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Growing advancements in the field of science and medicine brought about through evidence-based research, are a turning point to identifying, diagnosing, and treating various infections thereby; reducing mortality and morbidity. One of the greatest inventions in bio-medical science was the discovery of vaccines, which have contributed to the prevention of deadly infectious diseases such as smallpox, polio, and measles (Grant, 2012). Despite the success of vaccination programs for global health, there has been a controversial debate regarding its safety and efficacy. Certainly, vaccination is considered one of the cost-effective strategies to minimize infectious diseases, however; public confidence in vaccination has been significantly diminished. Not everyone considers vaccines as the only way to protect against infectious diseases and concerns have been raised about alleged untoward serious consequences (Hausman, 2019). The behaviors regarding, and attitudes towards, vaccination are due to perceived fears, personal experiences, or beliefs. Therefore, some are questioning the safety and effectiveness of vaccines, thus causing reduced numbers of vaccine uptake both in developing and Western countries. As a result, various campaigns and stringent policies have been initiated to mandate vaccination globally during outbreaks in order to protect the public from epidemics and prevent the spread of infectious diseases, which continue to present.
Moreover, the media has greatly contributed to the ubiquitous misinformation and doubt about vaccines in the general public. In particular, the emergence of social media such as Facebook or Twitter has stirred the circulation of inaccurate information on vaccines and vaccine-related practices (Grant, 2015). This paper aims to discuss vaccine safety controversies, perceived fears and perceptions regarding vaccines, integration of gender and race, representation and influence of social media, government-based strategies in various countries to increase uptake of vaccines, and the role of health professionals to mitigate barriers to immunization programs by building trust and clarifying myths about vaccinations.
Vaccine safety controversies and the anti-vaccination movement
The most common public perception about vaccines is that they have more harm than benefits (Schwartz, 2012, p. 50). Fears and myths surrounding vaccination are not something unknown. With the introduction of the smallpox vaccine by Edward Jenner in the eighteenth-century, public resistance towards vaccination resulted in the implementation of mandatory vaccination as a prerequisite for school attendance in Europe and the US; those not abiding by the rules were punished with fines and jail terms (Schwartz, 2012). Mandatory legal enforcement of vaccinations, especially between outbreaks helped to increase vaccine uptakes and decrease the number of smallpox cases. Nevertheless, such enforcement was not accepted wholeheartedly by those who opposed vaccines, who thought the liberty and right of individuals were being compromised by the government (Conis, 2014). The origins of anti-vaccination emerged based on perceived health risks, scientific innovation, and rejection of compulsory laws regarding vaccine uptake (Hausman, 2019).
With the increasing use of vaccines, more new vaccines were introduced and made mandatory. Nevertheless, there has been continuous pushback by vaccine skeptics against vaccines including measles, mumps, and rubella (MMR), pertussis, and the oral polio vaccine. For instance, parents refused to vaccinate their children against pertussis when a British study linked the pertussis vaccine to neurological disorders (Hausman, 2019, p. 17). Consequently, a documentary on the vaccine side effects was also aired, motivating the establishment of an anti-vaccination movement (Hausman, 2019, p. 17). This group was initially named Dissatisfied Parents Together, which has now become the largest anti-vaccination organization. The mission of the anti-vaccination movement is not only on theological arguments but also, on political and legal grounds. In the mid to late 1990s, the Food and Drug Administration (FDA) raised concerns about increased mercury used in thimerosal, a vaccine preservative that may cause neurological damage in children. Although, there were no serious consequences or link found between thimerosal and autism. Food and Drug Association mainly wanted vaccine makers to exercise precautionary measures and avoid the use of mercury (Hausman, 2019). However, misinterpretation of this FDA communication provoked concerns and fears among the public. Similarly, the publication of Andrew Wakefields article that claimed an association between the MMR vaccine and autism drew public attention at large (Hausman, 2019). Several studies disproved and debunked the MMR-autism connection in young children, vaccination rates continued to decline. In the years 2014 and 2015, the measles outbreak in the US was associated with low vaccination rates (Hausman, 2019). To overcome this, the government introduced Vaccine for Children program with the aim to minimize socioeconomic and racial disparities. In addition, the media portrayed parents who delay or resist vaccines as irrational, misinformed, vaccine-fearing parents, ignorant, stupid (p. 32) without understanding their beliefs and fears towards vaccination (Conis, 2014; Hausman 2017). Controversies regarding vaccination spread to many other parts of the world, causing a persistent decline in vaccination rates, changing public attitudes and beliefs, and increasing multiple outbreaks of infectious diseases resulting in thousands of deaths. Moreover, the perceived fears and myths connected to vaccination have raised resistance and rejuvenation the anti-vaccination movement, especially at that time of MMR-autism claims.
