Vaccine Hesitancy and Refusal.

Abstract

1. Joshua Natbony, MD* 2. Marquita Genies, MD, MPH* 1. *Johns Hopkins Children’s Center, Baltimore, MD In 1998, English gastroenterologist Andrew Wakefield published a controversial case study claiming an association between the measles, mumps, and rubella (MMR) vaccine and autism. Although initially published in The Lancet , this study was later discovered to be fraudulent and was redacted in 2011. These assertions have since been tested extensively, with a 2019 longitudinal study involving 600,000 children again lending no support to any such association. Nevertheless, Wakefield’s infamous paper continues to affect vaccination rates and the perception of vaccine safety worldwide. Since its introduction in 1963, the measles vaccine has led to a 99% decrease in worldwide prevalence of measles. The United States, however, currently ranks 114th in the world for MMR vaccination rates among 1-year-olds, with an overall MMR vaccination rate of 92%, which is insufficient to maintain herd immunity. As a result, by April 2019 there were confirmed outbreaks in multiple states and more than 200 cases of measles across the United States. According to Centers for Disease Control and Prevention (CDC) data, the incidence of other vaccine-preventable infections, such as mumps and Haemophilus influenza B, is also increasing. Given the urgency of this issue, the American Academy of Pediatrics (AAP) has made the elimination of nonmedical exemptions (NMEs) to vaccines its top priority. Families who reject the standard vaccine schedule usually fall into 2 groups. The first group, vaccine hesitant, may delay or space out vaccines or accept specific vaccines only. In a 2011 survey, 13% of US parents with children younger than 6 years fit this characterization. Parents who accept no vaccines for their children fall instead into the vaccine refusal category. In 2017, …