</a> that making “myth busting” information as interesting and engaging as the myth itself, to ensure that it is memorable. That approach is not ideal, but it has been found to reduce the negative effects of misinformation on intention to vaccinate. It also <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jasp.12453">reduces the opportunity</a> for the correction to backfire, at least in <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2819073">some contexts</a>.</p>
<h2>Strategy No. 3: ‘If you get vaccinated, I will too … ’</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249044/original/file-20181205-186073-ahqxfo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A child about to receive a vaccine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-happy-girl-get-injection-vaccination-379214668?src=XniXufeqF_jeY2X3X2kaNA-1-58">didesign021/Shutterstock.com</a></span>
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</figure>
<p>A third strategy that health researchers and professionals use to encourage people to get the flu vaccine attempts to appeal to people’s desire to reciprocate. This often takes the form of appeals to larger group behavior, or emphasizing the importance of getting vaccinated to protect others in the community, irrespective of whether or not people subscribe to scientific consensus on vaccine safety.</p>
<p>Some studies suggest that this approach can be effective, for some people. <a href="https://www.nature.com/articles/s41562-017-0056">Recent work</a> found that cultures that focus on collective benefits have higher rates of compliance with vaccines and communicating the concept of “herd immunity” improves an individual’s willingness to get vaccinated. Similarly, <a href="https://www.sciencedirect.com/science/article/pii/S1054139X12000961">another study</a> found that those who believe their network supports vaccination feel more positively towards vaccines and express stronger intent to vaccinate themselves.</p>
<p>While it seems like individuals might have an interest in protecting the health of others for some sense of the “greater good,” the benefits of appealing to this sentiment are limited. Studies find that this type of message often produces mixed results. For example, <a href="https://khaglin.weebly.com/uploads/4/4/6/1/44617687/vaccines_commimm.pdf">one study</a> found that while an appeal to social identity and the behavior of others in their community may work for some groups, overall, appeals to join others getting vaccinated did not change behavioral intentions. Another <a href="http://psycnet.apa.org/record/2013-30843-007?casa_token=Ohj5Oxhlz8oAAAAA:NhEPICmhOBuqccKmrLwT988-oEpKGji5gY_yvUxdyrWrfJlxPIQX0pFwgxIl1vWFo-S_hfe96Ytax9-VqTyg204">study</a> found that communications about social and community benefits were only effective when the costs of getting vaccinated were low. In other words, appeals to reciprocity may work for some individuals, but overall do not have a strong effect. </p>
<h2>Where does this leave us?</h2>
<p>Correcting misinformation about the flu vaccines is hard, and the academic literature provides mixed signals about approaches to tackling this problem. The best evidence suggests that a more effective way of dealing with misinformation is not spreading it in the first place. That means avoiding repeating various myths, even if you’re debunking them. Appealing to widely recognized and accepted societal norms may be also effective, under some circumstances. It also cautions us to be aware that correcting misinformation does not guarantee that people will pursue healthy behaviors.</p>
<p>This is, however, just a starting point. We encourage scholars, health professionals and science communicators to devise and test alternative approaches to correcting misinformation about vaccines. For example, appeals that discuss the deadly nature of the flu virus, compared to past years and other common causes of death, such as car crashes, may make the risks of getting the flu more tractable, in a way that encourages vaccination in the general population. </p>
