Worldwide, 79% of people believe vaccines are safe, according to a new study that provides the most detailed picture yet of attitudes toward vaccination.
But views on vaccines vary greatly from country to country according to the survey, which included some 140,000 people across more than 140 countries and was backed by the Wellcome Trust, a medical research charity based in London.
Highlights include Bangladesh, where almost 98% of people believe that vaccines are both safe and effective. But there are also trouble spots, including France, where 1 in 3 people disagree that vaccines are safe, and Ukraine, where only about half of the population thinks that vaccines work.
Both of those countries have in the past couple of years been gripped by serious outbreaks of measles. France had 2,913 cases in 2018 and 964 so far this year, according to the latest figures from the World Health Organization. Ukraine recorded 42,874 cases by the end of April this year, following last year’s count of 53,218.
The Wellcome team also asked people about their knowledge of science and their trust in scientists, medical professionals, and institutions, including the government and media. The survey has provided fresh insights into why people in some countries have low confidence in vaccines — despite overwhelming scientific evidence that they are safe and effective.
“It’s the first time we’ve got this global picture,” Wellcome Trust head of public engagement Imran Khan told BuzzFeed News.
“This landmark survey shows that understanding people and society is as important as understanding viruses and immunology,” Jeremy Farrar, director of the Wellcome Trust, said in a statement.
Overall, some of the biggest problems with trust in vaccines are in Europe.
In countries like France, Switzerland, and Austria, attitudes seem to be highly polarized between those who agree that vaccines are safe and effective and those who disagree. But in Ukraine, Belarus, and other vaccine-hesitant countries in Eastern Europe, the main problem seems to be a large number of people who are unsure what to believe — they neither agree nor disagree that vaccines are safe and effective.
“I think that’s the group that’s still open to discussion and there’s an opportunity there,” Heidi Larson of the London School of Hygiene & Tropical Medicine and director of the Vaccine Confidence Project, told BuzzFeed News.
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In the US, for comparison, about 11% of people disagreed that vaccines are safe, putting the nation in 45th position worldwide for vaccine skepticism on that measure, and about 16% neither agreed nor disagreed.
The survey results suggest that vaccine hesitancy in different countries is being driven by different factors — which means there will be no “silver bullet” to raise trust in vaccines across the globe.
Distrust of the MMR (measles, mumps, and rubella) vaccine grew in many countries after 1998, when a team led by the British doctor Andrew Wakefield published a now-discredited study claiming that it was linked to autism.
In France, vaccine skepticism was heightened further by a controversial program in 2009 to vaccinate against a strain of influenza that officials feared might cause a global pandemic. Critics argued that the WHO, which backed the program, had been influenced by the pharmaceutical industry.
In Ukraine, meanwhile, doubts about vaccines have been exacerbated by disruption of the country’s health system by the armed conflict with Russian-backed rebels in the east of the country.
“What’s happening in France is not the same as what’s happening in Ukraine, is not the same as what’s happening in Japan,” Brendan Nyhan, a political scientist at the University of Michigan who has studied attitudes toward vaccination, told BuzzFeed News.
What is clear is that simply providing people with more information about vaccine safety and effectiveness is unlikely to shift attitudes. In some regions, including Eastern Europe and Southern Africa, people who had more scientific knowledge and education had less confidence in vaccines. And overall, people who said they had recently sought information on science and health were less likely to agree that vaccines are safe.
“This suggests that putting out more scientific information, or trying to educate more people, will not be enough to change minds on this issue,” the report concludes.
According to Nyhan, there’s little good research on what actually changes hearts and minds on vaccines. But evidence from other areas of political psychology suggests that pointing out that most people believe that vaccines are safe and effective, and do get their children vaccinated, are most likely to be effective. Also, it helps to provide these messages through trusted sources, such as medical professionals or community leaders.
“Social consensus is a powerful force,” Nyhan said.
In most regions, people who said they had high trust in doctors and nurses were more likely to consider that vaccines are safe.
“People trust those individuals more than they trust governments or the media,” Khan, who led the study, said.
Still, even where people have concerns about vaccines, policies that require shots can make a big difference, evidence suggests. “We often have a policy problem rather than a communication problem,” Nyhan said. “I think sometimes people worry too much about the messaging.”
The French government seems to have taken this on board. In January 2018, it expanded the number of compulsory vaccines from three to eleven for children under the age of 2.
And last week, New York Gov. Andrew Cuomo signed into law a ban on religious exemptions from the state’s vaccine requirements, in the face of a measles outbreak concentrated in Orthodox Jewish communities in New York City and Rockland County. Since September 2018, there have been more than 850 cases.
Vaccination hasn’t yet become a partisan issue in the US. But Nyhan warned that there’s a danger of a backlash that would be hard to counter if arguments about vaccination get tangled up with partisan politics — much as has happened with attitudes toward climate change.
“We have to be very careful,” Nyhan said.
This piece has been updated to include statistics on vaccine hesitancy in the US.