In recent years, an increase of misinformation about vaccines has contributed to declining vaccination rates and the rise of the anti-vaccine movement. In turn, countries including the US and Italy have seen outbreaks of preventable diseases such as measles.
While the parents who oppose vaccines make global headlines, experts say the focus should be on a larger segment of the population — those who are reluctant to vaccinate, but will likely do so when given reliable information from trusted sources.
As the associate medical officer of health at Toronto Public Health, Dr. Vinita Dubey works to increase vaccination rates across the city, which includes addressing vaccine hesitancy. Global Citizen caught up with Dubey to discuss the prevalence of vaccine hesitancy, her strategy in addressing it, and the role of both clinicians and the general public in fostering healthy conversations around vaccines.
What exactly is vaccine hesitancy and how common is it?
When I was in medical school 20 years ago, we didn’t have the term “vaccine hesitant.” We’ve always had people vehemently opposed to vaccines, and now with social media they have a megaphone, so although they’re few, their voice is loud. But this idea that people are sitting on the fence and are questioning whether to vaccinate — this is new.
About 3% of the population are firmly against vaccines. It seems from surveys that about 20% of parents in Canada are sitting on the fence. They may have every intention to vaccinate their child. They themselves were vaccinated, they're not opposed to it, but they say things like, “I don’t want my child to get autism.” They have heard enough anti-vaccine sentiments that it makes them question. Those parents will likely choose to vaccinate their kids — and we focus on that.
What do you know about parents who are vaccine hesitant?
Some of the vaccines we advise for children are not new; they’ve been around since the 70s, but the questions around them are new. We attempt to meet parents’ need for information. On one hand, some parents ask question, after question, after question: “How about aluminum or formaldehyde? How can I be 100% certain there is no risk?”
What I know through my research is this is a tactic the anti-vaccine movement tells parents — to ask whether there is no risk. We know there are risks associated with vaccines, but the benefits outweigh the risks. Nothing in life is without risk, like driving a car or being outside and getting struck by lightning. There are risks in everything, but you need to weigh them.
What are conversations typically like with parents who are vaccine hesitant?
Parents who are vaccine hesitant are really earnest in getting answers, but sometimes the misinformation is so ingrained that it's difficult for them to accept the response I give. I have had to stop conversations when people are not being respectful, or when they keep asking the same question repeatedly, expecting a different answer.
One of our recommendations for parents who have questions is to reach out to your health care provider because this is a trusted relationship, which makes conversations more effective.
You published a paper that advises doctors on how to navigate these conversations. What do you recommend?
Some doctors say, “This parent came in and is talking about aluminum in vaccines, and I don't know what to say,” and the reverse applies. There are parents who say, “I asked my doctor about a vaccine and they can’t give me a response.” That’s why we published this paper.
Part of the issue is that physicians are confident in vaccines, but unsure how to answer questions, and through their body language, they are making the parent uncomfortable. Some physicians say, “I have been a physician for 20 years and have never had to think of those responses.” It's part of the clinician’s role to be prepared to respond, so they can reassure parents.
Toronto Public Health
Toronto Public Health
Toronto Public Health
Toronto Public Health
How are you working to increase vaccine uptake and tackle hesitancy from a policy perspective?
From a systems perspective, I look at whether there are laws that can be made to promote vaccines and vaccine delivery, to keep coverage and herd immunity high. There is an act in Ontario that says all students must be vaccinated to enroll in school, or they need a valid exemption — whether it’s medical, or religious/philosophical.
In Toronto, our exemption rate is still low at under 3%, but for the last decade there has been a steady increase in the philosophical exemptions. At what point is that rate too high? We now have pockets in schools of people who are unvaccinated. Toronto gets a lot of travellers and measles comes to our city every year. If measles were to come to a school with a low herd immunity, it could spread.
Throughout your work, is there a memorable conversation you’ve had with a member of the public on their views about vaccination?
There was a woman, Safia, who came to a board meeting at Toronto Public Health and shared her story. She was born in Somalia and her parents delayed vaccinating her because they were hesitant. She contracted polio before the age of 1, and now, in Toronto and in her 40s, she lives with the effects. She has had surgery and uses a mobility device.
Her story was in contrast to those who came to the same meeting and said vaccines harmed their children. This was a moment that was very telling — you have two sides and they are before you. One is committed to expressing why they don’t like vaccines and don’t trust them, and yet, there others are sharing stories of how the harm they experienced could have been prevented.
How do we promote healthy conversations around vaccines, so that parents feel comfortable asking questions and seeking information?
The one place we don’t need to have this conversation is on social media. The internet has played a very negative role in spreading misinformation. People need to be cautious about what they read on social media and not take it at face value.
We all have a role to play to make sure that our population continues to be vaccinated. In the place we are right now with COVID-19 ... already there is misinformation and anti-vaccination sentiments. Recognizing how to interpret the science and make informed choices is something we all have a part to play in. It’s not just up to health professionals to change people’s minds.
This interview has been lightly edited for clarity.
If 2020 has taught us anything about global health, it’s the importance of vaccines. The World's Best Shot is a profile series dedicated to sharing the stories of vaccine activists around the world.
Disclosure: This series was made possible with funding from the Bill and Melinda Gates Foundation. Each piece was produced with full editorial independence.