Vaccine hesitancy is a growing problem in the world that does not get enough attention. The issue of parents refusing to vaccinate their children can and has led to the return of previously eradicated diseases, and an increase in cases of uncommon illnesses in areas where vaccination rates are low. Vaccine hesitancy itself is the postponing in acceptance or refusal of vaccinations even though there are vaccination services available. There are a lot of different factors that influence people to become vaccine hesitant, and those various factors are the key to combatting this issue throughout the world. Educating society on the benefits of vaccination, and establishing programs for individuals to become more educated on what exactly it means for a person to be vaccinated are just a few examples of how combatting the problem of vaccination hesitancy can be done. The phenomenon of vaccine hesitancy has developed because of many cultural, social, and political factors within society. Educating is important because it allows individuals to become more aware of the benefits of vaccination and can address any concerns they might have in general that causes them to be hesitant. The role of health care professionals, public health systems, and the overall trust people have over each of those things are important to fighting vaccine hesitancy as well. In order to address vaccine hesitancy in today’s society and try to fix the problem, there has to be an understanding of the significance, cause, effects, and general elements of the issue at hand. 

Vaccination itself has a very short history compared to the many centuries humans tried very desperately to cure themselves of plagues and various other diseases with homemade methods. Vaccinations have helped to treat so many different diseases since they first came to be; “since the time of Edward Jenner, vaccination has controlled 12 major diseases, at least in parts of the world: smallpox, Diptheria, tetanus yellow fever, pertussis, Haemophilus influenza type b disease, polio, measles, mumps, rubella, typhoid, and rabies” (Plotkin 1). Throughout history there have been many disease epidemics that have at times wiped out millions of people across the world. Without Edward Jenner discovering that by inoculating a person with the cowpox virus it could protect someone from getting the smallpox infection, the discoveries scientists have made since then may not have been discovered today. Edward Jenner made history just by testing a hypothesis because of its eventual eradication of the smallpox disease in general. There were many other scientists who began to experiment with vaccinations which led to an increased interest from the science community; “The middle of the 20th century was an active time for vaccine research and development. Methods for growing viruses in the laboratory led to rapid discoveries…including the creation of vaccines for polio” (The History of Vaccines). The creation of vaccines is so important to history and modern times because of the fact vaccines have helped to eradicated many diseases and prevent the potential deaths of millions of people. Apart from the scientist who have developed vaccinations, there are also world organizations such as the World Health Organization (WHO) that aid in vaccination efforts; “WHO made an enormous eradication effort and invested more than 300 million dollars over 11 years in the Intensified Smallpox Eradication Program.” (The Global Value of Vaccination). The efforts and funds organizations like WHO put towards vaccination efforts and eradication diseases all end up saving many human lives. “…eradication has spared the global community of some 350 million new smallpox victims and some 40 million deaths from the disease.” (The Global Value of Vaccination). Because of vaccination, poliovirus has been basically completely eliminated from the western hemisphere and now almost 200 countries are also polio free with it only existing in about 20 countries in different regions of Africa. The progress vaccination research and efforts have made over time have been detrimental in a sense to the way our societies thrive today just by being healthier, thanks to vaccinations millions of lives have been saved and continue to be saved.

A modern day example of what can happen if too many people are hesitant about vaccines and choose to not vaccinate their children at all is the measles outbreak at Disneyland in California in 2014. According to the Los Angeles Times, the rate of medical exemptions for incoming elementary schoolers the year following California ending the personal-belief exemption increased very sharply. California ending the personal-belief exemption rule was important to fighting vaccine hesitancy because it made it harder for parents to refuse their children a vaccination when they were entering kindergarten. Some parents though found a way to cheat the system; “some parents who don’t want to vaccinate their children may have found doctors willing to give medical exemptions to students – a potential trend that may undercut the collective protection against contagious diseases that the state law sought to bolster” (Khan). It’s standard in most states that when children enter school they must get vaccinations against certain diseases like chickenpox and measles because of how dangerous the infections are and how quickly they can spread throughout the schools. As a result of the low vaccination rates prior to the end of the personal belief exemptions, there was a measles outbreak that started at Disneyland in 2014 and up to 159 people were infected. Part of removing personal belief exemptions was to increase the herd immunity. Heard immunity is when a portion of a community is immunized against a highly contagious disease, therefore protecting the members of the community that aren’t protected against a disease because there isn’t a great opportunity for an outbreak. 

Vaccine hesitancy is the postponing acceptance or refusal of getting a vaccination even though vaccine services are readily available. These people who are vaccine hesitant are typically parents who are afraid of vaccinating their children whether it be for religious, cultural, or social reasons, or even just the fact they do not trust vaccinations. The parental acceptance of immunizations in children is gradually deteriorating. “Nearly 12% of parents have refused at least 1 recommended childhood vaccine and there is an increasing number of parents who are filing philosophical exemptions from required childhood vaccines” (Opel). This statistic comes from a survey of about 105 parents who have a child between the ages of 19-35 months. These parents who do choose to not vaccinate their children have been found to do so because they don’t think that the vaccination will be effective, they don’t trust the vaccine, or they aren’t educated enough on what the vaccine does to give them enough trust towards allowing their child to get that particular vaccine. Based off a study completed by Julie Leask, it was determined that there a 5 groups on the spectrum of parent’s attitudes towards vaccinations; “unquestioning acceptors, cautious acceptors, hesitant parents, late or selective acceptors, and those who refuse all vaccines” (Identifying and Addressing Vaccine Hesitancy). Although the number of parents who refuse vaccines all together is small compared to the amount who ultimately accept vaccines all together, there are still the groups on the spectrum that fall in-between and those are the parents who are vaccine hesitant and that is the group of people that are at the center of the problem in today’s society. After California passed the law to no longer allow personal belief exemptions, researchers used it as an experiment to see what would happen to immunization rates after the law went into effect, “from 2015 to 2016, the medical exemption rate jumped from 0.17% to 0.51% -- an unprecedented threefold increase in the rate… but the total exemption rate dropped from 2.54% to 1.06%, the researchers found” (Khan). If more states like California end personal belief exemptions as an option, there might just be an increase in the vaccination rate despite the fact persistent vaccine hesitant parents will always find a way around the laws. 

