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Is vaccination approaching a dangerous tipping point?

Vaccination is one of the most highly effective public health interventions, responsible for saving millions of lives each year, yet an increasing number of people are now declining vaccination for various reasons, ranging from safety concerns to religious beliefs, write Dr Peter Marks and Dr Robert Califf in JAMA Network.

In the US, authorised or approved preventive vaccines must be manufactured with high quality, and their effectiveness and favourable safety profile must be demonstrated.

Their safety over time is also closely and continuously monitored through multiple overlapping passive and active safety surveillance systems, including the Vaccine Adverse Event Reporting System, the Vaccine Safety Datalink, and the BEST Sentinel Initiative.

And yet, despite the care taken in the development and deployment of vaccines and their clear and compelling benefit of saving individual lives and improving population health outcomes, more and more Americans are now refusing to have them.

The situation has now deteriorated to the point that population immunity against some vaccine-preventable infectious diseases is at risk, and thousands of excess deaths may occur this season due to illnesses amenable to prevention or reduction in severity of illness with vaccines.

To counter the current trend, we urge the clinical and biomedical community to redouble its efforts to provide accurate plain-language information regarding the individual and collective benefits and risks of vaccination.

Such information is now needed because vaccines have been so successful in achieving their intended effects that many people no longer see the disturbing morbidity and mortality from infections amenable to vaccines.

For example, smallpox has been eradicated, and polio has been eliminated from the US, through effective vaccination campaigns.

Measles was similarly eliminated, but imported cases remain a threat to those who are unvaccinated as well as to those who are immunocompromised.

Regrettably, paediatric vaccine hesitancy now has been responsible for several measles outbreaks in the US, including one in Ohio involving local acquired cases in 85 children, 36 of whom (42%) had to be hospitalised for complications.

It is sobering to note that vaccine hesitancy to childhood vaccines, like the measles, mumps, and rubella vaccine, is clustered in middle- to high-income areas among parents with at least a college degree, who preferred social media narratives over evidence-based vaccine information delivered by clinicians.

Anyone doubting the benefits of vaccination need only look to low-income parts of the world where measles vaccination is inaccessible, and many thousands of children continue to die each year from preventable disease.

Unfortunately, with the success of paediatric vaccination campaigns to date, increasing numbers of people have become complacent and underestimate the actual risk of forgoing vaccination.

In addition to making a difference regarding childhood immunisation, communication regarding the potential benefits of vaccination can hopefully also improve the number of people accepting vaccination to protect against Covid-19, influenza and respiratory syncytial virus (RSV) disease.

Vaccination rates against these respiratory pathogens are inadequate, and this is most distressing in older individuals in whom the benefits of vaccination in reducing hospitalisation and death are eminently clear.

In fact, uptake of the updated Covid-19 vaccine (XBB.1.5 monovalent) in the US is only about 35% in those over 65, which is about half the rate in this age group in the UK.

What can we do to start tipping the scales in the direction of evidence-informed vaccine acceptance to reduce the risk of death and illness from diseases in which vaccines are effective?

Evidence indicates that the most trusted source of information about health decisions remains clinicians who provide care. Broadly interpreted, this also includes retail pharmacists, who may serve as the only source of medical advice for the many people who who lack a primary care clinician or are uninsured.

All of those working in healthcare, while being straightforward about the risks, need to better educate people on the benefits of vaccination, so they can make well-informed choices based on accurate scientific evidence.

For example, contrary to a wealth of misinformation available on social media and the internet, data from various studies indicate that since the beginning of the Covid-19 pandemic, tens of millions of lives were saved by vaccination.

The benefits of these vaccines in prevention were largest in older individuals. However, studies show that people of all ages who are up to date on vaccination benefit and have a lower risk of developing long Covid.

And although the argument is sometimes made that Covid is not a serious illness in younger people, those who received at least one dose of any Covid-19 vaccine had a notably reduced risk of dying from this disease, compared with those who had never been vaccinated.

Comparing 11.71m unvaccinated individuals with 9.9m who had received at least one dose of a Covid-19 vaccine, the risk of death was 2.46-fold higher in the unvaccinated group. And this finding is not an outlier; other studies report equal or greater benefit.

The message from the data on vaccination status and serious illness, subsequent hospitalisation, and death, is clear, and this can be communicated in verbal or visual terms to those contemplating vaccination.

It is often difficult for someone to take action when the individual risk of an outcome is relatively low, even when the consequences of complications are high, and the population effects are substantial.

In situations such as with seat belts, however, the discussion ultimately has led to almost uniform use, and vaccination use had similarly been almost uniformly accepted. The current reversal of vaccine acceptance has already resulted in hundreds of thousands of excess deaths from Covid-19 and concern about the re-emergence of previously conquered infectious diseases.

We believe the best way to counter the current large volume of vaccine misinformation is to dilute it with large amounts of truthful, accessible scientific evidence.

To reduce deaths, hospitalisation, and the burden on families and the healthcare system, everyone directly interacting with individuals in a healthcare setting, ranging from front office staff to retail pharmacists to primary care physicians, needs to focus at every appropriate opportunity on helping to ensure that people have the necessary information to make informed choices regarding vaccination, considering the benefits and risks.

By doing so, we can both help prevent paediatric infectious diseases and dramatically reduce the harm from pathogens like Covid-19, influenza, and RSV disease before we have another large wave of any of these vaccine-preventable illnesses.

We will do our part at FDA by continuing to provide healthcare clinicians and the general public with timely and accurate information in plain language to help explain the benefits and risks of vaccination.

Marks and Califf are both with the US Food & Drug Administration (FDA)


JAMA Network article – Is Vaccination Approaching a Dangerous Tipping Point? (Open access)


See more from MedicalBrief archives:


Vaccine hesitancy sees drop in childhood jabs post pandemic – Unicef


Vaccine hesitancy among adolescents in sub-Saharan Africa reaches 88%


Vaccine hesitancy — one of the world’s top 10 health threats


PANDA’s ‘misleading and pseudoscientific’ claims drive vaccine hesitancy






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