Vaccine hesitancy was listed as one of the top 10 threats to global health by the World Health Organization (WHO) back in 2019 — but in 2021, it remains as threatening as ever.

Defined by the WHO as the “reluctance or refusal to vaccinate despite the availability of vaccines,” it has the potential to reverse progress in eliminating some of the world’s deadliest infectious diseases.

Today, as the COVID-19 pandemic continues to ravage communities worldwide, the threat of vaccine hesitancy has become even more evident and urgent.

The current global health crisis has killed more than 2 million people, infected more than 100 million, and impacted the lives of most people around the world, regardless of geographic location or socioeconomic status.

One of the best ways to stop transmission of the deadly virus, while minimizing fatalities, is to immunize the global population with COVID-19 vaccines.

“If people don’t get vaccinated, not only can they get infected, but they can transmit deadly infectious diseases,” Jeffrey Lazarus, head of health systems research at the Barcelona Institute for Global Health (ISGlobal), told Global Citizen. “Since taxpayers are paying for health care, there are a lot of good reasons to keep the population healthy, and vaccines are relatively inexpensive and extremely safe.”

Why is it important to address vaccine hesitancy?

Next to the challenges of producing enough supply to vaccinate everyone and distributing available doses equitably, a major barrier to ending the COVID-19 pandemic is convincing people to actually get the vaccine once it’s available.

In a global survey led by Lazarus that looked at potential COVID-19 vaccine acceptance rates in 19 countries, respondents from China gave the highest number (89%) of positive responses when asked if they would take a “proven, safe, and effective vaccine,” while respondents in Russia gave the lowest number (55%) of positive responses.

In eight of the countries, including Canada, Singapore, Nigeria, and France, less than 70% of the population responded positively. 

This data doesn’t bode well for plans to develop herd immunity against COVID-19. Between 70% to 90% of the population will likely need to be vaccinated against the virus in order to achieve herd immunity and halt transmission, US infectious disease expert Dr. Anthony Fauci said last December.

But fighting vaccine hesitancy isn’t just specific to the COVID-19 pandemic. Vaccination is one of the most efficient and cost-effective ways to ward off disease — it currently prevents 2 to 3 million deaths a year.

However, should generations become complacent about getting vaccinated, infection and deaths could easily rise. Measles, for instance, saw a 30% spike in cases globally from 2016 to 2017, causing a resurgence in some countries that were close to eliminating it altogether.

Why are people hesitant about vaccines?

People who are vaccine hesitant are those who delay the acceptance of or refuse vaccines despite availability of vaccination services, according to the WHO. This reluctance or refusal to vaccinate can stem from religious beliefs, fear of needles, lack of confidence, and more. 

The spread of misinformation is a main driver of vaccine hesitancy, Lazarus said. Whether it’s twisted truths, downright lies, or conspiracy theories, misinformation about vaccines has played a big role in reducing public trust and confidence in the immunization process.

In the age of social media, misinformation spreads like wildfire.

Last year, Facebook and YouTube announced that they would remove false claims about the COVID-19 vaccine that have been debunked by public health experts, a move that aimed to help stem the spread of false claims that deter immunization efforts. 

It is also linked to distrust in the system — be it the government or the public health system. A recent Lancet survey found that higher percentages of respondents with no recent vaccination history were associated with lower trust in national government.

Distrust in the system can also vary among specific communities within a nation. In Pakistan, vaccine distrust strengthened after the US government created a fake Hepatitis B vaccine program in an attempt to collect DNA evidence while searching for Osama bin Laden. 

In the Democratic Republic of Congo, distrust in the Ebola vaccine derived from years of armed conflict and political instability that created an environment of skepticism towards responders, authorities, and health care workers.

In the US, Black Americans are less inclined to get vaccinated than other racial and ethnic groups, with only 42% responding that they would definitely or probably get the COVID-19 vaccine in a December study by the Pew Research Center.

Black Americans’ relatively low acceptance of the vaccine is part of the community’s broader mistrust of medicine, based upon historical instances like the Tuskegee syphilis study, as well as continued racism within the health care industry that have given them reasons to be skeptical of the system and its recommendations.

Vaccine hesitancy can also be a result of inconvenience in terms of opportunity or economic cost.

“If you have a job and have very few days off every year, do you use one of those days to get a vaccine for a disease you don’t have? You may not prioritize that time,” Lazarus said. “This particularly affects those of lower income or people with many kids.”

People in poorer countries or communities may face even more complications that increase vaccine hesitancy, such as a lack of transportation to the nearest clinic, or the time and cost needed to travel to the vaccination site, Lazarus said. Migrants and internally displaced people face similar challenges, in addition to potential language barriers and lack of access to health care.

All of these factors play a role in determining how likely an individual is to get a vaccine.

How do we combat vaccine hesitancy?

One of the main ways to combat vaccine hesitancy is to spread awareness and improve vaccine literacy. That means informing the public about the facts, debunking myths, and building confidence in the safety and efficacy of approved vaccine candidates.

In the context of the COVID-19 vaccine, awareness campaigns can help people understand that the speed at which the vaccine was developed did not sacrifice regulatory practices, the new mRNA technology used in the vaccines is not actually that new, and the risk of potential side effects is expected in any vaccine or medical treatment.

Many celebrities and politicians have also chosen to receive their COVID-19 vaccine doses in public or use their platforms to share their vaccination experience as a way to boost public trust.

Lazarus also said that it’s important to “find messages that resonate with the target population.” To convince young people to get the vaccine, for instance, public health messaging can emphasize the importance of getting vaccinated for the benefit of older friends and family members. For those over age 80, getting vaccinated provides them with a better chance at a longer life.

Countries also need to develop ways to provide accessible services to more isolated populations. For people who live in rural or poorer areas, it’s important that services be brought to them instead of expecting them to make sacrifices to get vaccinated.

“It’s about bringing the services closer to the client and creating people-centered health systems,” Lazarus said. “Health systems have to have outreach services, or even mobile services, to meet people on their own terms.”

There are many reasons why people are hesitant toward vaccines, despite their history of safety and efficacy. But for the sake of the global community, replacing hesitancy with confidence is essential to achieving a world where everyone, everywhere can be healthy.