Further, Hausman (2019) discussed that vaccine-skeptics hold a different opinion and make a decision towards vaccination based on their personal experiences, beliefs, and social networks. The integration of nutrition, views on illness and health, and community responsibility are the means expressed by vaccine skeptics to protect themselves from infection (Hausman, 2019). Additionally, these people perceive health and illness with a strong belief that good nutrition plays a significant role in preventing illness and maintaining health. Unlike vaccinators, they avoid the use of conventional therapies such as drugs to treat minor illnesses. Some are also concerned that the growing number of vaccines and administering many of them together can cause immunization overload (Hausman, 2019). Many believe that illness is a part of life and, needed to help build a strong immune system, they also argue that public health authorities such as clinicians often over-treat people with unnecessary medicines. As responsible community members, they recognize the risk of spreading disease by containing and managing illness in outbreaks such as if the sick would rather stay home and rest over the uncertainties of medication (Hausman, 2019). Moreover, these vaccine-skeptics had negative experiences with public health professionals such as often labeled as being irresponsible towards their family and community, without having had their concerns and uncertainties associated with vaccines understood (Grant, 2012; Hausman, 2019).
The other significant perceived fear among vaccine-skeptics is corruption in medical research and pharmaceutical companies to produce and sell vaccines that undermines public trust and lacks transparency. For instance, an experiment conducted by anthropologists and physicians alleged infecting the Yanomami Indians with attenuated live-virus measles vaccine to study the effects of primitive societies instead of vaccinating, as per the claim, to protect from an epidemic (Hausman, 2019). This kind of act is a serious violation of human rights, raises concerns about contamination, creates fear and suspicion in research studies, and breaks trust in the general public trust. Furthermore, the introduction of the Gardasil vaccine for girls between the ages of eleven to sixteen was constructed on the point that it is more efficient before girls develop sexually active. Nevertheless, the vaccine was perceived by conservative families as a means of provoking sexually promiscuous among young girls (Hausman, 2019, p. 29).
Several studies have shown the association of vaccination compliance and resistance with social determinants of health that can vary in each nation depending on income status, education level, migration, religion, culture, gender, and racism. Looking back in the early nineteenth century, England began a mandatory smallpox vaccination campaign for the underprivileged, armies, and the working class, initiating a structured resistance (Grant, 2012). Anti-vaccination movements were formed against this act as this was regarded as unequal treatment and an unjustified violation of an individuals autonomy to make decisions regarding health (Hausman, 2019). Similarly, education plays a key role in participating in preventive measures such as vaccines. According to Hausman (2109), a study revealed that 92% of parents with a college degree are more likely to consider vaccination as safe in comparison to 77% of parents with high school degrees or less education.
Influence of social media on vaccine controversies
Undoubtedly, social media has become an easy way to communicate and connect with people around the world. The internet has been considered one of the means contributing towards vaccination promotion and resistance at the same time. The internet is a transformative approach that brings individuals and communities to a critique on vaccines and vaccine policy, particularly anti-vaxxers, a pejorative term used for those who oppose vaccination (Grant, 2012). Some sites are directed to target the general population and provide means to educate about vaccination while others are directed to promote resistance amongst anti-vaxxers. The Internet has played a vital role in adopting pro-vaccine strategies to improvise communication among communities. For this case, a mass communication strategy has been implemented, where images and personal narratives are presented to explain the vaccine-preventable disease mortality and morbidity. Statistics are shared to compare decreased vaccination rates resulting in increased vaccine-preventable diseases. However, these strategies have not been proven to be as effective for anti-vaccination parents. Additionally, personal experiences as narrative or personal images can be shared on Web 2.0 which can attract viewers with similar vaccination beliefs and promote the anti-vaccination movement (Grant et al., 2015).
It is not an undeniable fact that vaccination resistance can be dated back to the day the very first vaccine was introduced. Nevertheless, the anti-vaccination movements continued to proliferate in recent years because their promoters are using social means such as Facebook, Twitter, or Instagram to create or share anecdotal information. The increased use of the internet these days is considered to be a significant source of vaccine controversy (Grant et al., 2015). The anti-vaccination movement as mentioned previously has existed since the introduction of national vaccination programs across Europe and North America (Green, 2017). In those early years, anti-vaccine activists used cartoons and published pamphlets and journals that were circulated along with protestations to fight against the governments mandatory vaccination enforcement (Grant et al., 2015; Green, 2017).
Social media greatly contributes to the dissemination of negative and inaccurate information to the public. Additionally, it is used by anti-vaxxers to force people to oppose vaccines by raising skepticism about the scientific evidence regarding the risks and benefits of immunization. Green (2017) discussed the use of memes is very common in spreading anti-vaccination messages in the form of animated videos and images. A good meme should be simple and bold allowing an easy understanding of information and encouraging people to keep reusing it for the dissemination of the intended message (Green, 2017). Visual memes dont only facilitate online membership but, can exhibit an individuals extensive knowledge and understanding about a particular topic or issue (Green, 2017). Therefore, anti-vaccination memes are frequently used as a campaign tool to attract people and trigger emotions. The anti-vaxxers present the information by twisting the language of science and education in the form of conference posters making people believe in the information (Green, 2017).
