What’s the Right Way to Increase Vaccine Uptake?

 by Maddy Ross

 As you might have read in the news recently, childhood measles vaccination rates have reached the lowest rates for a decade. The MMR uptake rate has reached 85.5%, well below the ideal level of 95%, the level at which experts deem there to be herd immunity, posing a genuine risk to the children who are not jabbed. When a population immunity level is below this 95% level, the ‘herd’ can not effectively protect those who cannot have the vaccine due to medical reasons such as an compromised immune system. Conversations around MMR vaccine uptake are certainly topical in our world where discourse around the coronavirus vaccine seem to be endless. Many are recommending we follow our European neighbours, Australia and Canada and introduce vaccine mandates, but would this really be the right approach? 

Vaccinations’ importance really can’t be overstated; not only in terms of preventing people catching severe diseases with possible long-term effects, but in terms of saving lives. Measles is a highly contagious disease, more than coronavirus and for some it can lead to life-threatening complications. Measles has a high R0 value of 12-18 which means that each person with measles would, on average, infect 12 to 18 other people in a totally susceptible population, giving an idea of its transmissibility. Thus the MMR vaccine is so important as it gives 99% protection against measles and rubella and about 88% against mumps. None of us are blind to the effects of coronavirus, whether or not we’ve caught it ourselves we all know someone who has had it and or of someone who was admitted to hospital or who tragically died as a result of the disease. With Covid, there is also the matter of ‘long-Covid’, when people who have had sometimes debilitating symptoms for months after testing positive for the virus. And with vaccines against coronavirus proven to be very effective even against variants and importantly protecting against severe disease and hospitalisation, it seems only logical to get vaccinated for your own safety but also those more vulnerable. It’s due to this reason that many people are suggesting vaccine mandates so vaccine uptake can increase for the sake of public health and safety. But would this be actually be the right way to increase vaccination numbers? 

Many do believe that vaccine mandates are the way to increase vaccine uptake and as a result, combat vaccine hesitancy. Statistics from Canada and Europe seem to support this view. Four economists analysed the results from 4 Canadian provinces that had introduced a vaccine requirement to enter bars, gyms and restaurants, as a way to see how effective mandates really are. The economists from Simon Fraser University in British Columbia found that first-dose vaccinations increased by 42% over the previous week and by 71% over two weeks after the mandate. They concluded that an estimated 287,000 more people were vaccinated within six weeks as a result. 

France, Germany and Italy have all also introduced similar mandates on vaccination for non-essential activities. The economists calculated that by the end of October 2021, more than 85% of Italy’s eligible population had received the vaccine, an estimated 12% more than if there were no restrictions imposed. In France they estimated a 8% increase and in Germany a 5% increase in those being jabbed. These increases in vaccine uptake seems to have a significant effect on the number of deaths, hospitalisations and other disruption caused by people catching the virus. A paper by Miquel Oliu-Barton and his colleagues found that the vaccination mandates prevented 46,000 hospital admission, 9.5 billion euros ($11.2bn) in economic losses and 6,400 deaths. The data shows that vaccine mandates have an undeniable effect on vaccine uptake and we know that this directly leads to the important decrease in deaths, hospital admissions and also economic losses. As Hans Kluge, the WHO’s Europe director said in November, “most people hospitalised and dying from COVID-19 today are not fully vaccinated.” 

In terms of the MMR vaccine, which is also not mandatory in the UK like COVID-19 vaccines, there is divided medical and ethical opinion on whether there should be policies that ‘involve some degree of coercion,’ as stated on the Commons Library website. Some countries including Italy and Germany have have introduced mandatory measles vaccination programmes in response to decreasing vaccination rates. In Germany and Italy there are fines for parents who don’t get their children vaccinated by a certain age. There is evidence that these have been effective in increasing uptake. 

However, when looking past the clear benefits of vaccine mandates, we can see that there are social issues that could arise as a result. There are concerns that mandatory vaccination may risk undermining public confidence in other public health measures. Dr Samantha Vanderslott of the Oxford Vaccine Groups argues that there is a potential problem of ‘polarisation’ and ‘public backlash’. It could strengthen conspiracy theorists’ anti-government and healthcare opinions. In terms of the political climate, there is a risk of parties tapping into this concern in their political campaigns, creating more social unrest. As Vanderslott says, if that happened ‘we don’t have the option anymore to use that [vaccine mandates] as a policy anymore.” 

It’s also worth noting that despite the success stories of increased vaccine uptake due to mandatory vaccinations, there is no evidence that this strategy would work cross-culturally. It’s important to realise that cultural differences between nations would enable some states to enforce rules with positive effect, while in others, citizens might not be as willing to comply with restrictions and would respond more positively to other measures. 

So what would be a way to combat decreasing vaccine uptake rates without the possible social problems of a mandate? Tim Harford in the Financial Times makes a convincing argument in favour of helping those who are already halfway to being jabbed. According to polling in the US, only fewer than half of of the unvaccinated people say they will “definitely not” get jabbed. Most unvaccinated say that they would but either aren’t currently able to or will wait until they’re required to. He argues that fixing these little obstacles would be easier and would cause less social problems than a mandate. For example in a study by behavioural scientists to test the most effective tactics to persuade Americans to get the flu jab, the most effective technique was a simple text message reminder stating a flu vaccine had been “reserved for you”. This is evidence how simple initiatives can really make a positive impact on vaccine uptake, with limited effect on social tensions. 

Vaccine hesitancy is a genuine threat to public health, such that the WHO itself has named it in its top 10 threats to global health. Yet vaccine mandates don’t seem to be the only solution. While their health benefits of mandatory vaccinations are clear, it’s important to recognise the cultural nuances of a nation when implementing public health measures. The social ramifications of such a policy does not seem to a be trade off the UK government is willing to make. This is seen in the government being set to scrap its mandatory vaccines for NHS workers after concerns of major staff shortages. Thus the government must focus on strategies that would increase uptake in a way that recognises that the unvaccinated are not all ideologically opposed to vaccinations. We need to make vaccines and vaccine education more accessible. In providing support for people who for example might be scared of needles or rare side effects, need childcare or who might just need a digital reminder to get jabbed, we avoid fuelling anti-government rhetoric while still increasing vaccine uptake. 

Sources 

https://www.economist.com/graphic-detail/2022/01/22/do-vaccine-mandates-a ctually-work https://www.bbc.co.uk/news/health-60200774 https://www.bmj.com/company/newsroom/should-measles-vaccination-be-com pulsory/ https://www.bbc.co.uk/news/world-5950633