[Jerome H Kim] Rebuilding trust in vaccines amidst declining confidence

Today (Nov. 20) is World Children’s Day, and as we reflect on the future these young lives represent we are confronted by an insidious, but ultimately lethal, trend. Confidence in childhood vaccinations has fallen. According to the UNICEF report, "The State of the World’s Children 2023: For Every Child, Vaccination," there was a marked drop in the perception of the importance of vaccines for children in 52 out of 55 countries studied.

This is an issue that demands immediate attention and strategic intervention.

South Korea, in particular, witnessed the greatest decline, about 44 percentage points, emphasizing the severity of the issue. Previously, South Korea's confidence in vaccines at the 90+ percent level was among the highest globally. Fortunately, this drop in vaccine confidence has not yet resulted in a notable drop in childhood vaccination in Korea. However, in the event of a real adverse event or, more critically, a calculated misinformation campaign, weak vaccine confidence could cause a real and detrimental decrease in vaccination that could cause real outbreaks or prevent effective epidemic outbreak responses.

Especially worrisome is that people under 35 and women who are mothers of young children were more likely to report less confidence than people 65 and older about vaccines for children after the start of the pandemic in most countries. Trust in vaccines declined broadly worldwide but fell more sharply in low-income countries including Papua New Guinea, Ghana and Senegal.

This concerning pattern is also evident in another report in the US. A study published early November by the Annenberg Public Policy Center of the University of Pennsylvania indicates a broader erosion of public confidence in vaccine safety, especially in the context of the COVID-19 pandemic. Notably, only 71 percent of Americans considered vaccines safe in the most recent survey, down from 77 percent in April 2021. This decline in confidence is accompanied by an increase in misinformation, with a notable rise in false claims such as vaccines causing autism or mRNA vaccines causing cancer. These may have combined with pandemic fatigue, distrust in expertise and political polarization to cause mounting distrust in vaccine safety.

Globally, this sharp decline in confidence has been revealed in the wake of the largest sustained reduction in childhood immunization in 30 years. The COVID-19 pandemic disrupted childhood vaccination efforts globally, resulting in 67 million children missing out on crucial DTP vaccinations between 2019 and 2021, with 48 million not receiving a single routine vaccine, also known as “zero-dose” children. Fortunately, the world has managed to partially catch up with routine childhood vaccination with a decrease from 18.1 in 2021 to 14.3 million zero-dose children in 2022 (it was 12.9 million zero-dose children in 2019). Nearly 50 percent of deaths from vaccine-preventable diseases occur in these zero-dose kids. Missed vaccinations, coupled with a decline in overall confidence and a rise in vaccine hesitancy, pose a serious threat to global and public health, potentially leading to outbreaks of vaccine-preventable diseases such as measles and diphtheria.

To address this urgent issue and rebuild trust in vaccines, a multipronged approach is necessary. First, discussions of vaccination should occur ideally in the context of societal scientific literacy but should, in any case, be explained in a manner that can be understood. Second, governments, health organizations, and health care professionals must provide clear, easily understandable information about vaccines and the benefits of vaccination, while transparently addressing concerns of vaccine safety. Third, health sectors need to be strengthened so that vaccination can be a more effective base for healthy societies. The good news? The data are overwhelmingly in support of vaccination – reducing death, reducing disease, reducing cost (to societies), reducing poverty, improving educational attainment, improving physical and mental development, protecting others from disease (this was less obviously the case for COVID-19 vaccines), and improving economic performance.

The world developed COVID-19 vaccines at a record speed. The vaccines already saved an estimated 20 million lives but could have saved more if delivered as targeted. We must make the most of the power of innovation and new breakthrough technologies, including mRNA, to develop and deliver safer and more efficacious vaccines faster.

Despite the observed decline in vaccine confidence, the UNICEF report highlights resilient overall support for vaccines globally. In nearly half of the 55 countries surveyed, over 80 percent of respondents “perceived vaccines as important for children.” The dip in vaccine confidence is apparently a strong warning sign, but the world should not allow them to become a real threat. Importantly, too, as societies age, vaccines that prevent illness in the elderly become even more important -- vaccines aren’t just for children anymore.

By implementing strategies collectively and making more innovative vaccines available and accessible and information on vaccines more transparent, responsive and available, we can hope to reverse the current trend of falling vaccine confidence, rebuild trust and safeguard the health of our future generations.

Jerome H. Kim

Jerome H. Kim is the director general of the International Vaccine Institute, a Seoul, Korea-based international organization. -- Ed.