<p><em>Editor’s note: This article was updated to clarify that flu shots cannot get people sick with the flu. It was also changed to clarify that the flu shot does not contain live virus; a weakened live virus is used in the nasal spray flu vaccine.</em></p><img src="https://counter.theconversation.com/content/106479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dominik Stecula receives funding from the Social Science and Humanities Research Council of Canada for part of his research on misinformation. </span></em></p><p class="fine-print"><em><span>Kathryn Haglin and Matt Motta do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccination rates for children in some parts of California are down, despite a law that narrowed exemptions. Here’s a look at why people refuse to listen to evidence when it comes to the flu vaccine.Matt Motta, Postdoctoral Fellow in the Science of Science Communication at the Annenberg Public Policy Center, University of PennsylvaniaDominik Stecuła, Postdoctoral Fellow at the Annenberg Public Policy Center, University of PennsylvaniaKathryn Haglin, Postdoctoral Fellow at the Annenberg Public Policy Center, University of PennsylvaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1061412018-11-19T11:37:47Z2018-11-19T11:37:47Z3 ethical reasons for vaccinating your children<figure><img src="https://images.theconversation.com/files/245855/original/file-20181115-194497-k3ffuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine work because they help create herd immunity.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-looking-his-arm-while-227904523?src=cA4V5TbdL5K95Fdnfw39dg-1-10">JPC-PROD/Shutterstock.com</a></span></figcaption></figure><p>Across the country, <a href="https://www.apnews.com/87fcfe6ec2b34ca8900f4e7bc1e5cf81">billboards are popping up</a> suggesting that vaccines can kill children, when the science behind vaccination is crystal clear – vaccinations are <a href="https://www.ncbi.nlm.nih.gov/pubmed/25086160">extremely safe</a>. </p>
<p>Researchers who study the <a href="https://www.routledge.com/Values-and-Vaccine-Refusal-Hard-Questions-in-Ethics-Epistemology-and/Navin/p/book/9781138790650">beliefs of anti-vaxxers</a> have found <a href="https://theconversation.com/anti-vaccination-beliefs-dont-follow-the-usual-political-polarization-81001">many different reasons</a>, not just religious or political, as to why some parents refuse to get their children vaccinated. </p>
<p>As a <a href="https://scholar.google.com/citations?hl=en&user=igbI6WoAAAAJ">bioethicist</a> who investigates how societal values impact medicine, I consider such decisions to be downright indefensible. And here are three reasons why. </p>
<h2>1. Failure to contribute to the public good</h2>
<p>Public goods benefit everyone. Take the example of roads, clean drinking water or universal education. <a href="https://books.google.com/books/about/Health_Civilization_and_the_State.html?id=Uz5ExznezQoC">Public health</a> – the health of the overall population as a result of society-wide policies and practices – also falls into this category. </p>
<p><a href="http://www.hup.harvard.edu/catalog.php?isbn=9780674005112">Many ethicists</a> argue that it is unfair to take advantage of such goods without doing one’s own part in contributing to them. </p>
<p><a href="http://www.who.int/vaccine_safety/publications/en/">Years of research</a> involving <a href="https://www.ncbi.nlm.nih.gov/pubmed/24814559">hundreds of thousands of people</a> have proven vaccines to be safe and effective. One reason why they are so effective – to the point of complete eradication of certain diseases – is because of what scientists call <a href="http://op12no2.me/stuff/herdhis.pdf">“herd immunity.”</a> </p>
<p>What this means is that once a certain percentage of a population becomes immunized against a disease through public health programs, it provides general protection for everyone. Even if a few people get sick, the disease won’t spread like wildfire. </p>
<p>Those avoiding vaccination are aware that their children might nonetheless benefit from protection on account of herd immunity. This is unfair. For if everyone acted in that way, herd immunity would disappear.</p>
<p>Indeed, this happened in <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6406a5.htm">California</a>, where measles made a comeback because so many parents chose not to vaccinate their children. </p>
<p>These parents not only failed in their duty to contribute to the public good, they also actively undermined it, hurting others and also costing the economy <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2643169">millions of dollars</a>.</p>
<h2>2. Impact of health choices on the vulnerable</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/245867/original/file-20181115-194516-e10z72.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People with weakened immune systems are likely to get sick more easily.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-woman-working-home-243413818?src=rocx1RleaND02Pl-xUjbhQ-3-36">Kaspars Grinvalds/Shutterstock.com</a></span>
