In 1959, at the age of 29, the promising England footballer Jeff Hall died of polio. His death sent shock waves across Britain, and caused an immediate change in attitudes towards vaccination, from complacency to a sudden rush to clinics. A polio vaccine had been available for three years, but takeup was low. After Hall’s death, the demand was so high that vaccines had to be flown in from the US. As the Daily Express put it: “In the past 10 years over 3,000 people have died of polio in England and Wales. But it took the death of one footballer to get [people] pouring into the clinics.” More than half a century later, we may be returning to complacency when it comes to getting children vaccinated.
The past decade has seen a decline in the uptake of almost all routine vaccinations for children in England. Currently, no childhood vaccinations meet the 95% target set by the World Health Organization. The US has a similar shortfall, and the WHO warns that the long-term decline in childhood vaccination rates is a global phenomenon. Here, the consequences have been increased cases of vaccine-preventable diseases such as whooping cough in nurseries and schools, as well as a rising number of polio samples found in sewage in London.
The Covid-19 pandemic years (2020-22) only accentuated this decline in England, as well as in countries such as Mozambique and Myanmar. However, some countries, such as Uganda and Pakistan, managed to maintain their childhood vaccination programmes. And in Scotland childhood vaccination rates significantly increased during the first lockdown, compared with the year before the pandemic.
But it would be myopic to look only at Covid-19’s impact on vaccination levels: overall decline has been happening since the early 1990s. To increase the uptake among children requires looking at what could be driving these relatively lower figures. And it defies one simple explanation – instead it’s a combination of supply and demand challenges.
In terms of supply, with health services increasingly strained and under-resourced, access to vaccination clinics for parents and caregivers can be challenging. Limited services (with hours mirroring many parents’ workdays) and long distances (requiring a car journey or long travel) can mean parents struggle to get their child vaccinated, even when they understand the value of it. And a certain level of parental complacency sets in, given that the general risk of diseases such as measles or rubella is considered low (because of the public health success of their near elimination).
Scotland’s boost in vaccination rates during lockdown is probably linked to flexible working for parents (which enable them to attend vaccination appointments) and mobile vaccination centres. A real push to make vaccination clinics easily accessible to parents is also how Pakistan and Uganda have maintained their levels over the past few years.
Concerns over the safety and efficacy of vaccines is also a factor, linked to the rise of the anti-vax movement. Vaccine hesitancy increased dramatically – not only in England but globally, after the now discredited study by Andrew Wakefield linking MMR vaccination to autism. The published findings have subsequently been retracted; however, the impact on parental trust in vaccination has been massive. Despite being struck off the General Medical Council register, Wakefield has attracted a large and dedicated following, and continues to speak and lecture against vaccines around the world. And since Wakefield, we have seen an increasing number of celebrities such as Russell Brand moving towards anti-vax positions in the Covid-19 era, recognising the followers, fame and fortune that this stance brings.
Those leading anti-vax movements often don’t even seem to believe what they are saying to their followers, based on their personal actions on vaccines. Robert F Kennedy Jr has become famous as an activist against vaccines, including those for Covid-19. His anti-vaccine organisation, Children’s Health Defense, increased its revenue six-fold between 2018 and 2020, and his book linking Anthony Fauci, Bill Gates and big pharma spent weeks as a top bestseller on Amazon. Yet guests invited to a holiday party at his home in December 2021 were urged to be vaccinated or tested for Covid-19. Donald Trump spent months as president of the United States downplaying the risks of Covid-19, hosting large rallies during the height of the pandemic and calling it “kung flu”. Yet he (and his wife) secretly received the first two doses of Pfizer/BioNTech’s Covid-19 vaccine before leaving office in January. There are plenty of other examples of “do as I say, not as I do.”
The problem for medical doctors and scientists is that pushing back against this misinformation, or even talking about the importance of vaccination, results in an onslaught of abuse. There are not many positive incentives for talking about how vaccines work, or why they’re important: the only incentive is in trying to protect children (and adults) from serious illness and death. Possible solutions include medical organisations such as the Royal College of Paediatrics and Child Health running social media and outreach campaigns that bring together dozens of established voices, rather than single individuals – as well as working with social media platforms to better regulate the information being circulated.
To increase childhood uptake of vaccines, we need a targeted push by health authorities to make vaccination easily available to parents and caregivers who are juggling a number of different responsibilities, as well as continued messaging to parents about why vaccination matters. Hopefully this happens without having another young person die unnecessarily, like Jeff Hall, from a vaccine-preventable disease.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
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