Anti-Vaccine Decision-Making and Measles Resurgence in the United States

"Understanding the sociobehavioral variables that influence vaccine-hesitant parents is critical because it will allow the public health community to develop a more targeted and effective response campaign..."

Since 2014, public health officials have observed an increase in vaccine opposition throughout the United States (US). In 2019, measles outbreaks reached emergency levels not only in the US but also in countries such as the Philippines, Ukraine, Venezuela, Brazil, Italy, France, and Japan. This article addresses the social and contextual factors behind the measles resurgence in order to provide health professionals with tools to develop an effective pro-vaccine response campaign. The hope is that understanding these factors can prevent behavioural trends associated with the "anti-vaxx" from gaining additional traction throughout the US and beyond.

The article traces the history of anti-vaccine activism, pointing, for example, to the 1998 publication of a series of articles in The Lancet - later retracted - erroneously suggesting a connection between the measles, mumps, and rubella (MMR) vaccine and development of autism in young children. The anti-vaxx movement may also be situated within economic and social movements in the US.

As is explained here, persuasion from entertainment and pop culture figures can influence health behaviour and decision-making about vaccinations, particularly when misinformation is shared on social media. Some social media influencers are parents who attribute the deaths of their children or illnesses they contract to vaccines and take to the internet to discuss their experiences and warn other parents. In addition, the widespread involvement of bots and malware in online public health discourse skews discussions about vaccination and fuels the belief that the science behind vaccine efficacy and safety is still debatable (e.g., that vaccines contain "contaminants").

While social media platforms such as Instagram are taking steps to try to make it more difficult for a lay person to come across anti-vaccine propaganda, the authors suggest an earlier intervention: "Effectively countering the anti-vaccine movement should be addressed through understanding mechanisms for increasing trust between the medical community and parents." When doctors and public health officials embrace their responsibility to keep the science behind vaccines transparent to inform parents, confidence and trust around the practice can take hold and, presumably, make misinformation communicated via social media less alluring.

As a specific response to the anti-vaxx content that can spread on social media, the public health community could use social science and behavioural research to develop pro-vaccine narratives. Doctors and public health organisations could publish stories online (or in pamphlets) of successful vaccine appointments, for instance. Parents might also volunteer to provide their email addresses (or phone numbers) to the clinic to hand to vaccine-hesitant parents, allowing peer-to-peer communication to serve as an intervention.

Among the policy implications of the arguments set forth here is the need to close vaccine loopholes. The authors explain that 17 states grant philosophical exemptions for those opposed to vaccines because of personal or moral beliefs, and 45 permit "conditional entrance" to school on the promise that children will be vaccinated - yet there is often no follow-up, according to the authors.

The article concludes with the suggestion that research by sociologists, psychologists, public health researchers, and other scholars on long-term solutions to the root causes of the measles outbreak should be integrated with strategies launched by nonprofits, state-level health initiatives, and community health promotion efforts.