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<p>Viruses do not affect everyone equally. Oftentimes, it is the elderly, infants, and people with weakened immune systems, who are most at risk.</p>
<p>In my family, my brother, <a href="http://time.com/4892412/gene-editing-crispr-cas9-neurodiversity/?iid=sr-link1">Jason</a>, often had to be rushed to a hospital as he would easily catch a bug. So, when we had visitors, my family would inquire if they could let us know if they had any infections. </p>
<p>Often the answers were not truthful. Some would say that it was merely an “allergy,” and some others would be downright offended. My brother would end up catching the germs and more than once, nearly lost his life due to their lack of concern for his health.</p>
<p><a href="https://www.press.uchicago.edu/ucp/books/book/chicago/P/bo5974942.html">Ethicists have long argued</a> for special obligations towards the most vulnerable. And we need to be mindful of the impact of individual health choices on others, particularly the vulnerable.</p>
<h2>3: Health is communal</h2>
<p>Political philosophers like <a href="http://dewey.pragmatism.org/">John Dewey</a> have argued that democratic public institutions necessarily <a href="https://plato.stanford.edu/entries/dewey-political/">rely upon belief in scientific evidence and facts</a>. People can hold different personal beliefs, but there are some truths that are irrefutable, such as the fact that the Earth is round and revolves around the sun.</p>
<p><a href="https://www.mdpi.com/2076-0760/7/4/64/html">Anti-science attitudes</a> are dangerous because they undermine our ability to make decisions together as a society, whether about education, infrastructure or health. For example, if too many people treat the scientific consensus on climate change as just “one perspective,” that will hinder our ability to respond to the massive changes already underway. In a similar manner, treating the science on vaccines as just “one perspective” negatively impacts everyone.</p>
<p>In the face of overwhelming scientific evidence concerning the efficacy, safety and importance of vaccines, citizens have a duty to support vaccination and <a href="https://www.ncbi.nlm.nih.gov/pubmed/27586522">encourage others</a> to do so as well. </p>
<p>At the foundation of each of these duties lies a simple and powerful truth: <a href="https://www.ncbi.nlm.nih.gov/pubmed/30369509">Health is communal</a>. Health-related ethical obligations do not stop at our own doorstep. To think that they do is both empirically misguided and ethically indefensible.</p><img src="https://counter.theconversation.com/content/106141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joel Michael Reynolds does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Billboards spreading misinformation on the risks of vaccination have popped up around American cities. A bioethicist explains why decisions not to vaccinate children are indefensible.Joel Michael Reynolds, Assistant Professor of Philosophy, UMass LowellLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/810012017-08-24T00:34:42Z2017-08-24T00:34:42ZAnti-vaccination beliefs don’t follow the usual political polarization<figure><img src="https://images.theconversation.com/files/182638/original/file-20170818-7952-1h1mg3d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Signs from a protest in 2015 against a California bill that prohibits parents from using a religious exemption as a reason to not vaccinate their children. The bill became law. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Vaccines-California/9bd4e7d8168943c2b23e1ea6e6d0572f/14/0">AP Photo/Rich Pedroncelli</a></span></figcaption></figure><p>When health officials learned that the 2015 measles outbreak was caused by clusters of unvaccinated children, Americans once more wanted to understand why some parents do not vaccinate their children. In our highly polarized culture, media commentators and even academics began to connect opposition to vaccination to either the left or right of politics.</p>
<p>So a question arises: Who is more likely to be opposed to vaccination, liberals or conservatives? As a sociologist who studies infectious disease, I took a look at this. The answer seems to depend on what question you ask. </p>
