Stuart Blume examines the reasons for vaccine hesitance, a growing trend among middle-class parents

Global childhood vaccination coverage decreased worldwide last year, a trend that began to deepen after the Covid-19 pandemic and which also includes Argentina. The World Health Organization (WHO) and UNICEF indicated in a recent report that an estimated 2.7 million more boys and girls in 2023 did not receive the vaccine or received fewer doses compared to levels before -2019 the two international organizations took into account the national vaccination coverage (WUENIC ) including vaccination against 14 diseases. Therefore, they pointed out that the latest trends show that there are “too many unvaccinated children” in many countries, which is why it is necessary to make efforts to modernize, recover and strengthen systems . “Closing the immunization gap requires a global effort for governments, partners and local leaders to invest in primary health care and community workers to ensure that all children are vaccinated and that health care is generally strengthened,” the document said.

Findings from WHO and UNICEF indicated that the number of boys and girls who received three doses of the diphtheria, tetanus and pertussis (DTP) vaccine in 2023 remained stable at 84% (108 million people). However, the number of boys and girls who did not receive a single dose of the vaccine increased from 13.9 million in 2022 to 14.5 million in 2023. More than half of the unvaccinated child population, the document said, lives in the 31 countries with weak. in contexts, affected by conflict and in vulnerable situations, which make them particularly susceptible to preventable diseases due to lack of access to security, nutrition and health services. This trend of a significant reduction in global vaccination coverage has remained almost unchanged since 2022 and, which is a stark observation for experts, has not returned to pre-pandemic levels.

“Vaccines are a wonderful public health tool, but governments have over-relied on them. Therefore, when there are no vaccines for some diseases, they are lost. We need to rebuild vaccine production in the public sector, reintegrating it into public health goals,” he said. elDiarioAR the British explorer Stewart BlumePhD in Chemistry from Merton College in the University of Oxford and professor of Science and Technology Studies at the University of Amsterdam, the city where he lives. Blume is the author of the book “Vaccines, a controversial story”, published in Argentina by Godot Editionsin which he deals with the development of new technologies applied to health and the dynamics of the global immunization system.

In his work, Blume states that vaccines were “originally public health tools, used in conjunction with others to protect a population from known threats to their health.” ” However, “as time passed, the methods ended. As public health became increasingly dependent on vaccination, the basic parameter changed. It was no longer the health condition of the people, but the level of vaccination coverage,” he said.

–Do you think there are national states that have left part of their health policy in the hands of laboratories and their vaccines? Is there a way to reverse that?

– To the first question: of course yes! Governments around the world are increasingly relying on vaccines to solve public health problems that are too complex to allow such a simple solution. The problem – and we saw it during the Covid-19 pandemic – is that, to some extent, other types of protective measures (quarantine, forcing people to keep their distance and wear masks) difficult to apply and very neutral. Vaccines are a wonderful public health tool, but governments have over-relied on them. So, when there are no vaccines, states are lost. Public sector vaccine production needs to be rebuilt, reintegrating it into public health goals.

–Do you realize that there is a real danger that the governments themselves, with their health policies, have exacerbated the problem of vaccine hesitancy?

– In part, yes. Loss of trust in politicians and lack of funding for health care has been fundamental. Beyond people who oppose vaccination on principle, vaccine reluctance is largely due to fear of side effects. This can be addressed by the institutions that are supposed to collect and analyze reports on the outcomes of vaccines, better known as pharmaceutical surveillance. These institutions must be known, accessible and reliable. People need to be assured that their concerns will be addressed.

–What lessons have countries learned, in your opinion, regarding vaccination after the Covid-19 pandemic and, finally, what mistakes should not be repeated in the future in health conditions of this type?

-I’m not sure if they would consider it a mistake, but from a global perspective rather than a national one, it was a mistake in the way rich countries were able to monopolize the limited supply of vaccines.

-In your book you mention a relationship, as a visibility tool, between the internet and people who are against or reluctant to vaccinate. How do you think this situation can be changed and what messages can be spread?

-Undoubtedly, anti-vaccination groups and people have used the Internet to spread the message. Meanwhile, public health institutions have turned to that tool to make sure people see their pro-vaccine message first. But in reality, it is not clear what effect these messages had on the actual behavior of the people. I think those investigating anti-vaxxers focused on internet posts because it was much easier to do that than to talk to people about how they decided would they get the vaccine or the vaccine.

–Are there other elements or measures that can be implemented to avoid coercion as the only way to encourage population vaccination?

-I live in the Netherlands, where vaccination is voluntary and has one of the highest levels in the world. The factor that, above all, leads to a high vaccination rate is trust in the government; much more important than coercion. In addition, it is important that public health services are accessible, adequately funded and organized, and socially equitable. The only step that can be taken is to organize and finance public health services and children’s health services.

–In one section of his book he states that populations are “increasingly sensitive and risk-averse” as an explanation for why mothers and fathers are not sensible and persistent in their position on vaccines. How does this translate into consistency and sustainability?

– In medicine, when treating disease, people are expected to decide for themselves, to be “informed consumers.” That means weighing the pros and cons of doing one thing or another. When it comes to vaccination, we are not supposed to do that, but what we are told. The roots of this problem lie in the “commercialization” of health care and how patients become consumers of care. But there is no simple answer to how to influence risk perceptions, which may also differ across cultures. For many years, health authorities have blamed all vaccine refusals on the activities of anti-vaccination groups that spread misinformation. In this way, they refused to see that there was something more complex in the middle. The possibility that established structures and practices had some responsibility for what was happening was never considered. The introduction of the concept of “vaccine hesitancy” ten years ago was a step in the right direction. It was a way of acknowledging that the some The issue was not the militant refusal of vaccination. Instead, there was growing skepticism, especially among middle-class urban parents, who were increasingly convinced that vaccination policies had much to do with the real risks to their children’s health. What we see now, the number of people who had serious doubts about the Covid-19 vaccine, shows us that these doubts have taken root. What is that because of? To the way vaccination policies are formulated and who formulates them. Many of the vaccines introduced in recent years were not developed as responses to a pressing social need. The changing structure of the pharmaceutical industry seemed to give rise to a sense of commercial opportunity to over-indulge in the development of new vaccines.

-Do you see any relationship between the anti-vaccination social movement and right-wing political views?

– No doubt. There is research from some countries that shows this relationship. Trust in experts, elites and scientific knowledge seem to be core beliefs in right-wing populist movements. And, of course, there are famous politicians on the right who have opposed mass vaccination.

–What is the role of international organizations, such as the WHO, in influencing national states to provide vaccination as a basic part of their health policy?

-We can say that his previous emphasis on “health for all”, prioritizing affordable basic healthcare, has been eroded by the rise of neoliberalism in the 1980s, since then, role of organizations such as the WHO and PAHO (Panamericana de la Salud Organization). has been to help countries get the vaccines they need at a price they can afford. During the Covid-19 pandemic, the COVAX kit was developed to help poor countries get the vaccines they needed. It wasn’t very successful, partly because some manufacturers and some rich countries were undermining it, but it certainly helped.

– Do you think there is less political will to protect natural habitats from destruction than there is to change health policies so they don’t make vaccination worse as a solution?

– For sure! Profits are made from the sale of vaccines, but who makes money protecting natural habitats? Unfortunately, it is not the actual value of things, but the profits that can be made, that determine policies in much of the world.