The Decibel - Why fewer people have confidence in childhood vaccines

Episode Date: April 24, 2023

Since the pandemic, confidence in childhood vaccines has decreased around the world, according to a new report by UNICEF. Before COVID hit, 91 per cent of Canadians believed vaccines are important during childhood. That number is now 82 per cent.So what has caused this drop in the faith in children’s vaccines? The Globe’s health reporter, Carly Weeks explains to us how this happened, how it could affect Canada’s future outbreaks and what can be done to get those rates back up.Questions? Comments? Ideas? Email us at [e-mail]

Since the pandemic, confidence in childhood vaccines has dropped worldwide, including here in Canada. That's according to a new report released by UNICEF. It comes at a time when 67 million kids around the world are not up to date on their shots for things like measles, whooping cough and HPV, making them more vulnerable to preventable diseases. Carly Weeks is a health reporter for The Globe, and she's on the show to tell us what's behind this drop and what impact it's having. I'm Mainika Raman-Wilms, and this is The Decibel from The Globe and Mail.

Carly, thank you so much for being back on the podcast. Thank you for having me. So last week, UNICEF released a report that says confidence in childhood vaccines has gone down in 52 of 55 countries when we compare before COVID in 2018 and now. And we're talking about vaccines that have been around for a while, like those for measles. So Carly, what is it about the pandemic that made people feel less confident about vaccinating kids? I think there's a number of factors at play. One, vaccine confidence has been in flux for the last decade, decade and a half, because of some of the fraudulent reporting and research about linking vaccines to autism. So we've already had some doubts lingering in the background, especially with the onset of social media, kind of making it easier for people to share false information. Then, of course,

we had the pandemic, which really, I think, enabled in a much bigger way, a lot of bad actors to take advantage of a situation and continue to amplify false information about vaccines, it comes at a time when people are asking legitimate questions. I think basically this pandemic, it thrust some issues related to public health so much into the public consciousness that we thought about vaccines in a bigger way than we ever have before. And so just to be clear, you kind of alluded to this there, but when we're talking about vaccines for measles and things like that, these have been around for a long time. These have been proven to be safe and beneficial for kids, right? Yeah. So we have vaccines that have been

around for decades, like for measles, mumps, rubella, whooping cough, you name it. You know, and there's been some questions about those from people who are simply in that anti-vaccine world who are always going to be questioning any kind of vaccine, no matter how safe and effective it's proven to be. I think what happened with the COVID-19 vaccine, it was almost sort of like this gateway vaccine that started people asking more questions, thinking about vaccines in ways they probably haven't since they were even kids. And then when you have this onset, this onslaught, I should say, of misinformation from, you know, a handful of bad actors kind of in your face on social media all the time.

I think that's when we started to have that conversation widen to not just about COVID vaccines, but basically all vaccines that, you know, maybe we shouldn't be having any vaccines. I think that more and more people are starting to ask some of those questions as a result of this sort of vacuum that was created by, I think, frankly, the lack of really great, robust public health messaging about why such vaccines are so important, why they're so safe, how we know they're safe, how many kids used to die from these illnesses that have basically disappeared or become nothing more than, you know, mild cases that tend to be more of a nuisance for

the majority of families. We don't see the horrors of the pre-vaccine world anymore. And it has allowed us to pretend like this is not an essential part of keeping, you know, children in particular, but everyone healthy. And we will start talking about the public health messaging soon, because I think this sounds like it's an important part of it. But I just want to like, let's just go through the report a little bit to kind of establish what UNICEF actually looked at here. So how did UNICEF measure people's feelings towards vaccinating kids?