The advancement in technology such as websites, blogs, e-mails, and other media sources allows people to openly interact and share their experiences and stories with an invaluable support system, especially for vulnerable parents experiencing vaccine-related concerns (Green, 2017). The abundance of health information available on the internet is viewed by many as a pandoras box of misinformation (Grant et al., 2015, p. e133). This negative influence of media on the public has resulted in decreased coverage and a decline in vaccination rates (Hausman, 2019). According to Grant et al. (2015), 75% of people looked up the Internet for health information and 35% self-diagnosed themselves rather than seeing a physician. The available pro-vaccination websites are developed by the US federal government to educate the general public about the vaccine and vaccine-related practices (Grant et al., 2015). These websites are unidirectional with limited social interactivity space restricted to feedback only that could not be seen by other users as well as fewer hyperlinks, images, videos, and spreadsheets focusing on promoting evidence-based knowledge and creating a sense of authority (Grant et al., 2015). On the contrary, vaccine-skeptical websites express numerous claims on unsupported scientific literature and offer users an interactive discussion forum to share their personal experiences with vaccination (Grant et al., 2015). The anti-vaccine sites use images and videos to get connected with vulnerable people emotionally. Moreover, these web pages are filled with dense information and multiple hyperlinks connecting to other social networking sites to promote information sharing within groups (Grant et al., 2015). Particularly, the lack of social interactive forums on pro-vaccine websites has turned people who experienced vaccine-related side effects to approach anti-vaccine sites to gain support from people with similar experiences (Grant et al., 2015).
As awareness towards vaccine increase, parents curiosity and questioning of journalists and health experts have taken the rise. Social movements aiming to concern about chemical pollution, uncertainty towards modern medicine, and rejection of cultural norms are contributing to skepticism about vaccination rationale (Conis, 2014). This skepticism is changing into beliefs. Some of them agree that it is necessary to protect the lives of children from vaccine-preventable diseases, while others believe that it violates the right of children to education and the right of parents to make health care decisions in the best interest of their children. The rationales for not receiving vaccines are a presentation of norms and anxieties of a particular moment in time.
Pro-vaccine strategies with the collaboration of government and healthcare professionals to address vaccine hesitancy
The growing issue of vaccine hesitancy cannot be addressed lonely by public health professionals. Therefore, it requires support from the government and health policymakers. Globally, there have been diverse vaccination policies (Walkinshow, 2011). Some countries support educational programs to create awareness about the benefits and risks of vaccination and allow individuals to make decisions while others have made vaccination mandatory such as three of the provinces in Canada and every state in the US with the exception of some states that allows exemption on the ground of religious or medical basis (Walkinshow, 2011). Countries like Australia do not have mandatory policies, however, has strategically placed interventions such as offering a financial incentive for those parents who vaccinate their children to increase compliance rates (Walkinshow, 2011). In contrast, some countries follow aggressive vaccination programs like Slovenia where religious exemption is not accepted and failure to comply with policies can result in penalties such as fines or imprisonment (Walkinshow, 2011).
According to Sergi, Comeau-Vallée, Lusiani, Denis, & Langley (2016), In healthcare power, authority, and legitimacy are diffused between managers, clinicians, and other organized groups such as unions and external bodies including government in most countries . It is a collaborative approach essential to promote vaccine education, incorporate policies, and reduce public health risks by effective use of the vaccine to prevent infectious diseases by increasing vaccine coverage. The major trigger in the acceptance of the vaccination process is distrust. To overcome this, healthcare professionals can build trust in vaccine-hesitant people by encouraging open and transparent discussions on vaccination with the support of current evidence-based research (Hausman, 2019). It has been found that parents who are provided health information and recommendation from health professionals have fewer concerns than those parents who rely on social media and family networks (Grant et al., 2015). Additionally, primary care providers are in a position and have an opportunity to start early discussions during prenatal visits. This allows and promotes an honest discussion about vaccine-related consequences and potential risks along with including successful benefits to prevent childhood illnesses. At the same time, it is imperative that clinicians should be non-judgemental and respect an individuals choice on the vaccine as developing trust is a key component in promoting vaccination programs.
Another important aspect to address which requires special attention is social media affecting vaccine-related attitudes. It not only contributes to spreading misinformation regarding vaccination through messages and videos but also, damages the immunization programs and creates barriers between the public and healthcare. The advocates of vaccines can address these concerns by using media and focusing on the positive aspects of vaccines (Grant, 2012). There are pro-vaccine websites that attempt to respond to and correct the inaccurate information circulating on the internet. However, the pro-vaccine sites present their counterarguments that focus on calling out anti-vaxxers beliefs as irrational and unreasonable and maintaining a defensive posture to vaccine allegations (Grant 2012; Conis, 2014). Eventually, this causes marginalization and creates a sense of mistrust among vaccine skeptics. To overcome growing concerns about vaccination, both government and healthcare professionals should work together to address peoples beliefs and attitudes to vaccination, provide easy access to vaccination services, assist parents to keep a record of immunizations such as scheduling and arranging appointments, and offering respectful engagement.
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