December - Vaccine Hesitancy and Ebola: Implications for Public Health

Beverly Miller, MHA, MBA, Acting Area Director

Indian Health Service California Area Office

Recently, as a nation, many of us experienced fear when Ebola encroached upon our shores.  Given a reported death rate of 70% and apparent uncertainty regarding how the virus passes from person to person, there were and are legitimate reasons for concern.  Fortunately, we quickly found that death rates may be lowered if a diagnosis can be made quickly and comprehensive care is immediately offered in a modern hospital setting.  There is one other important point that many may have missed during this experience – the ultimate solution for successfully decreasing and/or eliminating Ebola is development and successful delivery of an effective vaccine.

This may be the most important lesson we can learn from the Ebola experience – vaccination is an essential component of ensuring good public health outcomes.  In a recent interview with Humanosphere, Bill Foege, one of the most prominent and renowned experts in public health, reinforced the importance of vaccines and also addressed the potential, if not inevitable, consequences of vaccine hesitancy:  “Vaccines are better than drugs, in general, because organisms don’t develop resistance.  But even with these great tools, these organisms have co-opted some parents who refuse immunizations for their children.  So measles and whooping cough are now able to rebound even in the face of great protective vaccines.”

Another reality is apparent – people who do not receive appropriate immunizations are at increased risk of infection and possible diseases that can cause significant sickness and death.  In a recent article published by Andrea Atkins (5 Infectious Diseases That Are a Bigger Threat Than Ebola), we note the number of measles cases are already beginning to increase in some parts of the nation.  She points out that the Ohio Department of Health has reported almost 400 cases of measles thus far this year.  Doctor Tara Smith, an infectious disease epidemiologist from Kent State University, describes the importance of this development: “It’s (measles) one of those viruses that is very scary because it lives for a really long time in the air.  If someone is sick in a room and sneezes, two hours later someone else can go into the room and still get sick with measles.  It could infect many people in those couple of hours.”

According to some reports, there are many who do not find this scenario of concern.  For example, some say it is fine to get infected and allow our natural defenses to stop the infection from causing disease.  Indeed, this may be true for some, but not everyone is so fortunate.  It is also important to understand what may happen to people who develop disease.  According to the Centers for Disease Control and Prevention (CDC), “Measles is a dangerous disease because it can lead to pneumonia, cause lifelong brain damage or deafness, and, in about one-third of the cases of measles around the world, death.” 

Clearly, given the increasing rate of vaccine hesitancy in our nation, it is important to gain awareness of what nations around the world experience when vaccination rates are low in the population.  Here is a recent report (November 14, 2014) from Reuters regarding what is happening with measles around the world: “Progress toward wiping out measles around the world has stalled, with deaths from the highly contagious disease rising last year and poor vaccine coverage leading to large outbreaks, the World Health Organization (WHO) said on Thursday.  More than 145,000 people died of measles in 2013, up from 122,000 in 2012, the WHO said.  Epidemics in China, Congo and Nigeria contributed to this, but there were also outbreaks in the WHO’s European region, including in Georgia, Turkey and Ukraine.”  Peter Strebel of the WHO’s immunization department relayed a key warning in this article: “Failure to reverse this alarming trend could jeopardize the momentum generated by a decade of achievements in reducing measles mortality.  Countries urgently need to prioritize maintaining and improving immunization coverage.” 

Our nation is also one of the countries that must listen to this warning.  That is, health care providers and public health officials must make expansion of immunization coverage in the populations we serve a top priority.  We must recognize the real public health threats that are already looming in our backyard. 

Many issues need to be addressed to be successful and strategies will have to be developed and successfully implemented.  Unfortunately, vaccine hesitancy is now one of those issues and we can no longer ignore the grave implications.  Let’s work together to make this happen before measles and other preventable diseases begin to cause significant sickness and death in the communities we serve.