They essentially asked people in surveys, you know, about their confidence levels, how they felt just taking the temperature of people in a survey format. And this is something that they do sort of on a regular basis, this is actually a really important sort of public health initiative to try and figure out what people's feelings are when it comes to vaccines, why they may feel a certain way, be more willing to take vaccines in certain communities or countries versus others. And so that's essentially what they set out to do is try and measure people's thoughts and feelings and even intentions around vaccines. Generally speaking, Carly, are there any age or gender breakdowns around confidence levels? Like, do we see a difference between younger and older people? Yeah, we tend to see, and most surveys do back this up, that older age cohorts tend to have

higher confidence in vaccines. And I think that that's likely due to a number of factors. One, we're talking about a cohort of people that can remember things like polio, even things like chickenpox, that now we just don't see lots of kids breaking out in those rashes. And in fact, there was a children's hospital that had their first ever chickenpox outbreak in Canada in the last year. And a lot of the physicians on staff didn't even know what they were looking at. So I think older generations remember these illnesses as being very real threats. And younger people, especially people who are, you know, under 35, who are very high users of social media, where a lot of the bad information is being spread, what surveys like this one tend to show is that they do appear to be less likely to hold high confidence in vaccines. So let's zero in on Canada for a moment. So we're kind of in the middle of the pack here. There was a drop in confidence here as well. What did the report find?

So we had a drop in Canada of 8.2 percentage points. So basically before the pandemic, just over 90% of people said they felt confident in vaccines, that they're really important for kids to have during childhood. Now it's sitting around 82%. So it's still a majority of people are confident in vaccines and are likely to have their child vaccinated. But that is a pretty big drop when you consider that you need to have, you know, 90, 95% vaccine coverage to stop outbreaks from happening. So even though it's 8.2 doesn't sound like a big number, but you're saying that actually makes a big difference in a place like Canada. It can make a really huge difference. You know, it can mean the difference between measles outbreaks in schools and not having a measles

outbreak. You know, measles is one of those illnesses that's just so highly contagious. So if a person is infected with measles, they're in a room, they leave that room, and you walk into that room, you could catch measles even though that person is gone. It's very highly contagious, and it doesn't spread in Canada anymore. That's how well vaccines have done to actually stop the spread of this illness that was once so common. Wow. Yeah. I think this is, you know, when we talked about during the pandemic, we talked about vaccination. We heard the phrase herd immunity a lot of the time. And this seems to be kind of what you're getting at, Carly. Can you just remind us what that is and what level of the population needs to be vaccinated in order for us to actually see

those benefits? Herd immunity is, you know, that concept of, you know, you have to have a certain threshold of people vaccinated to make sure that sort of everybody is protected, that viruses don't get spread around. So measles is a really good example because it's very contagious and it's no longer endemic in Canada. So it's the only time there's a measles case in Canada right now currently is when a traveler brings it from another country where it is still spreading. So, again, that's when you look at, you know, dropping confidence rates in other countries. It has global implications for everyone. So essentially, what happens is, you know, for measles, you typically want to have at least 90, but really more around 95% vaccine coverage to make sure that a population is protected, they have that herd immunity. What we've seen more and

more in Canada in recent years is that as those numbers have started to drop, we have seen more measles outbreaks occurring. You know, typically in schools, you know, a lot of similar countries to ours does threaten, you know, that status that we have of measles not being endemic anymore. And there's, that's been a worry that's been there for, you know, a decade or more. Yeah. So there's 55 countries that are included in this data. So let's talk about some of the outliers here. Where did confidence really sink? There's huge drops in confidence in a couple of different countries. You know, some of the ones that stand out, for instance, are, you know, Japan and South Korea. South Korea fell by 44 percentage points in terms of confidence in vaccines.

That seems pretty dramatic, Carly. Like, do we have any idea why there's such a dramatic drop there? Yeah, I think there's a couple of different explanations. So in a lot of countries where we saw those huge drops in confidence, those tend to be places that have long struggled to have high public levels of confidence in vaccines, you know, which is funny, because I think in some ways, we think about countries like South Korea and Japan Japan who seem to do so well during the COVID pandemic. But I think that there's been a couple of things that have gone on in recent decades with, you know, problematic vaccine rollouts. So there tends to be more public skepticism of vaccines. If your response and rollout is done in the right way and you make vaccines accessible and available to where people live, make it easy for them to take it, easy for them to have their questions answered, you'll start to see uptake go up and research backs this up. So on the other hand, we did see a few countries, Mexico, India and China, where confidence is actually increased.

