Commissioners of the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA
Vaccines are one of the most effective tools for the prevention of infectious diseases.1 However, the success of immunisation programmes depends on widespread acceptance and high coverage of vaccination.2 Over the past decade, vaccine refusal has accelerated in the USA, with increased non-medical exemptions to school immunisation requirements that have been linked to outbreaks of vaccine-preventable diseases.3 Although vaccine refusal is not uniformly spread across the USA and national childhood vaccination rates remain high, vaccination has declined in many communities and school districts that are consequently at increased risk of outbreaks of vaccine-preventable diseases.4
Achieving optimal and uniform vaccine acceptance is a complex challenge, especially because early evidence suggests that key factors affecting vaccine acceptance may have shifted over the past few years. Anti-vaccine activities are prominent,5 but are only a part of why vaccine refusal has increased. Other factors include ongoing distrust of the medical community, particularly among socially vulnerable communities, and poor or inconsistent public communications on the safety of vaccines to prevent emerging pandemic threats.
Organised anti-vaccine activities are a concern. In the past, the US anti-vaccine movement generally operated at the fringes of society, but it has now expanded its reach through increased political activities and amplification on the internet, social media, and e-commerce platforms.5 Homegrown anti-vaccine organisations at the state and national levels, combined with weaponised health attacks from some foreign nations, now dominate the internet through coordinated disinformation.5, 6, 7, 8
One recent study found that just two homegrown anti-vaccine organisations were responsible for more than half of all anti-vaccine advertisements on Facebook.9 National and international organisations now host regular anti-vaccine conferences and stage rallies.7 Additionally, in many states, such as California, Oklahoma, and Texas, political action committees influence or lobby state legislatures, often through libertarian or far-right legislators touting so-called health freedom.7 This movement has built on a growing interest in non-pharmaceutical interventions and alternative medicine, and heightened scepticism of the drug industry.10
The repercussions of these efforts cost lives. The number of measles cases in the USA increased in the past few years;11 in 2019, there were more than 1200 cases of measles and multiple hospitalisations and intensive care unit admissions. 12 Adolescents are also unnecessarily placed at risk for human papillomavirus cancers as are adults,13 and many Americans die every year from influenza.14
The USA is potentially facing frequent and costly public health crises due to outbreaks of infectious diseases arising from low vaccine acceptance…
Racial, ethnic, and economic disparities are issues that need to be addressed in efforts to build vaccine acceptance. COVID-19 transmission, morbidity, and mortality have disproportionately affected essential workers, Americans living in low-income neighbourhoods, and communities of colour, which reflects the effects of systemic racism.15..
The Lancet has established the Commission for Vaccine Refusal, Acceptance, and Demand in the USA to design a multisectoral plan for public policy to support high acceptance of safe and effective vaccines in the USA. Our goal is to understand and report on the state of vaccine acceptance and its potential link to vaccine hesitancy. Additionally, we will work to identify and predict future trends in vaccine acceptance and impacts on the public health community. We will also identify and assess demand-side vaccine uptake interventions and solutions to counter anti-vaccine information.
Similar disparate health outcomes have occurred in other pandemics, such as the H1N1 influenza pandemic in 2009, and they are likely to arise in future disease outbreaks…
The Commission had its first meeting in 2020, and we aim for a first interim report on COVID-19 vaccines in the coming months. We expect to present a comprehensive report on broader vaccine acceptance and hesitancy in the USA by 2022. We will post updates about the Commission’s ongoing work on the Commission website. We are hopeful that confidence in and acceptance of vaccines in the USA can be improved through a cooperative strategy…