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World Immunization Week-April 24 2019

Vaccine Hesitancy

Vaccine hesitancy, usually expressed by the anti-vaccination movement is not a new concept, it is as old as the first vaccine introduced in the early 1800’s.

The current anti-vaccination wave was triggered by an article in the Lancet in 1999 by Andrew Wakefield that claimed autism was associated with measles vaccination. The claim has never been scientifically proven and the original article was retracted and deemed invalid for major methodological reasons and conflicts of interest by the author. The cost to society from the lapse in vaccination against measles has been huge, not only in Europe but in the US where several Measles outbreaks have already occurred.

“Vaccine hesitancy” is defined as the denial or late acceptance of vaccination in a society that provides vaccines and vaccination services. This is a global multi-factorial issue with individual and socio-political causes.

Individual factors:

Vaccine hesitancy can result from:

  • An individual’s tendency to draw order and predictability from random occurrences/events,
  • An individual’s tendency to bias data to fulfil a desired outcome/theory
  • An individual’s difficulty in unravelling/unmasking the bias and manipulation of data reported from anti-vaccination theories

Socio-political reasons:

  • Lack of trust in government bodies, public health authorities and the scientific community
  • Alternative lifestyles (alternative medicine and therapies)
  • Media that inflates and dramatizes single events in order to make headlines while ignoring successful disease prevention strategies that have helped tens of millions of people.
  • Internet and social media: gives the ability for the user to create and disseminate information related to personal experience, unsubstantiated opinions on diseases and medical treatments, in addition to creating open forums with other online users (for example blogs).
  • Information from the internet from unreliable sources
  • Distorted theories from the anti-vaccination movement that are abundantly available on the internet.

The tactics of the anti-vaccination movement include distortion of research, studies with methodological issues that support anti-vaccination theories towards the negative effects of vaccination which conclude that:

  • Vaccinations cause idiopathic and neurological diseases, diabetes and autism
  • The number of vaccinations recommended to children have hidden dangers and weaken the immune system.
  • Diseases pass either way and holistic and that alternative approaches are preferable for management.
  • Mandatory vaccination is a violation of individual rights and freedom

In fact, refusal to vaccinate actually increases the dangers of infection for the individual but also for the general public, raising reasonable ethical questions:

  • Responsibility to our own health: Is it ethical to refuse vaccination?
  • Responsibility to protect our children: is it ethical to refuse vaccination on behalf of a child?
  • How ethical is it to ignore our responsibility to the general public and specifically to vulnerable and high risk groups (ie neonates, pregnant women, immunosuppressed)?

The reality is that properly implemented and enforced vaccination schedules successfully:

  • Eradicate the disease and prevent future outbreaks
  • Improve morbidity and mortality at the individual and population level
  • Prevent disease, reduce disease severity and prolong life expectancy
  • Create Herd immunity, protecting those not vaccinated (for example infants)
  • Protects from infectious diseases and consequently prevents certain types of cancers related to the initial infection, for example, HPV vaccination protects against the HPV virus which causes many cervical cancers among women.
  • Prevents antibiotic resistance
  • Safer travel and protect against bioterrorism
  • Reduces financial burden on health systems and promote economic growth
  • Vaccines are safer than the disease and their medical treatment
  • Vaccine safety has improved significantly as a result of advancements in biomedical engineering
  • Today, the development, circulation and safety of vaccines is ensured through a complex, multi-step process of multiple control measures for the quality, purity, dosage, efficacy and adverse effects.
  • Monitoring of manufacturing companies and their production processes (FDA, WHO)
  • Continuous monitoring and vigilance for as long as the vaccine is in circulation, resulting in the accumulation of a huge database of its use in practice, allowing for immediate action and improvement of the vaccine to constantly increase its safety accordingly.

Paradox: The dramatic reduction in vaccine-preventable transmissible diseases, in fact the vaccine effectiveness itself, has led to the public perception that the severity of the disease is not a risk but also that the dangers from transmission of disease have been reduced.

Of course, also very important, is the role of healthcare professionals at all levels of the Healthcare System, in both private and public sectors. Many physicians and nurses share limited knowledge, awareness and conflicting personal opinions on vaccination, while also sometimes refuse/discourage vaccination being unaware of the impact they have on their patients.

Is it ethical and morally appropriate for an un-vaccinated physician or nurse to visit their immune-compromised patients during a seasonal influenza outbreak?

Is it ethical for physicians to ignore the documented international guidelines in relation to the prevention of communicable diseases? Could it be considered malpractice?

Is it rational to blame the state and demand protection from dangers while denying that protection when it is offered?

Further improvement is needed at all levels:

  • Proper information, training and awareness of the public
  • Re-establishing public confidence in government bodies, public health authorities and the scientific community through highlighting the benefits of vaccination
  • Training healthcare providers on communicable diseases, immunization and vaccination counselling.

For more information on vaccination schedules, click the links below.

For Adults here (in Greek).
For Children here (in Greek).


  • Hickler, Benjamin, Sherine Guirguis, and Rafael Obregon. 2015. “Vaccine Special Issue on Vaccine Hesitancy.” Vaccine 33(34): 4155–56.
  • Keith, Jacqueline A. et al. 2013. “Delivering the Promise of the Decade of Vaccines: Opportunities and Challenges in the Development of High Quality New Vaccines.” Vaccine 31: B184–93.
  • Luyten, Jeroen et al. 2014. “Kicking against the Pricks: Vaccine Sceptics Have a Different Social Orientation.” European Journal of Public Health 24(2): 310–14.
  • Patricia, M, Shannon Stokley, and Neal A Halsey. 2015. “Factors Associated With Refusal of Childhood Vaccines Among Parents of School-Aged Children.” 159(May 2005).
  • Salmon, Daniel A et al. 2006. “Compulsory Vaccination and Conscientious or Philosophical Exemptions: Past, Present, and Future.” Lancet (London, England) 367(9508): 436–42.

Read the Greek version of this article here.