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Journalists’ role in covering vaccine hesitancy

Bara Vaida and Tara Haelle

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Scientific evidence overwhelmingly supports the safety and effectiveness of CDC-recommended childhood vaccines for protecting children against preventable infectious diseases such as measles, pertussis (whooping cough), rotavirus and meningitis. These diseases can result in death or serious, lifelong health effects, such as blindness, deafness and brain damage. Like everything in life, vaccines do carry risks as well, outlined in detail at the Centers for Disease Control and Prevention website.

Despite the evidence (including this new study) showing that the safety of vaccines considerably outweighs their risks compared to the danger of vaccine-preventable diseases, some parents remain anxious about vaccine side effects or misinformation they have heard from others. In beginning of 2019, the World Health Organization identified vaccine hesitancy as one of the top ten threats to global health.

Opposition to vaccines has been around since physician Edward Jenner first figured out how to inoculate people from smallpox in the late 1700s. Anti-vaccine efforts have waxed and waned, with the latest flare-up of fear driven largely by a now-debunked study conducted by a British researcher who falsely claimed to find a connection between the MMR vaccine and autism. (British journalist Brian Deer, who relentlessly pursued the story of Andrew Wakefield’s fraud until the Lancet retracted the study, has documented the full story on his website.)

“Vaccine hesitancy” as a term has emerged in recent years as a more neutral way to discuss attitudes toward vaccines, without identifying people strictly as “anti” or “pro” vaccine. The term describes people who may consider vaccination if their concerns are addressed, but for varying and complex reasons, may not be ready to vaccinate their children, or themselves, or may wish to selectively vaccinate or delay vaccinations instead of following the schedule recommended by the CDC. Vaccine hesitancy occurs along a continuum, from refusing all vaccines to accepting all but one or two, or even fully vaccinating but doing so with an extra dose of anxiety.

The reasons people may be hesitant can be social, psychological and economic. They can include lack of trust in vaccines’ safety or effectiveness or in the medical system or their health care providers. They can also include a perception that vaccines are unnecessary or ineffective or that contracting a disease naturally is a “better” way to develop immunity against the disease (despite the inherent illogic of this route).

The vast majority of American parents vaccinate their children and follow the CDC’s recommendations for when and what kind of vaccines their children should receive. But the number of U.S. children who are not getting some or all of the vaccines recommended has quadrupled since 2001 according to the CDC.

Among children born in 2015, 1.3 percent of 19- to 35-month-olds hadn’t received any recommended vaccinations, up from 0.3 percent in 2001, according to the CDC. That means an estimated 100,000 U.S. children under age 2 have not been vaccinated against 14 serious and preventable diseases, pediatrician Amanda Cohn, a CDC senior adviser for vaccines, told the Washington Post.

The rise in unvaccinated children, especially in smaller regional pockets of the U.S., has led to an increase in outbreaks of diseases such as measles, one of the most contagious infectious diseases in the world. In early 2019, Washington state declared an emergency to respond to an outbreak that has led to 65 cases as of Feb. 24, 2019. More than 80 percent of cases weren’t vaccinated.

But it’s not just children not getting vaccinated. Vaccination rates for adults for preventable diseases such as pneumonia and shingles were less than 70 percent in 2015, according to the nonprofit Immunization Action Coalition. Flu vaccination rates among adults is even lower. During the 2017-18 flu season, the CDC estimated that just 37.1 percent of adults received an influenza shot. About 80,000 people died from the flu in the 2017-18 flu season, many of whom had not been vaccinated. In previous flu seasons, deaths ranged from 12,000 to 56,000.

Increasing vaccination rates and overcoming vaccine hesitancy (and the misinformation that contributes to it) remain public health challenges. The CDC, state health departments and public health experts have repeatedly funded and supported education campaigns on vaccinations but, as measles outbreaks over the past year show, education campaigns aren’t enough.

Research on effective interventions had lagged until the past decade, but there are no straightforward, easily implemented strategies that work for all people, especially since different fears and concerns drive hesitancy in different people. A 2018 paper analyzing dozens of behavioral and psychological studies on vaccination hesitancy found that behavioral strategies more effective than just providing information, which makes sense since social scientists have long known that the deficit model is flawed. (The deficit model is the idea that people’s behavior is driven primarily by lack of accurate information and that providing that information will then change behavior.)

Vaccination, like getting adequate physical activity or quitting smoking, is a behavioral decision, the study stated, and a wide range of possible interventions can nudge or persuade people to vaccinate, including patient/parent reminders, proactively made appointments for future vaccinations and presumptive vaccination phrasing by providers (ie, assuming the patient will receive recommended immunizations instead of asking).

But institutional and statewide incentives, sanctions and requirements — such as making it more difficult for children to be exempt from state immunization requirements for public school and daycare — also play a role, the study noted.

For more on covering vaccine hesitancy, AHCJ has compiled some story ideas, links to prior media coverage, and a list of trusted experts for resources. Because there has been so much misinformation spread in media about vaccines, we have also compiled a list of experts who have made public statements that do not represent medical consensus.

