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Bridging the Vaccine Confidence Gap

Vaccines are on everyone's mind as COVID-19 vaccine distribution is underway in the U.S. The accelerated development of a COVID-19 vaccine has once again brought up questions on the safety and efficacy of vaccination. After reading this article, you will come away knowing more about vaccines and how we can increase public trust in vaccination.

What are vaccines?

Vaccines are designed to mimic disease agents, a.k.a. viruses or bacteria. Normally, when your immune system encounters a pathogen like a virus, it first sends immune cells to detect the antigens present on the pathogen. Then, specialized cells create antibodies to target the pathogenic antigens. Finally, memory cells are produced so that if you encounter the pathogen again, it will be recognized and dealt with quickly. Vaccines are essentially pathogen imposters. Through the use of the immune system, they create memory cells to help you better fight off infection in the future. Vaccines contain a weakened or dead version of the pathogen. [1] This allows your immune system to “practice” on a pathogen look-alike, but you don’t have to be exposed to the real disease-causing agent! Neat, right?

Why is there a distrust of vaccines?

Vaccines are safe and effective. So why do some people insist on not being vaccinated? There is actually a long history of “anti-vax” sentiment since the time that vaccines were first put into practice. Opposition to vaccination goes back as far as the 1700s, when Edward Jenner (known as the “Father of Immunology”) developed the first vaccine against smallpox by infecting individuals with the relatively mild cowpox virus [2]. Whether for theological, political, or other reasons, the argument against vaccines has never gone away. An example from more recent history is the rise in anti-vaccination attitudes that came after the publication of a now-retracted article in Lancet in 1998. [3] The authors claimed that the 12 children in their study experienced the onset of gastrointestinal disease and developmental issues that were linked with the timing of their measles, mumps, and rubella (MMR) vaccination. However, this study had a small sample size (a low number of children who participated), and 11 out of the 12 participants were boys, which does not represent the normal population. Plus, there were a number of factors other than the vaccination that could have contributed to the results they observed, such as the discharge of one of the children from the study for actually being – get this – developmentally normal. If the subjects of their study were all not developmentally normal, that would really skew their results. Not to mention, the first author of the study, Andrew Wakefield, faced charges for violating ethical research practices [4]. Despite the lack of rigor in this scientific publication, the message had already reached many parents that vaccines are risky for their children. Now, scientists and medical professionals are still working to reassure people that vaccines are indeed safe.

Why is vaccination important?

When groups of people don’t get vaccinated, they risk the health of many others. Take the recent measles outbreaks, for example. Measles was eliminated in the U.S. in 2000, but because certain communities decided against having their children get the measles vaccine, it has popped up again. In the first nine months of 2019, 1,249 U.S. measles cases were reported, which is the highest annual number since 1992. Eighty nine percent of measles patients were not vaccinated or had an unknown vaccination status, and ten percent were hospitalized. Eighty six percent of cases were associated with outbreaks in under-immunized, close-knit communities. [5] This goes to show just how important widespread vaccination is to eliminating, and maintaining the elimination of, disease presence (often referred to as “herd immunity”).

How do we increase vaccine confidence in the U.S.?

Because vaccines are so important for public health, we need to find ways to spread more fact-based information on vaccines and the benefit of vaccination. This is going to take a large concerted effort between our government, nonprofit and grassroots organizations, professional societies, the media, and other stakeholders like parents and health practitioners. Simply providing evidence-based scientific messages have not ended vaccine concerns [6]. Appealing to the emotions and lived experience of people may have more of an impact, for which metaphors can be a useful tool. For example, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, likes to compare vaccines to seatbelts. He writes, “Although we do not expect to be in an accident every time we drive a car, we still buckle up and strap our children in car seats. Even though some vaccine-preventable diseases are uncommon in the U.S., it is important to continue to receive recommended immunizations.” [7] Public health officials, scientists, and other advocates help to set an example and spread information, but we also need systemic solutions in the U.S. to promote vaccination and educate the public on the safety and efficacy of vaccines.