What does that tell us? The fact that confidence has only increased in three countries, I think, is a pretty damning statement. If you look a little bit deeper at some of those countries, I mean, I think China is its own special case. There has been such problematic use of COVID rules there, COVID restrictions. It's hard to really drill down and say why confidence there may have increased. But if you look at a place like India, they've had some really good successes with vaccine rollout, with sort of garnering public support. It's less of a patriarchal just take this vaccine now

and more of a rallying communities around the importance of getting vaccinated. And I think in India, the confidence went up from 95 to 98%. I mean, that's pretty high. That's very high. It's very high. And, you know, and I think that also if you look at, you know, places like India and other lower income countries where infectious illnesses are more of a daily reality, that's also playing a role here as well. You know, there are countries around the world that are clamoring for access to vaccines that can't get them. And so it's such a different scenario than the one in Canada, where we tend to be awash in vaccines and sometimes can't give them away.

We'll be back in a moment. We're talking about feelings here, but this survey, not actual vaccination rates. But do we have any sense of a correlation here, Carly? Like, do these sentiments translate into vaccination rates in kids actually dropping? Yeah, actually, we do have some sense. And during the pandemic, there was a massive drop in vaccine uptake. Some of the research still needs to be done to tease out exactly what's going on. Some of that's due to simply things shutting down. So it's difficult, you know, there's no school-based vaccination programs because schools are closed. Parents are

having a hard time taking their kid to a public health nurse to get a vaccine because the public health nurses are at the COVID clinic. But part of that is also, you know, and I think this is something I've spoken to a lot of researchers and physicians about their concern that there is sort of this lingering effect of lowered confidence of more anti-vaccine sentiment, more vaccine hesitancy, that's keeping people from catching up now that the pandemic is sort of waning in that sort of emergency type scenario. So we know the pandemic had an impact on these kind of health services. So kids who are simply unvaccinated against anything, which is very scary considering, you know, just how much a threat some of these childhood illnesses can be. Here in Canada, we're starting to get some

data from throughout the pandemic about what's gone on. So I can tell you that, you know, in Ontario, for instance, we were waiting for them to release data from the most recent school year to see if some catch-up programs have been able to make up that ground that was lost during the pandemic. And sad to say, no, it hasn't. So, you know, for instance, during the pandemic, there is the human papillomavirus vaccine, so preventing against HPV, which can cause cervical and other forms of cancer. During the pandemic, there was a cohort of 12 year olds who I think there was about 3% got vaccinated. In the most recent school year, only about one in four of those kids had caught up and were fully vaccinated. So that basically means we have the vast majority of kids in that

cohort who are unvaccinated against something that can cause cervical cancer and will in some small section of the population. Yeah, we saw numbers from Saskatchewan as well, according to a report from last August, where only 73% of two-year-olds are vaccinated against measles. That's compared with 81% in 2018. So, I mean, we're looking at that's an 8% drop there as well. That's right. And that number pre-pandemic was not stellar either. And so now to see that drop, that is a huge section of the population that is completely vulnerable if there is a measles outbreak. And, you know, it's a scary prospect. And I think when you start to look at some of the provincial data that's been made available during the pandemic, so we're waiting for more recent data. But what

it shows is that across the board, there are huge gaps, much bigger than we've seen in decades, I think, since the beginning of vaccination programs, really, frankly, for a lot of these illnesses. You know, and this is not to paint an alarmist picture, but the frank reality is that if there is, you know, a measles outbreak, and 30% of kids have never been vaccinated, you're going to have a real problem on your hands. And I think that a lot of parents don't necessarily understand those risks either. I've talked to some researchers who fear that is what is going to have to happen for people to gain some of that trust back in vaccines. That we're going to have to have some event where we do see the reality of what happens when you expose unvaccinated children to some of

these very scary viruses. Okay, let's talk a little bit about what can actually be done here, Carly, to get confidence back up. So what did experts that you talked to tell you about what we can do to improve that confidence? Yeah, and that is, I think, the good news here is that there's actually a ton of things that can be done, not necessarily overnight and not super easy. There sort of is like this trifecta of things that all go into a decision of whether or not to get vaccinated. And it can come down to, you know, convenience. So how easy is it for a person to get vaccinated? Do they have to take three buses and miss a day of work? Or can they just, you know, go downstairs and there's a mobile vaccination truck that will make the decision easier. So the convenience factor is huge.

