Vaccine hesitancy: unshackling perceptions

By Muhammad Majid Shafi
Fri, 05, 23

The list of myths and misconceptions surrounding vaccines is a long one, and it is the outcome of lack of knowledge and ‘cognitive bias’....

Vaccine hesitancy: unshackling perceptions


“Vaccines cause diseases that they are actually meant to prevent”, “Getting infections help to build immunity better than vaccines can”, “After getting this vaccine, you’ll be unable to have kids” and “Vaccines contain ‘haram’ ingredients and thus Muslims must not allow them to be administered” are a few of the many old wives’ tales that result in a general hesitancy among the majority of public to get inoculated.

The list of myths and misconceptions surrounding vaccines is a long one, and it is the outcome of lack of knowledge and ‘cognitive bias’. Understandably, such misconceptions have resulted in various losses for individuals and for the society. Therefore, unless an effective strategy to change the unfounded perceptions regarding vaccines is devised, one cannot expect significant progress in achieving the desired response for a particular vaccine.

History of vaccine rejections

Since the first formal vaccine, developed by Edward Jenner against small pox, was administered over 200 years ago, vaccine hesitancy has existed in one form or the other. The majority was reluctant in getting inoculated against small pox and the influential people used mocking cartoons showing humans turning into cows after vaccination to capitalise on the public’s ignorance of the vaccine and concerns about ingesting foreign substances!

A news documentary titled “DPT: Vaccine Roulette” released in 1982 added fuel to the vaccine scepticism fire. It highlighted instances of parents’ and medical professionals’ claims that children who received the diphtheria-pertussis-tetanus (DPT) vaccine experienced convulsions and long-term brain damage. Seizures were, nevertheless, only a very uncommon adverse reaction to the vaccination.

One of the most notorious scientific studies in history was published in The Lancet, in 1998. In the study, it was stated that the Measles, Mumps and Rubella (MMR) vaccine, according to British doctor Andrew Wakefield, is linked to autism and inflammatory bowel disease. It was ultimately discovered that Wakefield had received funding from solicitors who were collaborating with the parents of the study’s participants to attempt and uncover a basis for a lawsuit against the vaccination industry. Investigations revealed that Wakefield was a fraud and liar who intentionally selected data to support the attorneys’ claims and misrepresented other sources of information. The damage, however, had been done!

Coming to our very own country, Pakistan, and its neighbour, Afghanistan, both dominated by a Muslim majority population, the situation is no different.

In the early 21st century, the local Taliban published fatwas condemning vaccination as a strategy used by the Americans to sterilise Muslim populations. The idea that vaccinations represent an effort to thwart Allah’s will is another prevalent misconception propagated by the radical Islamists. Abdul Ghani Marwat, the head of the government’s immunisation campaign in the Pakistani tribal areas’ Bajaur Agency, was killed by the Taliban. Attacks on polio workers in Pakistan continue to date.

Vaccine hesitancy: unshackling perceptions

Basis of the myths

All the misconceptions surrounding vaccines result from nothing but lack of knowledge and a general mistrust of evidence-based science by laypersons among the masses. Many people follow the ‘wait and watch approach’ for vaccines, and thus do not step in to get vaccinated unless a reasonable number of people in their contacts get vaccinated and ‘testify’ that they witnessed no vaccine associated adverse reaction!

At times, the people’s degree of trust in policy makers and healthcare system is low, and it adds to their trust deficit in the vaccines themselves. Moreover, in many remote areas, accessing vaccination centres is difficult and many life-saving vaccinations are not free of cost. Therefore, people who are ignorant about the necessity of vaccines (unfortunately, the majority living in remote and rural areas is uninformed) do not bother ‘wasting’ their time and money in getting them for themselves and their offspring.

Adverse reactions to vaccines, though very rare and usually not serious, can occur. This is where cognitive bias comes into play. The availability of an emotionally compelling story about a rare adverse effect (AE) might cause parents to perceive that rare incident as a frequent AE and nudges them towards vaccine hesitancy. This factor plays an instrumental role in promoting avoidance of vaccines in many communities.

