Routine vaccinations recorded sharp declines during the early months of the pandemic as the country put non-COVID-19-related health care on the backburner. Now, physicians are urgently trying to catch patients up on their immunizations so that communities can continue to keep highly infectious, vaccine-preventable diseases at bay.
But slow progress and the growing influence of the anti-vaccine movement are raising alarm bells among health care professionals. Vaccine opponents seem to have used vaccine hesitancy around COVID-19 as an entry point to encourage skepticism around routine immunizations. As a result, people who historically got their routine vaccinations, and who got their kids vaccinated, may now be choosing to bypass the process.
“As we see greater success by organizations that are aligned against public health and seek to leverage people’s fears to spread disinformation, the effect ultimately is going to be outbreaks of vaccine-preventable diseases and needless suffering and death,” said Dr. Jason Terk, a pediatrician who is part of the Cook Children’s Physician Network in Texas. “That’s what I fear ultimately will come from this.”
How the anti-vax movement is increasing vaccine hesitancy
Anti-vaccine sentiments certainly did not begin with the COVID-19 vaccines, but the proliferation of misinformation and the politicization of vaccines over the past two years have increased hesitancy on a larger scale.
A frustrating characteristic of misinformation is that it tends to stick in people’s minds, even once it’s been corrected. This is known as the continued influence effect. Once people are exposed to a story questioning the safety or effectiveness of a COVID-19 vaccine, the feeling of unease tends to persist in their brains, even if they no longer believe the initial story. This skepticism can pervade their confidence in other immunizations.
Concerning trends are already showing across the nation. A March 2021 survey found that although a majority of respondents said their confidence in vaccines has either increased or stayed the same since the onset of the pandemic, 20 percent reported a decrease in vaccine confidence. This is not an insignificant proportion, said Dr. Gretchen LaSalle, a physician and clinical assistant professor at Washington State University, who led the survey.
“Twenty percent of people expressing decreased confidence is obviously worrisome, especially if you think about all the other vaccine-preventable diseases that we have traditionally vaccinated for, some of which, like measles, have to have a really high percentage of community immunity to keep it out of our population,” LaSalle said.
In order to maintain herd immunity against measles, vaccination rates need to be at about 95 percent. Any significant decrease in vaccine confidence could cause immunization rates to drop below this number, cracking the window open for the disease to return and threaten children. This has previously happened in Minnesota in 2017, New York City in 2018, and the Pacific Northwest in 2019.
How hesitancy is affecting routine immunizations
The latest data shows that routine immunization rates have reached a critical point. During the 2020-2021 school year, vaccination coverage among kindergartners nationwide dropped about 1 percentage point from the previous school year. Coverage now sits at 94 percent, just under the 95 percent target. Certain states have seen especially drastic declines: Maryland reported a 10 percent drop in measles vaccine coverage, while Wisconsin, Georgia, Wyoming, and Kentucky all reported 5 percent declines.
It’s still unclear how much of this downward trend is attributable to increasing hesitancy as opposed to the pause in physician access at the beginning of the pandemic. But Terk said he has seen hesitancy play a bigger role in his own pediatrics practice, noting that there have been more cases of parents asking if their kid can get routine immunizations at another time or asking for more time to make a decision.
“We’re spending a significantly greater amount of time in our patient encounters trying to assuage concerns and overcome hesitancy for vaccines that were previously accepted by families,” Terk said. “It’s just a trend at this point, and we’re still able to overcome a good deal of hesitancy if we have the skills and wherewithal to do it, but it is a concerning trend.”
LaSalle notes that vaccine opponents have capitalized on not only the lack of access to physicians at the beginning of the pandemic, but also a more politically divided country and the public’s reliance on social media.
Both LaSalle and Terk are now focusing their efforts on catching people up on their routine vaccinations and reducing the steep drop that resulted from the early stages of the pandemic. Even so, there are gaps that they cannot address.
“The groups I worry more about are those that don’t have primary care, including people in certain socioeconomic groups and our young adults,” she said. “How do we access those people and reach those people to have these questions answered?”