Vaccine hesitancy on the rise across the globe, reveals cross-country survey

India bucks the trend; Afghanistan, Indonesia, Pakistan, the Philippines, South Korea major concerns

By Banjot Kaur
Published: Friday 11 September 2020
The trend towards confidence in vaccines has been decreasing in several countries overall, say the study’s authors. Photo: Yoshi Shimizu / World Health Organization

The trend of vaccine hesitancy has increased in many countries between 2015 and 2019, showed a study published in journal The Lancet September 10, 2020. The study’s researchers sought to understand how people across the world felt about the effectiveness, safety and importance of vaccines.

A survey among 284,381 individuals in 149 countries was carried out. India ranked the highest among countries where people believed vaccines to be effective, with 84.26 per cent believing so in 2019, according to the survey. Albania ranked the lowest in this regard, with 14.2 per cent people believing vaccines were effective.

Uganda ranked the highest in the safety parameter, with 87.24 per cent people in the country believing vaccines to be safe in 2019, while Japan ranked the lowest in this regard, with 17.13 per cent people believing in vaccine safety in the same year.

“This might be linked to safety scares against the human papillomavirus (HPV) vaccine — given against cervical cancer — that started in 2013,” the authors said. The Japanese Ministry of Health, Labour and Welfare had suspended proactive recommendations of the HPV vaccine after the scare.

London School of Health and Tropical Medicine’s Alexandre de Figueiredo and Clarissa Simas from the Imperial College of  London’s were the joint first authors of the paper.

In Iraq, the maximum number of people said vaccines were important (95.17 per cent) in 2019. Albania, at 26.06 per cent, was at the bottom of this category as well.

The trend towards confidence in vaccines was decreasing in several countries overall, said the study’s authors. They estimated confidence on all three parameters fall most sharply in Afghanistan, Indonesia, Pakistan, the Philippines and South Korea between November 2015 and December 2019.

The Philippines stood out as an example of the steepest fall in vaccine confidence: The country ranked in top 10 countries in all the indicators of vaccine confidence late 2015, but ranked no higher than 70th in 2019.

This could be attributed to a dengue vaccine (Dengvaxia) manufactured by Sanofi SA, according to the study. It was introduced there in 2017 and given to nearly 850,000 children before it emerged the vaccine posed a health risk.

Indonesia witnessed a large drop in confidence between 2015 and 2019, partly triggered by leaders questioning the safety of the measles, mumps, and rubella (MMR) vaccine, according to the study's authors. The leaders issued a fatwa — a religious ruling — claiming the vaccine contained ingredients derived from pigs and was, thus, not acceptable, they said.

However, religion was not found to be a determinant that influenced vaccine behaviour across the globe. Misinformation or communication of bad science that rested on not-so-sound scientific evidence was found to be the reason for this by the researchers.

In South Korea and Malaysia, online mobilisation against vaccines has been identified as a key barrier to vaccination. The internet was a main source of vaccination information in Malaysia where misinformation was identified as influencing vaccine reluctance.

In South Korea, an online anti-vaccination group named ANAKI (Korean abbreviation for ‘raising children without medication’) strongly advocated against childhood immunisation.

France, India, Mexico, Poland, Romania and Thailand, however, bucked the trend of increasing vaccine hesitancy. Several determinants were also found to be associated with better confidence towards vaccines in these countries:

  • High confidence in vaccines (66 countries)
  • Trusting healthcare workers more than family, friends or other non-medical sources (43 countries)
  • Higher levels of science education (35 countries)
  • Gender, with women more likely than men to report any child
  • Age (younger age groups had better chances of uptake)

The novel coronavirus disease (COVID-19) pandemic has led to the initiation of the world’s fastest vaccine development processes, with people pinning their hopes on these efforts.

The authors of a linked comment to the study, however, said there were risks of vaccines against COVID-19 never reaching their potential, due to a continued inability to quickly and effectively respond to public vaccine safety concerns, real or otherwise.

There needs to be substantial global investment in active vaccine safety surveillance, continuous monitoring of public perceptions and development of rapid and flexible communication strategies, the authors added.

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