<p>Because the <a href="http://www.latimes.com/local/california/la-me-measles-full-coverage-sg-storygallery.html">outbreak</a> started in the wealthy, liberal enclave of Marin County, California, and because some of the best-known “anti-vaxxers” are <a href="http://jezebel.com/heres-a-fairly-comprehensive-list-of-anti-vaccination-c-1714760128">Hollywood actors</a>, some right-leaning media outlets connected opposition to vaccination to <a href="http://www.nationalreview.com/article/413297/anti-science-left-ian-tuttle">liberals</a> and related it to other “anti-science” beliefs like fear of <a href="http://www.politico.com/magazine/story/2014/06/democrats-have-a-problem-with-science-too-107270">GMOs</a>, use of alternative medicine, and even <a href="http://thefederalist.com/2015/02/04/five-ways-liberals-ignore-science/">astrology</a>. Other writers have opposed such a <a href="https://www.washingtonpost.com/news/energy-environment/wp/2015/01/26/the-biggest-myth-about-vaccine-deniers-that-theyre-all-a-bunch-of-hippie-liberals/?utm_term=.f8694e8ce1b3">caricature</a> and have argued that opposition to vaccination is actually either <a href="http://www.slate.com/articles/news_and_politics/politics/2015/02/conservatives_and_liberals_hold_anti_science_views_anti_vaxxers_are_a_bipartisan.html">bipartisan</a> or a specifically <a href="http://www.motherjones.com/environment/2014/09/left-science-gmo-vaccines/">conservative</a> problem. Academic research on the topic is also conflicted.</p>
<p>While <a href="https://books.google.com/books?id=Kw-lgaREKGgC&source=gbs_navlinks_s">historians</a> have shown that there is a <a href="https://www.minnpost.com/second-opinion/2015/07/100-plus-year-history-anti-vaccination-movement">long history</a> of opposition to vaccination in America, the contemporary anti-vaccination movement got its major boost in 1998 when <a href="https://en.wikipedia.org/wiki/MMR_vaccine_controversy#1998_The_Lancet_paper">Andrew Wakefield</a> published faulty research in The Lancet that falsely claimed that the mumps, measles and rubella (MMR) vaccine was related to autism.</p>
<p>As to whether liberals or conservatives are now more likely to be opposed to vaccination, some <a href="https://books.google.com/books?id=dJaA7aN6GdAC&source=gbs_navlinks_s">researchers</a> have suggested that, while anti-vaccination beliefs have spread to libertarians on the right, the anti-vaccination movement originates and finds its strongest support in the political left. A later <a href="http://www.realclearscience.com/journal_club/2014/10/20/are_liberals_or_conservatives_more_anti-vaccine_108905.html">article</a> by the same researchers similarly argues that Centers for Disease Control and Prevention (CDC) evidence shows that states that voted for Obama in 2012 have higher rates of nonmedical vaccination exemptions.</p>
<p>Yet, other research suggests that it is in fact conservatives who are more likely to believe that vaccines cause <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2015/03/01/conservatives-are-more-likely-to-believe-that-vaccines-cause-autism/?utm_term=.df5ed1a784d2">autism</a>, that it is liberals who are more likely to endorse <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158382">pro-vaccination statements</a> and that the more strongly someone identifies with the Republican Party, the more likely he or she is to have a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2386034">negative opinion</a> of vaccination.</p>
<h2>Some new evidence</h2>
<p>The <a href="http://www.pewinternet.org/2015/01/29/public-and-scientists-views-on-science-and-society/">Pew Research Center</a> has conducted two surveys that asked about vaccination. One survey in early 2015 asked respondents about whether they thought vaccines were safe, and another survey in late 2014 asked respondents about U.S. vaccination policy and whether vaccination for children should be required or a parent’s choice. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many people worry about the effects of too many vaccines, but public health officials see them as lifesaving drugs for millions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-syringe-vaccine-616263095?src=bVj_95DT-aNeJI-Lxrl5CQ-1-13">Billion Photos/Shutterstock.com</a></span>
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</figure>
<p>When relating the answers to these questions in the Pew surveys to people’s political views, I find an interesting divergence. The more conservative and also the more liberal someone is, the more likely he or she is to believe that vaccination is unsafe. </p>
<p>Yet only those who are very conservative are more likely to believe that vaccination should be a parent’s choice. This suggests the social dynamics that shape Americans’ personal beliefs about vaccine safety are not the same as the social dynamics that shape their views about whether parents can decide not to vaccinate their children. </p>