Cost, if you're going to have to pay for it, then studies show, this is backed up, you know, in plenty of evidence that you're going to have less uptake. And also, again, that whole idea of sort of that trust. Who is telling you to get vaccinated? And do you trust that person? You know, there's a lot of communities that, you know, for good reason, don't have trust in the medical profession. They don't feel comfortable in hospitals or speaking to a health professional to get their questions answered. And so in a lot of cases, what tends to work is having trusted community ambassadors. And I think you also spoke to one expert that mentioned a comprehensive vaccine registry. What is that and how would that

help? Yeah, this is a huge gap in Canada right now. So we don't really have any good sense of, you know, in a snapshot kind of way, just how many kids are vaccinated, where some of those gaps might be. So even though we do track some of that vaccine data in certain areas, it's not as robust as it needs to be. It's often relying on parents reporting that data into public health. So we're basically, you know, operating blind in some respects in terms of trying to identify, you know, where are the problems? You know, it's hard to fix the issue if you don't really know what's going on. You know, why is a certain community not getting vaccinated? And really, you have to tailor the response if you want to increase confidence. This is not a blanket message for everyone. It's really impossible to

create a tailored response if you don't know why people are not getting vaccinated or where they are. Even measuring things like vaccine confidence, you know, we likely don't do enough of that in Canada either. So getting a national registry is something that experts have been calling for for years, and we're still not there. And I think, you know, during COVID, there was actually a really good, robust collection of vaccine data. And it just showed you how important that kind of registry can be for all vaccines. Yeah. Carly, way back in October of 2021, before my time on the show, you were on the show and you were talking about vaccine hesitancy among parents wanting to give the COVID shot to their kids. And you talked about the importance of public health messaging there. I just wonder, has that kind of messaging become more effective?

Have we learned from what we've done during the pandemic? I mean, I think that the answer there is a little bit mixed because what we saw during the COVID pandemic is that most parents simply chose not to get their kids vaccinated. And now there's been sort of a walking back almost of the urgency around getting kids vaccinated with even the World Health Organization chiming in saying, you know, it's not essential to have kids vaccinated if they're not at high risk. So I think that in a lot of... Sorry, the World Health Organization said that in March. That was like this year, that was their recent recommendation. Yeah, exactly. And I think that that's had the effect of kind of saying for a lot of parents,

oh, well, see, it's not justified. We don't need to get our kids vaccinated. This is not really a real threat. And I think that when the pandemic played out the way it did, we had most kids who got infected, recovered. I think that, you know, what we really missed is that there's a small subset of kids who would go on to get really sick. Some kids died. And I think that we tended to gloss over that way too much. And we start to think about that. So if COVID is not a threat, maybe I don't need to get my child vaccinated against anything else either. Maybe none of this is really a threat. And you start to go down, you know, a bit of a dangerous road, frankly, because, you know, even if most kids will be fine, I mean, there's a small number who won't be. If there's even a small subset of children that are getting sick from a preventable illness, that is a huge failing on all of us as a society. And that's something that I think we don't, we haven't talked enough about during the pandemic. So as much as we learn, I think that what's going on with COVID vaccines for kids has raised us some troubling questions about the future with all vaccines. Carly, thank you so much for taking the time

to speak with me today. Thank you for having me. That's it for today. I'm Maina Karaman-Wilms. Our intern is Andrew Hines. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin.

David Crosby edits the show. Adrian Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.