MSD’s Cyril Schiever outlines why vaccine hesitancy is such a threat to global health, the misinformation around vaccines being spread online, and how multi-stakeholder collaboration can help counter this emerging problem.
The World Health Organization (WHO) recently identified vaccine hesitancy as one of the top 10 global health threats for 2019, alongside major health challenges such as climate change, non-communicable diseases, antimicrobial resistance, and Ebola. The problem is magnified by the spread of fake news and online misinformation. This year’s GLOBSEC provided a great opportunity to discuss the threat of dropped vaccination rates and how this impacts our global heath security.
Europe’s measles epidemic isn’t likely to end without major changes in the approach to vaccination
We are witnessing a global trend of decreased vaccine confidence. According to a recent survey in 67 countries, the least confident seem to be the population of France (41%), Bosnia (36%), Russia (28%), Mongolia (27%), and Greece/Japan/Ukraine (25%). This compares to the global average of 12%, and points to a problem that goes beyond each country’s borders.
One only has to turn on the TV these days to see and hear about measles outbreaks causing deaths or disabilities, long after we have discovered a very effective vaccine to prevent the disease. Measles is a serious cross-border health threat in the EU. The cost of these outbreaks, socially and economically, will be substantial not only in the short term, but also in the long term, and it will take a long time for Europe to recover. Europe’s measles epidemic isn’t likely to end without major changes in the approach to vaccination.
But the problem is not confined to Europe. Many countries are in the midst of sizeable measles outbreaks. Current outbreaks include the Democratic Republic of the Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand and Ukraine, causing many deaths – mostly among young children.
This is why, recently, the World Health Organization (WHO) identified vaccine hesitancy among the top 10 global health threats for 2019, alongside major health challenges such as climate change, non-communicable diseases, antimicrobial resistance and Ebola. 
A lot has been written globally on the causes of vaccine hesitancy: what can be done to mitigate it and improve immunisation coverage rates? But I want to touch on one of them, namely, misinformation.
There has been a rise in online misinformation on vaccine safety
There has been a rise in online misinformation on vaccine safety. False information, which is created, liked and shared by vaccine sceptics, is circulating on social media, damaging the public’s confidence in vaccines. Consequently, there is an increasingly poor understanding of the value of vaccines, which then has a knock-on effect on immunization rates across the world.
Community members are fueling each other’s concerns behind closed doors. To complicate matters, people are able to create (closed) virtual communities of like-minded individuals, who seek out information sources they feel comfortable with. Thus, people get more information they already agree with and few (if any) alternative views in online “echo chambers”. This results in anti- and pro-vaccine messages being shared and replicated in isolated groups, which polarizes conflicting views even further.
Additionally, search engines filter content based on an individual’s online behaviour and perceived preferences. This means social media users effectively surround themselves with content which aligns with their preexisting values and beliefs and fail to see the other side of the argument. This leads those who hold ‘extreme’ or controversial opinions to have a distorted perception of the prevalence/popularity of their views.
Studies have shown that fake news spreads six times faster than regular news. The lack of accountability, freedom of speech, leveraging emotions, and the lack of effort required to share something online, are only a few of the reasons why false messages spread fast. Anti-vaccination influencers know very well how to use these tactics. On the other hand, the public health and scientific community is struggling to engage with the public and communicate the right messages. Evidence-based statements, and the reports and the voices of trusted, credible scientific and public health leaders, don’t reach this social media space. To be effective communicators, we need to bridge this gap.
Just as vaccine hesitancy is complex and multifaceted, so, too, is the solution to building confidence and preserving trust. There is no “one-size-fits-all” approach. Vaccination programs exist in the context of a broad and diverse ecosystem, comprised of multiple stakeholders ranging from individuals and communities to health systems, as well as governments and public health leaders.
Coordination among these groups can create resilient systems, which are critical for generating and preserving high levels of vaccine confidence and driving vaccination uptake. In addition, we now see social media platforms taking action by, for example, demonetizing and reducing recommendations and rankings of anti-vaccination content or groups – some of them even decided to block or remove anti-vaccination materials.
We are also learning from the collective experiences of a variety of vaccines across the life course – from polio to measles, and from influenza to HPV. We are now starting to identify and document the characteristics that comprise a resilient immunization system, and that can protect and build vaccine confidence across the life course.
As a pharmaceutical company, we have a role and responsibility to work alongside public health authorities, healthcare providers and communities around the world to communicate the benefits of vaccination and improve access to potentially life-saving vaccines. We recognize that collaboration across all sectors of the immunization ecosystem is critical to improving public health through vaccination. This is why we attended this year’s GLOBSEC: to tell that story and help participants understand the impact of vaccine hesitancy on our global health security.
 Larsen, et al. The State of Vaccine Confidence 2016: Global Insights Through a 67-Country Survey. EBioMedicine, http://www.sciencedirect.com/science/article/pii/S235239641630398X (accessed 31 May 2019)