COMMENTARY || Making vaccinations easier to get will keep community safer

Focus on anti-vaxxers a missed opportunity for health-care system to better serve people who aren’t getting immunized for other reasons, argues nursing professor.


Achieving "community immunity" against diseases like influenza will require understanding what prevents some families from getting immunized and finding ways to remove those barriers, says a U of A nursing professor. (Photo: Getty Images)

Anti-vaxxer. It's a loaded pejorative term that's gained traction over past decades as vaccination myths continue to plague public health professionals. It's a label at the heart of pitched battles between the scientific and health-care communities and parents who often don't know where to go for quality, trusted information on vaccines in a digital era of fake news.

But too much focus on anti-vaxers is a missed opportunity. The data around vaccine uptake tell a very compelling story, and it's not the story most people imagine.

Many health-care professionals reference the concept of herd immunity, the threshold of vaccination required to protect the small proportion of the population who cannot be vaccinated against dangerous diseases because of specific health-related conditions. Perhaps a more apt term is "community immunity," because vaccinations are about community health, and community-and relationships within our communities-are at the heart of why we vaccinate.

There are real consequences to losing community immunity, especially for vulnerable, immunocompromised people, such as kids being treated for cancer or transplant patients. Because they can't be vaccinated, they rely on their community to protect them from deadly infections.

Some of these diseases, such as pertussis (or whooping cough), are making a comeback. Other infections, like the flu, seem benign-but the impact on vulnerable and immunocompromised people can be devastating.

For many diseases, the community-immunity threshold requires a 95 per cent vaccination rate-a level that isn't being met with today's health systems, policies and parental choices. In fact, we've only achieved vaccination levels of approximately 75 per cent for many childhood vaccines.

This leaves 25 per cent of children unvaccinated or not fully vaccinated. But what isn't clear to most people is why.

What people don't realize is that 20 per cent of unvaccinated or under-vaccinated kids come from families who don't hold strong beliefs about vaccinations. Many just have other reasons for not completing their vaccination schedules, such as barriers to access or competing demands on their time and resources.

The majority of these kids come from families who move a lot, with larger-than-average numbers of kids, and younger mothers. Many, if not most, have been partially vaccinated, but haven't completed their full vaccination schedule for a variety of reasons that have nothing to do with their parents' belief systems.

For example, if a parent has an hourly wage job, it's harder to take time off for vaccinations. Or if they're moving locations a lot, they're going to be preoccupied.

These parents want to do what's best for their kids and aren't necessarily opposed to vaccines, but in some cases, the more immediate demands of putting food on the table, managing child care or just generally dealing with life's many challenges come ahead of vaccination schedules.

The more barriers to access and competing demands on a given parent's plate, the less likely they are to vaccinate. This is especially important for vulnerable groups who are hit with a double whammy of poor access to vaccinations and higher vulnerability to infection and disease.

If community immunity is our goal, the better part of our energy should be dedicated to breaking down barriers to vaccinations and improving structures and systems through which they're administered.

As flu season brings on perennial debates about the safety and effectiveness of vaccines, this doesn't mean we should stop challenging disproven narratives that imply vaccines are harmful-on the contrary, this will continue to be important work.

Those of us working toward community immunity would be well served to start with the assumption that everyone wants what's best for themselves and their families, and to focus the bulk of our efforts on where we will have the most impact: learning about what systemic, structural and situational barriers make specific groups less likely to vaccinate, and then working with these groups to make the vaccination process straightforward, simple and supported.

In Alberta, we've made some big strides by offering influenza vaccine in non-traditional settings. Yet last year only 31 per cent of Albertans got vaccinated (for influenza, we typically aim for 80 per cent). Clearly, there's more work to do.

This flu season, it's well established that the influenza vaccine is your best shot at staying healthy, and keeping everyone around you healthy, too. To increase uptake, our most effective public health strategy is to make the healthy choice the easy choice.

Shannon MacDonald is a researcher and educator in the Faculty of Nursing.

This opinion-editorial originally appeared Nov. 5 in the Edmonton Journal.