Courtesy of ScieDev.
Public trust in vaccination is on shaky ground. Earlier this year, the WHO named ‘vaccine hesitancy’ one of its top ten threats to global health, defining hesitancy as “the delay in acceptance or refusal of vaccines despite the availability of vaccination services”. Health experts fear that when people question whether vaccines are safe or effective, they may decide not to vaccinate themselves or their children – and that puts everyone at higher risk. There is some evidence on how people feel about vaccines, but until now health experts had few details about these views in different parts of the world. Do most parents believe vaccination is safe, effective, and important for their children? And how do their views relate to how much they trust scientists and health professionals? This interactive visualisation explores these questions through the Wellcome Global Monitor – the first study of public attitudes to science and health on a global scale.
Send keyboard focus to mediaQuestions over how public views on vaccination are changing are more pressing than ever.If enough people decide against getting a vaccine, outbreaks become more common and diseases more difficult to control.If people lose confidence in vaccination, they are more likely to opt against it. It’s a decision that can affect not only their own health but that of others around them.This is because each person that gets immunised adds to a collective or ‘herd’ immunity that can stop a disease from spreading – but only if a large enough number of people get the vaccine.
How large is ‘large enough’? It depends on the disease. For measles, 90–95 per cent of the population needs to be vaccinated for this collective immunity to work. For polio, which is less contagious, it takes 80–85 per cent.
This loss of vaccine confidence is reflected in a global resurgence of measles, with a 30 per cent rise in cases from 2016 to 2017.
Outbreaks have also become more common, as seen in Brazil, India and the United States. The loss of confidence has been fuelled by anti-vaccination theories that began with a false claim of a link with autism.
Send keyboard focus to mediaGlobally, about eight out of 10 people have confidence in the safety of vaccines. Though encouraging, this also means one in five people question vaccine safety.And it’s the pockets of scepticism that matter, according to Heidi Larson, director of the Vaccine Confidence Project who was involved in the study.
Previous studies show that confidence in some vaccines has been dwindling across both high- and low-income countries.According to the Monitor, low-income countries are generally less sceptical than high-income countries when it comes to the safety of vaccines.
Confidence is lowest in Eastern and Western Europe, where just over half the population agrees that vaccines are safe (50 and 59 per cent). It gets a little stronger in Northern Europe (73 per cent) and North America (72 per cent).But confidence in safety is at its highest in low-income regions.South Asia tops the chart at 95 per cent, followed by 92 per cent in East Africa. Across the African continent and Latin America, about 84 per cent of people surveyed agree that vaccines are safe. The figure is slightly lower across Asia (80 per cent) and in the Middle East (79 per cent).
A global snapshot
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Published June 2019, the study was based on nationally representative surveys of people aged 15 years or older in over 140 countries.
More than 140,000 people were asked questions about their views on vaccination, their trust in health professionals and in science, as well as how science benefits society.
Before the questionnaire was rolled out it was tested across 10 countries, in local languages. One reason was to make sure that everyone could understand the technical terms.
To get a measure of scepticism about vaccination, researchers based their questions on an index developed by the Vaccine Confidence Project.
According to Larson, the index was designed to get a better picture of the spectrum of views. The idea was to capture not just strong opinions for or against vaccination, but also the views of people in between who still question and look for answers.
‘Do vaccines work?’
Send keyboard focus to mediaWhen people were asked if vaccines are effective, their answers weren’t so different from each other across parts of the world. Overall, 84 per cent agree that vaccines work.But a few countries stand out from the rest. On the side of scepticism, 28 per cent of Liberians disagree that vaccines are effective – the highest percentage in the world. Doubt over effectiveness is fairly high in a few other Sub-Saharan Africa countries, and in Peru.Still, most people in these places believe vaccines are safe. It could be that in countries where health services are difficult to access and infectious diseases persist, some will conclude that vaccines don’t work.At the other end of the spectrum, two countries – Rwanda and Bangladesh – stand out for backing the benefits of vaccination. In Rwanda, 99 per cent of people agree that vaccines are effective, in Bangladesh the figure is 97 per cent.Both have shown strong commitment to immunisation policy, and Larson believes high-income countries can learn from their approach.More than 80 per cent of children were vaccinated in Bangladesh by 2014. And in Rwanda, vaccination rates jumped from 30 to 95 per cent in two decades.
Trust in science
Send keyboard focus to mediaPeople’s level of education or scientific knowledge doesn’t have a clear bearing on how confident they are in vaccines.In places like Northern Europe, more education translates to less confidence. In others, like Central and Southern Africa, the opposite is true. It seems to make no difference in Latin America or in the Middle East.But trust is a strong indicator. Views on vaccination tend to be more positive if people say they trust scientists, but especially if they trust doctors and nurses. Although the link is stronger in some regions, it shows up in all parts of the world.
A separate part of the survey asked people about their trust in scientists and health providers. Their answers reveal more about how trust differs across the world, but not specifically about vaccines.Trust tends to get stronger with higher confidence in national institutions, like the government and justice system.
From views to action
Send keyboard focus to mediaThe good news is that despite lingering doubt, nine in 10 people globally agree that vaccines are important for children to have – and that’s true even in the most sceptical parts of the world.But in two developing regions – Southern Africa and Southeast Asia – a large proportion of parents said they have not heard of a vaccine.
The same regions also stand out for having a relatively high proportion of parents who say at least one of their children has not been vaccinated. It’s not clear whether the trend is related to beliefs or access to immunisation services.
This year’s data is the starting point of a plan by Wellcome to assess how attitudes change over time, using future Monitor surveys. The goal is to improve policy and help the public engage with the science that affects their lives.Showing countries where they stand in relation to others helps too, according to Larson. “When countries see where they are in the ranks, they have something to work against.”