In the early 2000s, America achieved a public health milestone that once seemed impossible -- the elimination of the measles virus. This victory followed the remarkable breakthrough of eliminating the nightmare of polio in the 1990s, and the near eradication in the 1940s of the highly contagious and particularly dangerous bacterial infection of pertussis, or whooping cough.
But by 2023, every one of these diseases had made a shocking comeback in the U.S. The risk of outbreaks of preventable childhood diseases that were virtually eradicated through vaccination is now at its highest point in 30 years, according to the Pan American Health Organization's Technical Advisory Group on vaccines.
The resurgence of these preventable diseases is not due to our scientific or technical inability to fight them. Rather, it is largely the result of the collective failure to successfully promote vaccination policies that protect the nation's children. This is especially true where policies require the input of public money: America's governments have avoided directly funding universal vaccination and the cost of vaccination appointments. The threat of infectious diseases crosses borders, as emphasized at the World Vaccine Congress in early April, where participants discussed crucial issues including the threat of non-vaccination and vaccine refusal.
Simply making vaccinations mandatory will never solve the problem of uptake, nor will it convince people that vaccines are safe, effective, and important. Even when vaccination is mandated, the U.S. must address significant social and structural factors if we are to ever truly eradicate these illnesses -- for good.
One factor preventing universal childhood vaccine uptake is the cost to end-users. In countries with robust public health systems, such as the U.K., vaccination is fully funded through the government instead of through private health insurance companies. But in the U.S., even for vaccines that have been offered "for free," many families without insurance struggle to pay for the pediatrician appointment to vaccinate their child or face other barriers that render them unable to use free services. Reducing or eliminating these systemic costs is imperative because it sends a message to the public that vaccination is a government priority.
A related problem is accessibility more broadly. People have complicated lives and finding a doctor, making a vaccination appointment, and keeping that appointment can be difficult when juggling the myriad demands of early parenthood. Creating a system in which parents can attend a free vaccination clinic at an easily accessible location run by trusted healthcare professionals would improve vaccine uptake in the early years -- even before school entry vaccine mandates play a role. It would also help families form trusting relationships with medical professionals who work for the government, generating broader buy-in for the vaccination program.
We need to win the hearts and minds of parents using other mechanisms, too. Misinformation can be deadly. Policymakers need to fund effective public campaigns using trusted messengers who clearly communicate the urgency of making vaccination part of the routine of having a new baby and continuing that routine through the lifespan. When parents have doubts or questions, we must have excellent government-funded resources to help them make informed decisions. These will need to be tailored over time to speak to different groups, to appear on relevant platforms, and to address emerging concerns.
For the majority of parents, vaccination is normal and routine. But "personal belief exemptions" to vaccine mandates may suggest to many parents that vaccination is just another personal choice, akin to breast versus bottle feeding or selecting the best method of sleep training. Eliminating personal belief exemptions may protect many more children, but it may also provoke lasting political conflict about vaccination, as has been the case in California. It is not clear that this policy change alone is the answer.
America has relied too extensively on mandatory vaccinations to drive uptake. The World Vaccine Congress focused on ways to improve vaccine uptake in the U.S., Europe, and throughout the developing world. We have the technology and the means to prevent future death and suffering. We just need to encourage our governments to tear down barriers so that hearts and minds will follow.
Katie Attwell, PhD, is an associate professor of public policy at the University of Western Australia, where she leads VaxPolLab. She presented her ideas about obstacles to vaccination at the World Vaccine Congress in April. Her forthcoming book, America's New Vaccine Wars: California and the Politics of Mandates, co-authored with Mark Navin, will be released later this year by Oxford University Press.