Covid-19 vaccine? Not for me, thank you

What makes some people refuse vaccination? Is it safe to participate in universal immunisation programmes like those being developed for Covid-19?

Everybody has heard of Covid-19. Everybody knows that the disease can result in serious medical complications, and even death. Across the world, medical scientists and governments are discussing the Covid-19 vaccine, how soon it can be made available, and how to ensure that richer countries will not corner supplies of the vaccine. However, surprisingly, surveys conducted in countries such as the USA and France, found that 14 to 26 per cent of respondents said that they would not take the vaccine when one became available.

Why would anybody even think about refusing the vaccine?

The harms associated with vaccine refusal are obvious. People who do not take a Covid-19 vaccine may suffer the disease and its consequences; so there is a risk to oneself. Furthermore, people who do not take a vaccine may suffer the disease and infect others; so they are a risk to others.

People are entitled to make decisions about their own health; in medical ethics, this is known as autonomy. However, what if their choices result in harm to others?

Reasons for refusing vaccination

This leads to the matter of why people refuse vaccines, and why some are militant anti-vaxxers. Lack of proper education about vaccination, misunderstanding or misinterpreting media and scientific information, and being deliberately misled by anti-vaxxer activists or even by religious leaders all play a role.

The reasons for vaccine refusal are many and are not mutually exclusive. Several vaccines have common adverse effects, such as pain and discomfort at the site of administration and short-lasting malaise or fever. Some vaccines have rare but potentially serious adverse effects. Some vaccines are expensive and are hence inaccessible to poorer segments of society. Getting vaccinated requires time and may entail some inconvenience.

There are other problems, too. Getting vaccinated may be against religious beliefs for people belonging to certain religious denominations, even in Western countries. In some African countries such as Nigeria, and in some Asian countries such as Pakistan, vaccination programs have been surrounded by conspiracy theories and they were or still are widely shunned.

People have also been found to harbour false beliefs, such as that the measles, mumps, and rubella (MMR) vaccine can cause autism in children who receive it (it does not); that vaccines contain mercury in the form of thiomersal, and this is potentially toxic (it is not); that postponing vaccination is acceptable (it is not); or even that it is better to acquire immunity by contracting the disease than by receiving a vaccine against the disease (it is not).

Vaccine safety considerations

Concerns about vaccine safety, however, are perhaps the most important reason why some people refuse vaccination. There is a long history for this. In 1955, some children who received the polio vaccine developed polio with paralytic complications. In 1976, panic over a flu virus resulted in the early release of a vaccine that caused Guillain-Barré syndrome, a serious neuromuscular disease, in some vaccine recipients. About 20 years ago, a rotavirus vaccine was withdrawn because it caused intussusception in some infants. Very recently, a vaccine against dengue fever was found to result in worse illness and even in death in children who had never been exposed to the disease.

Such instances are seized by mass media and by social media and are widely disseminated. This is understandable; why should a healthy child or an adult run the risk of potentially serious adverse effects? However, the sensationalisation of actual or imaginary risk results in distrust of all vaccines.

With specific reference to the Covid-19 vaccine, distrust may already have been created, and perhaps understandably so. In India, the ICMR seemed to want to bypass safety issues and bring out a vaccine by August 15, 2020. In the USA, President Trump appears to want the US to have an Operation Warp Speed vaccine ready before the election. In Russia, the Sputnik V vaccine was approved apparently after being studied in only 76 patients. In China, at least one vaccine has already been approved for emergency use although safety data are so far unavailable. The Oxford vaccine trial had to be suspended because one patient developed transverse myelitis, a serious spinal cord disease (the trial has now been resumed in most but not all countries).

While it usually takes many years, such as five years or longer, to bring out a safe and effective vaccine, the rush to bring out a Covid-19 vaccine may make even the ordinary reader nervous and, of course, it provides grist to the mill of the anti-vaxxers.

Need for universal immunisation

Opting out of universal immunisation programmes is dangerous because if too many persons in the population do so, herd immunity will not develop, and pockets of illness may periodically break out. This has been happening even in developed countries, such as the UK and the USA, where the misplaced belief that the MMR vaccine causes autism led to vaccine refusal and to outbreaks of measles in many places.

What should we do? Simply stated, read the reports on safety and efficacy and trust the health organisations whose word carries credibility. It can reasonably be assumed that the chances of benefit will outweigh the risks.

On a parting note, vaccine freeloaders are persons who do not get vaccinated but who nevertheless reap the benefits of vaccination. The benefits of freeloading arise when the rest of the population is vaccinated and immune; then, the disease does not spread, and so the freeloaders do not contract the disease. The desire to reap the indirect benefit, however, is not a usual reason for refusing vaccination.

(Dr Chittaranjan Andrade is Professor, Department of Clinical Psychopharmacology and Neurotoxicology, Nimhans, Bengaluru)

The views expressed above are the author’s own. They do not necessarily reflect the views of DH.