In order to create systemic change and convince the government that more resources and funding should be allocated to bridging the vaccine confidence gap, accurate measuring of vaccine trust in the U.S. is key. For example, the Vaccine Confidence Project was founded in 2010 in response to the hesitancy and misinformation on vaccination, like those that caused a boycott of polio eradication efforts in Nigeria in the early 2000s [8]. The purpose of the project is to monitor public confidence in immunization programs. To do this, they’re building an information surveillance system for the early detection of public concerns around vaccines. [9] Some groups have gone even further to gauge public attitudes on vaccination. The Vaccine Sentimeter is now being studied as a potential tool to monitor social media and mainstream media outlets in real-time [10]. The goal of programs like the Vaccine Confidence Project and the Vaccine Sentimeter is to aide health care professionals in quickly detecting a change in vaccine sentiment that may affect vaccination rates and, therefore, disease rates. Plus, this research will inform policymakers about what communities are more likely to have negative views of vaccination, and consequently, which subpopulations toward which to target immunization programming and education.

Researchers, health professionals, and politicians aren’t the only ones who can make a difference, though! For example, grassroots efforts have proven to largely impact the population’s confidence in vaccines. One such effort in Nigeria engaged political and religious leaders to participate in the vaccine campaign by showing roadside films on polio from mobile vans in the community [11]. Additionally, the media can play a significant role in the dissemination of accurate and unbiased information on infectious disease and vaccines. Media briefings and press conferences about these topics could help immensely with the publication and broadcast of reliable information, since many reporters may not have a background in public health [11]. Of course, I can’t talk about the communication of accurate information without mentioning our science education system. Educating students from a young age on disease prevention and the vaccine safety system will help to end misconceptions about vaccination in future generations [6].

What can YOU do?

Each one of us can make a difference to ensure the health of our communities, whether it is simply getting you and your family vaccinated, spreading accurate information and positive messages about vaccines, or even actively advocating for public health issues that you are passionate about. We can all have a say in public health policy, even if we're not on Capitol Hill.



1. How Vaccines Work. In The History of Vaccines [World Wide Web site]. Philadelphia, PA: The College of Physicians of Philadelphia, 2021 Available at 2. Riedel S. (2005). Edward Jenner and the history of smallpox and vaccination. Proceedings (Baylor University. Medical Center), 18(1), 21–25.

3. Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus, 10(7), e2919.

4. Gross L. (2009). A broken trust: lessons from the vaccine--autism wars. PLoS biology, 7(5), e1000114.

5. Patel M, Lee AD, Clemmons NS, et al. National Update on Measles Cases and Outbreaks — United States, January 1–October 1, 2019. MMWR Morb Mortal Wkly Rep 2019;68:893–896. DOI:

6. MacDonald, N. E., J. Smith and M. Appleton (2012). Risk perception, risk management and safety assessment: What can governments do to increase public confidence in their vaccine system? Biologicals 40(5): 384-388.

7. Fauci, A. (2019). Building Trust in Vaccines. National Institutes of Health: Science, Health, and Public Trust.

8. Isaac Ghinai, Chris Willott, Ibrahim Dadari & Heidi J. Larson (2013) Listening to the rumours: What the northern Nigeria polio vaccine boycott can tell us ten years on, Global Public Health, 8:10, 1138-1150, DOI: 10.1080/17441692.2013.859720

9. About Vaccine Confidence Project. In Vaccine Confidence Project [World Wide Web site]. London, England: London School of Hygiene & Tropical Medicine, Available at

10. Bahk CY, Cumming M, Paushter L, et al. Publicly Available Online Tool Facilitates Real-Time Monitoring Of Vaccine Conversations And Sentiments. Health Affairs (Project Hope). 2016 Feb;35(2):341-347. DOI: 10.1377/hlthaff.2015.1092.

11. Ozawa, S., & Stack, M. L. (2013). Public trust and vaccine acceptance--international perspectives. Human vaccines & immunotherapeutics, 9(8), 1774–1778.

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