One of the key components to helping combat the issue of vaccine hesitancy involves how important the role of health care professionals is and how the public health care systems can impact vaccine acceptance. Health care professionals are so important because when a parent takes their child to the doctor, that’s the person they get all their knowledge about vaccinations and preventability come from them. When a parent has good communication with their child’s doctor they are more likely to support vaccinations, but if they have poor communication than they are going to be more hesitant or inclined to reject a vaccination. In a Ted Talk about why parents are fearful of vaccines, Tara Haelle explains that she was once a vaccine hesitant parent. Haelle explains that she turned down a vaccine for her son because she was scared of doing the wrong thing and potentially harming her child (Haelle, Ted Talk). This is a common reason parents do not get their children vaccinated, and having a good relationship with their child’s health care provider might be all it takes for those parents to get their children vaccinated. It is also important for those health care providers themselves to be educated and confident about what they know of vaccines; “if providers themselves are hesitant, they are less likely to encourage their patients to vaccinate” (Identifying and Addressing Vaccine Hesitancy). The communication of public health systems with patients is also important when educating parents and society about vaccines. If parents receive any kind of miscommunication from these public health systems, understandably their opinions on vaccine safety will just make them more hesitant about the vaccines. Where on the other hand, good communication and recommendations will be enough to convince parents that vaccines they may be worried about are important for their children and that there is not anything to be scared of because they would not be doing the harm they think they would. It is also important for those health care providers to develop a certain level of trust with their patients. It is very easy for people to do their own research about vaccination and find all the negative information about them, and health care providers can be more transparent with the information they give their patients so that a level of trust can be developed. “Core principles to be followed by all health care providers, experts, health authorities, policy makers, and politicians include: engagement with and listening to stakeholders, being transparent about decision making, and being honest and open about uncertainty and risks.” (Larson). Trust is one of the most important factors to be taken into account when talking about strategies to confront vaccine hesitancy.

As it has been discussed in the previous paragraphs, an issue that is one of the main factors contributing to vaccine hesitancy is public perceptions of vaccines. The Strategic Advisory Group of Experts (SAGE) that focuses on immunization is the principle advisory group to the World Health Organization (WHO) which also focuses on vaccines and immunization. The Strategic Advisory Group of Experts reports to the director general so the World Health Organization can be advised on various global strategies that focus on the research of vaccinations and development of immunization programs. Because of the fact vaccine hesitancy is a new topic to researchers, there hasn’t been a whole lot of development on how to effectively create methods to combat the problem. “Only a few programs and measures have been shown to be effective in decreasing vaccine hesitancy in specific populations where hesitancy has been found.” (Eskola). Because of how many different things can cause and influence vaccine hesitancy, there is not a primary strategy that counts as the best intervention method. When a program is developed to help combat vaccine hesitancy a lot of different factors have to be taken into account like socioeconomic status, religion, culture, and where the person might live. “Experiences from low income countries receive most attention, but the lessons learnt that apply to vaccine hesitancy more broadly need to be shared with high and middle income countries” (Eskola). People in areas of poor socioeconomic status won’t have as much access to the information that people of higher socioeconomic status are provided, making them good candidates for better vaccination programs. “SAGE encourages the public health community to work together to develop the use of tools to address vaccine hesitancy… This should be done in different settings and subpopulations in high, middle, and low income countries…to ensure that they are acceptable to the local population” (Eskola). Constant updating of vaccine programs in various countries and states is one of the best methods of addressing vaccine hesitancy because information is constantly changing and more knowledge on the topic is constantly being acquired by health care professionals. If hesitant people are aware of what is going on with the science community and also better aware of the benefits and risks that come along with vaccinations, they might be more willing to be open to vaccinations. 

Although there needs to be more research done on the topic of vaccine hesitancy, it needs more awareness to be brought to it so that the re-emergence of previously eradicated diseases doesn’t occur. Like the example of the measles outbreak at the Disneyland in California as a direct result of vaccination rates in the entire state, the chance that there could be more outbreaks like that but worse have the potential to happen. The amount of people who are vaccine hesitant compared to the people who do choose to vaccinate their kids is so small, but that small number of people can have such a big impact on the health of society. The progress vaccination research has made over the years and all the information about vaccinations available to people today is a lot more than it was in the past. Educating health care providers on the changing vaccines and allowing them to relay that information to hesitant parents by explaining the risks and benefits, and also providing better vaccination programs to areas that have a harder time being educated are all ways to combat the issue of vaccine hesitancy today. The dangerous effects the vaccine hesitant people could have on the health of society are too risky to not do anything about, combatting this low key issue that can have a big impact is important to keeping people as healthy as possible and leave the eradicated diseases where they are. 