Story ideas:

  • Talk to parents of children who couldn’t be vaccinated for medical reasons, and what measles and pertussis (whooping cough) outbreaks have meant for them?
  • What is the impact of social determinants on vaccination rates and access, despite federal programs guaranteeing vaccines for all children such as Vaccines for Children? Though many parents who choose not to vaccinate are highly educated and live in high income neighborhoods, adults and children in low-income communities are at a higher risk of getting sick because they have less access to medical care.
  • What new strategies are local public health departments taking regarding vaccine hesitancy and/or rates?
  • What are local health providers doing? Are they addressing the behavioral component? Do they offer information sessions for patient families or have they adopted any evidence-based interventions?
  • What are the vaccination rates in your state? How do these pan out across the state in individual counties? Are some counties at particularly high risk for herd immunity breaking down? What are the factors driving vaccine hesitancy in those areas?
  • What is the school system’s approach to vaccination?
  • Are legislators in your state working to reduce exemptions to vaccinations or to increase them? Keep in mind that most state legislatures have at least one bill (often more) every session that attempts to expand or restrict non-medical exemptions to school immunization requirements, so keep an eye on these bills and watch for the ones that make it out of committee.

AHCJ resources:

From a panel at Health Journalism 2015

Panelists Urge Journalists to Report on How Vaccines Save Lives

  • Sharon R. Kaufman, UC San Francisco, parents, children and perceived risk. Slides
  • Rebecca Plevin, Southern California Public Radio, Vaccine hesitancy story ideas. Slides
  • Elizabeth Rosenblum, UC San Diego, professor of clinical medicine addressing Vaccine Autism Claims.

Vaccines and vaccine hesitancy sources

This is by no means an exhaustive list, but it’s certainly enough to get any reporter started in reporting on vaccines and vaccine hesitancy. This list strives to include a wide variety of experts in terms of geography, clinical and research specialties and demographics. Where possible, specializations have been noted. All journalists are reminded to do due diligence in confirming that sources are currently in good standing and that institutional, title or specialty information may change.