<p>To examine this issue, I used a statistical technique called logistic regression that allows you to examine how the probability of a certain outcome will change depending on the characteristics of a survey respondent. I used it to examine whether someone is more or less likely to think that (a) vaccines are unsafe and (b) that vaccination should be a parent’s choice depending on what political beliefs they hold.</p>
<p>I did this while controlling for respondents’ level of education, income, race/ethnicity, age, gender, and parental status. I used the category of “moderates” (what statisticians call a “<a href="http://www.theanalysisfactor.com/strategies-dummy-coding/">reference category</a>”) to compare liberals and conservatives with. Let’s first look at people’s personal beliefs about vaccine safety.</p>
<p>What I found is that the more political someone is, the more likely he or she is to believe that vaccines are unsafe. Those who are “very conservative” are one-and-a-half times more likely to believe this than moderates. </p>
<p>Yet, the same is true for those on the left: compared to moderates, those who are very liberal are also one-and-a-half times more likely to believe vaccines are unsafe. It seems that it does not matter what your politics are, the more partisan, the more likely you believe vaccines are harmful.</p>
<p>When we look at whether people think that vaccination should be mandatory or a parent’s choice, a different story emerges.</p>
<p>Now it is only the very conservative who are more likely to think that it should not be mandatory: they are twice as likely as moderates to think that it should be a parent’s choice. Liberals are now more likely to think vaccination should be required: Compared to moderates, liberals are 43.5 percent less likely to think it should be a parent’s choice and those who are very liberal are 14.2 percent less likely.</p>
<p>What explains this divergence? First we have to realize that there is a difference in the overall number of Americans who believe that vaccinations are unsafe versus the number who believe it should be a parent’s choice. The Pew surveys indicate that 8 percent of the U.S. population think that vaccines are unsafe, while 28.2 percent think it should be a parent’s choice.</p>
<p>This suggests that there are a number of people who believe that vaccines are safe but also believe that vaccinations should be a parent’s choice. Why would someone believe that? It may have more to do with their views of the government than their beliefs about vaccines.</p>
<h2>Maybe it’s not about vaccines, but about who’s in power</h2>
<p>Since President Obama was elected in 2008, those on the right have had a much more <a href="http://www.people-press.org/2015/11/23/beyond-distrust-how-americans-view-their-government/">negative opinion</a> about the federal government. The 2014 Pew survey shows that those who were dissatisfied with the direction of the country in 2014 were 10 percent more likely to believe vaccination should be a parent’s choice than those who were satisfied (33.3 percent compared to 22.7 percent). Who were the most dissatisfied with the direction of the country in 2014? The very conservative (89.1 percent) and the conservative (81.5 percent).</p>
<p>Essentially, it doesn’t matter if you are conservative or liberal; the more political someone is, the more likely he or she is to think that vaccines are unsafe. Yet it is only the very conservative that are more likely to believe that vaccination should be a parent’s choice.</p>
<p>When it comes to political affiliation, it appears that the social forces that shape Americans’ personal beliefs about vaccination safety are not the same as the social forces that shape their views of U.S. vaccination policy. </p>
<p>Beliefs about U.S. vaccination policy and the role of parents’ choice may have more to do with what Americans believe about the proper role of the government and which political party is in power than what they think about vaccines.</p><img src="https://counter.theconversation.com/content/81001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles McCoy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Opposition to vaccines still prevents many children from getting needed preventative care. Understanding who is opposed, and why, can help, but the answers may surprise you.Charles McCoy, Assistant Professor of Sociology, SUNY PlattsburghLicensed as Creative Commons – attribution, no derivatives.