Vaccination is an important cost-effective public health measure for preventing the spread of infectious diseases, and there is much hope that the SARS-CoV-2 pandemic will be controlled through an effective global vaccine. However, there is concern about the poor uptake (44.9%) of the seasonal influenza vaccination among those in clinical at-risk groups who are under 65 years of age and among those aged 65 years and over, with the uptake not yet reaching the 75% target (Public Health England (PHE), 2020). Although a minority view, the ‘anti-vaccination’ movement is attracting prominence through the internet and social media (Kata, 2012) and with its association with wider anti-COVID-19 activities. Some are concerned that this movement may undermine efforts to end the ongoing pandemic (Ball, 2020).
Wolfe and Sharp (2002) argued that today's anti-vaccinationists are very similar to those of the late 19th century, who challenged the loss of civil liberties with compulsory smallpox vaccination enshrined in the Vaccination Acts of 1840, 1853 and 1867. The 1898 Vaccination Act removed the cumulative penalties and introduced ‘conscientious objector’ into UK law to gain exemption. While the arguments remain very similar, the methods of disseminating (mis)information reflect the different eras and espouse deeply held beliefs that are critical of science and authority.
According to the World Health Organization (WHO), ‘vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific, varying across time, place and vaccines (WHO, 2014a:7). Vaccine hesitancy is viewed as a threat to global health and resulted in the formation of a Strategic Advisory Group of Experts (SAGE) Working Group on Vaccine Hesitancy (WHO, 2014a), to understand the phenomenon, underlying factors and potential strategies to counter vaccine hesitancy. Schmid et al's (2017) revision of the original systematic review for the WHO reported that a lack of confidence, inconvenience, calculation and complacency were barriers to influenza vaccine uptake to varying extents in at-risk groups and noted the importance of psychological determinants such as beliefs echoing an European Centre for Disease Prevention and Control (ECDC) (2015) literature review of vaccine hesitancy in Europe.
Few studies have evaluated interventions addressing vaccine hesitancy. Nonetheless, the most effective were multi-component interventions, which focused on uptake (convenience and access; reminders and follow-up); unvaccinated and under-vaccinated populations; knowledge and awareness (embed new knowledge within all healthcare contacts, including hospital procedures); and shifting attitudes towards pro-vaccination (dialogue-based interventions; engage influencers to promote vaccination; engage local community and local healthcare staff) (WHO, 2014b). Community nurses may find the ECDC's (2016) practical guide useful for designing local initiatives to increase vaccination confidence and uptake.
‘Some are concerned that the vociferous anti-vaccination movement may undermine efforts to end the ongoing pandemic.’