  • Carol Baker, M.D. — executive director of Texas Children’s Hospital Center for Vaccine Awareness and Research (CVAR), Vaccine Research; contact her via Sarah Frankoff at sarah@gwpr.com
  • Robert Bednarczyk, Ph.D. — assistant professor of Hubert Department of Global Health Cancer Prevention and Control, Emory University; specializes in HPV vaccine
  • Edward Belongia, M.D. — director of the Center for Clinical Epidemiology & Population Health at the Marshfield Clinic Research Institute; specializes in flu/flu vaccine
  • Julie Bettinger, Ph.D., MPH — Associate Professor and epidemiologist at Vaccine Evaluation Center at the University of British Columbia and at the VEC in the Department of Pediatrics- vaccine safety and vaccine preventable diseases
  • Stanley Block, M.D. – meningitis, Men B, HPV; has disclosures, pediatrician and researcher at Kentucky Pediatric/Adult Research
  • Ari Brown, M.D., F.A.A.P. — central Texas pediatrician, founder of 411 Pediatrics, and author of  Baby 411
  • Julie Boom, M.D., director on the Immunization Project at Texas Children’s Hospital in Houston
  • Richard Carpiano, Ph.D. – sociologist, professor of Public Policy and Sociology at University of California, Riverside; specializes in reasons for vaccine hesitancy/refusal attitudes and in HPV vaccination uptake
  • James Cherry, M.D. — professor of pediatrics and infectious disease at the David Geffen School of Medicine at UCLA; worked during years when vaccine-preventable diseases were common          (M.D. earned in 1957)
  • Eve Dubé, Ph.D. — invited professor of anthropology, Université Laval, Québec, Canada; medical anthropologist studying history of vaccine hesitancy and global reasons for it
  • Michael E. Pichichero, M.D., clinical professor of pediatrics at University of Rochester Medical Center; research specifically focuses on Hib vaccine, plus some research in pneumococcal, DTaP, hep B and polio vaccines (together)
  • Kathryn Edwards, M.D. — professor of pediatrics and scientific director of the Vanderbilt Vaccine Research Program; specializes in pertussis vaccination (especially during pregnancy) and control and maternal vaccination
  • Karen Ernst — founder and executive director of Voices for Vaccines parent advocacy group
  • Bruce Gellin, M.D., MPH — president of Global Immunization at the Sabin Vaccine Institute in Washington, D.C.; national policy; formerly HHS Deputy Assistant Secretary for Health and Director at the National Vaccine Program Office
  • Jason Glanz, Ph.D. — epidemiologist and assistant professor at the University of Colorado in Denver and senior investigator for the Kaiser Permanente Institute for Health Research
  • Maya Goldenberg, Ph.D. — associate professor of philosophy at University of Guelph in Ontario, Canada; specializes in “medical epistemology in social context,” including how people make evidence-based decisions
  • Devon Greyson, Ph.D. — assistant professor of communication at the University of Massachusetts at Amherst; studies sociological and health communication aspects of vaccine hesitancy in US and Canada (how public health and clinicians can build vaccine confidence with various groups of parents)
  • Neal Halsey, M.D.– professor emeritus of international health and vaccine safety at Johns Hopkins Bloomberg School of Public Health; especially knowledgeable about vaccine safety history/debates in late 90s/early 2000s, including the decision to remove thimerosal from childhood vaccines
  • Simon Hambidge, Ph.D. — professor and director of Community Health Pediatrics at the University of Colorado, Denver; MMR and seizure risk, Vaccine Safety Datalink
  • (Catherine) Mary Healey, M.B.B.Ch. — assistant professor of pediatrics and infectious disease at Baylor College of Medicine and Texas Children’s Clinical Care Center; maternal vaccination
  • Peter Hotez, M.D., Ph.D.–  Dean for the National School of Tropical and professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine; director of the Center for Vaccine Development at Texas Children’s Hospital in Houston; tropical diseases, vaccine hesitancy; has daughter with autism; outspoken (and targeted) vaccines advocate
  • Ruth Karron, M.D.  — professor of international health and global epidemiology at Johns Hopkins Bloomberg School of Public Health; maternal vaccination, flu vaccine, respiratory viruses, RSV vaccine development, vaccine ethics
  • Elias Kass, ND, LM — naturopathic physician who supports CDC-recommended immunization schedule, based in Seattle; also a midwife and lactation consultant
  • Sharon Kaufman, Ph.D. — professor emeritus of medical anthropology at the University of California San Francisco; studied public perception of risk and erosion of public trust in science following worries about autism from vaccines
  • Allison Kempe, M.D., MPH — Center Director for the Center for Research in Implementation Science and Prevention (CRISP) at the University of Colorado at Denver; immunization and preventative services in pediatrics; racial disparities
  •  Nicola Klein, M.D., Ph.D. — senior research scientist at the Kaiser Permanente Northern California Division of Research and director of the Kaiser Permanente Vaccine Study Center; pertussis waning; influenza vaccine; vaccines in pregnancy,
  • Mark Largent, Ph.D. — professor of social relations and policy at Michigan State University; a science historian who has interviewed many parents who refuse to fully vaccinate their children
  • Heidi Larson, M.A., Ph.D. — professor of anthropology, risk and decision-making at the London School of Hygiene and Tropical Medicine in England; anthropologist and Director of The Vaccine Confidence Project (VCP)
  • Julie Leask, Ph.D., M.P.H. – professor of nursing and public health at the University of Sydney Nursing School in Sydney, Australia; immunization uptake, policy, programs, controversies and communication; intersects psychology, sociology and public health ethics
  • Maimuna Majuer, M.D., Ph.D.  — postdoctoral research fellow at Harvard University’s Health Policy Data Science lab; computational epidemiology, models under-vaccinated regional pockets, including in California
  • Sean O’Leary, M.D., director of the Colorado Pediatric Practice-Based Research Network (PBRN) and associate professor of pediatrics/infectious disease/epidemiology at the University of Colorado School of Medicine and Children’s Hospital Colorado
  • Paul A. Offit, M.D. — director of the Vaccine Education Center and attending physician of pediatrics in the Division of Infectious Diseases at Children’s Hospital of Philadelphia; authored multiple books related to vaccines, vaccine safety and medical research
  • Saad Omer, M.B.B.S., M.P.H., Ph.D. — professor of global health and epidemiology and director of the Emory Vaccine Center at Emory University; vaccine hesitancy in US and regional pockets of low immunization rates, “
  • Doug Opel, M.D., MPH — director of clinical ethics and associate professor of pediatrics at the University of Washington in Seattle
  • Sen. Richard Pan, M.D. — California State senator, pediatrician; chairs the following state senate committees: Health Budget and Fiscal Review, Subcommittee on Health and Human Services, Committee on Public Employment and Retirement, Children with Special Needs, Asian Pacific Islander Affairs, 2020 United States Census; general vaccine resistance movement; legislation re: vaccines,
  • Manish Sadarangani, DPHIL, BM.BCh — assistant professor of pediatrics and director of Vaccine Evaluation Center at the University of British;
  • Daniel Salmon, Ph.D. — professor of international health and global disease epidemiology at Johns Hopkins Bloomberg School of Public Health and Institute for Vaccine Safety; previous work in US HHS re: vaccine safety
  • Wendy Sue Swanson, M.D. — professor of pediatrics and chief of digital innovation at Seattle Children’s Hospital; blogs at Seattle Mama Doc
  • Litjen Tan, Ph.D. — chief strategy officer at the Immunization Action Coalition; immunization advocacy
  • Tara Welch Smith, Ph.D. — professor of epidemiology at Kent State University; formerly director of the Center for Infectious Diseases at Iowa College; infectious disease, antibiotic resistance, zoonotic disease, zombies (yes, seriously)
  • Deborah L. Wexler, M.D. — founder and executive director of the Immunization Action Coalition and physician at Minnesota Children’s Hospital

Notable and recent coverage

Webcast/video

Why Parents Fear Vaccines (Tara Haelle, TedX May 2016)

Peer-Reviewed Studies on Vaccine Hesitancy

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