Lastly, many people, again due to lack of knowledge and exposure, underestimate the risks of a disease. Paradoxically, the low risk from a disease is, at times, the outcome of an effective vaccine because effective vaccines reduce the severity of that particular ailment against which they are manufactured. Instead of getting convinced in favour of getting vaccinated, many prefer to satisfy themselves by believing that the disease is not something to bother about. Many go a step further and question the requirement for a vaccine when it is not able to completely prevent the disease. We have recently witnessed this attitude in the wake of the COVID-19 pandemic.

Vaccine hesitancy: unshackling perceptions

Losses resulting from misperceptions

Early on in the pandemic, a survey of US adults found that 31–50 percent of Americans had reservations about getting the COVID-19 vaccination. This, and the reluctance in receiving other vaccines for various epidemics and pandemics in other societies, is a hurdle in achieving ‘herd immunity’ where a disease will be unlikely to spread because many in a population have gained immunity from it either by being vaccinated or surviving the disease.

Secondly, many diseases such as measles, mumps, rubella, tetanus and hepatitis continue to cause morbidities and mortalities even though effective vaccines have long been developed against almost all of them. This is only because of vaccine hesitancy.

Lastly, the crippling disease – polio – still continues to hover over our heads. It has been eradicated from all but two countries: Pakistan and Afghanistan, an outcome of the vaccine exemptions due to various unfounded personal, religious and societal views.

Vaccine hesitancy: unshackling perceptions

The way forward

In the midst of all the misunderstandings surrounding vaccine hesitancy, it is necessary that we devise a strategy to change the general public’s perception regarding vaccines. The foremost step in this regard is to share vaccine success stories in print and electronic media. Vaccines are, indeed, effective as summarised by scientists at Emory University who stated: “Ten historically fatal diseases have been reduced by 92-100 percent since the 20th century. Smallpox has been eradicated and polio is nearly gone”. It’s only the general public that needs to be apprised of these gains.

Secondly, the power of the influential people of a society: the clerics, politicians and celebrities, cannot be denied. Therefore, it is essential that these people are briefed about the necessity of the vaccines and the severity of diseases against which they are developed so that instead of resisting their administration, they can urge their followers to get inoculated. When the vaccines against COVID-19 were new to the market, a study suggested the Pakistani government engage religious leaders in disseminating the knowledge of the halal/ kosher nature of the vaccine. Same should be done for vaccine against polio, and against other diseases. Once this is done, we can certainly expect a positive outcome.

Vaccine hesitancy: unshackling perceptions

When the small pox vaccine was made mandatory in the U.S. and the U.K., people started stepping in to get vaccinated. The response was somewhat encouraging when the Pakistani government mandated COVID-19 vaccine for the general public, as well. Therefore, mandating various life-saving vaccines can be a reasonable approach in making the general public get inoculated.

Last but not the least, there is a need to make the vaccination process more streamlined. Pharmaceutical infrastructure and purchasing power are deciding factors in getting a vaccine, particularly for people living in rural and remote areas. COVID-19 vaccine is free of cost, and a door-to-door facility is provided for polio vaccine. Both show encouraging responses. If comparable facilities are provided for other vaccines as well, such as the MMR (Measles, Mumps, Rubella) vaccine and Hepatitis A, B and C vaccines, vaccine hesitancy can be lessened.

In conclusion, unfounded perceptions lead to vaccine hesitancy which is a barrier in reaping the desired results. The list of myths and misconceptions surrounding vaccines is a long one, and we have already suffered immense losses due to the failure of the government to create awareness about the benefits of getting vaccinated. Hence, it is the need of the hour to devise an all-encompassing strategy that offers a solution to the lack of knowledge and cognitive bias – two of the most important fundamentals that lead to vaccine hesitancy.