06 October 2020


'Impact of antivaccination campaigns on health worldwide: lessons for Australia and the global community' by  Helen Petousis‐Harris and Lisbeth Alley in (2020) 213(7) Medical Journal of Australia 300-301 comments 

The arrival of social media coincides with the point at which the antivaccination movement became globally coordinated 

The antivaccination movement has roots in the first vaccine, smallpox, although opposition to the practice of artificially inducing immunity reaches back to the practice of variolation. Despite over two centuries of vaccination practice and all the advances in medical science and societal changes that have occurred over this time, the objections still follow the same themes. These have been eloquently described as: vaccines cause idiopathic illness, unholy alliance for profit, vaccines as poisonous chemical cocktails, cover‐up, towards totalitarianism, vaccine immunity is temporary, vaccines are ineffective, and health lifestyle alternative. For over two centuries, antivaccination activities, distribution of literature, membership and scientific establishment responses remained unchanged. 

While the internet emerged in the 1960s, the idea of “surfing”, the first audio and video distributions, and real expansion of the number of websites and browsers, including Google, increased dramatically during the 1990s, and it became common for organisations and individuals to have a website and an email. For the first time, groups opposing immunisation could make literature widely available. This facilitated the sharing of ideas into the global arena, and people searching for information about vaccination could easily find material that was critical. However, this was not enough to fuel a global movement of significance. 

Social media arrived in the early 2000s, with Facebook going online in 2004 and reaching 400 million active users by 2010. This point in time approximates the dawn of a new era in the antivaccination movement. It coincides with the point at which the movement became globally coordinated through social media platforms, most notably at the time the human papillomavirus (HPV) vaccine became widely available. Today, unlike traditional media, the microtargeting algorithms on Facebook allow these antivaccination groups to target parents of young children, women in particular. 

Together, these multifaceted activities have had a profound impact on global vaccine confidence, so much so that, in 2019, the World Health Organization included vaccine hesitancy (ie, delay in acceptance or refusal of vaccines despite availability of vaccination services) as one of ten threats to public health, and in 2020, this was included again within the spread of misinformation.

'“No jab, no pay”: catch‐up vaccination activity during its first two years' by Brynley P Hull, Frank H Beard, Alexandra J Hendry, Aditi Dey and Kristine Macartney in the latest MJA reports that the authnors sought to assess catch‐up vaccination of older children and adolescents during the first two years of the “No jab, no pay” policy linking eligibility for federal family assistance payments with childhood vaccination status. 

They used a cross‐sectional analysis of Australian Immunisation Register data on catch‐up vaccination of children aged 5 to less than 7 years before (January 2013 – December 2014; baseline) and during the first two years of “No jab, no pay” (December 2015 – December 2017), and of children aged 7 to less than 10 years and young people aged 10 to less than 20 years (“No jab, no pay” period only). That involved excamination of catch‐up vaccination rates for measles–mumps–rubella vaccine second dose (MMR2), by age group, Indigenous status, and socio‐economic status; catch‐up vaccination of children aged 5 to less than 7 years (third dose of diphtheria–tetanus–pertussis vaccine [DTPa3], MMR1), before and after introduction of “No jab, no pay”. 

They report that the proportion of incompletely vaccinated children aged 5 to less than 7 years who received catch‐up DTPa3 was higher under “No jab, no pay” than during the baseline period (15.5% v 9.4%). Of 407 332 incompletely vaccinated people aged 10 to less than 20 years, 71 502 (17.6%) received catch‐up MMR2 during the first two years of “No jab, no pay”, increasing overall coverage for this age group from 86.6% to 89.0%. MMR2 catch‐up activity in this age group was greater in the lowest socio‐economic status areas than in the highest status areas (29.1% v 7.6%), and also for Indigenous than for non‐Indigenous Australians (35.8% v 17.1%). MMR2 catch‐up activity in 2016 and 2017 peaked mid‐year. 

Their conclusion is that linking family assistance payments with childhood vaccination status and associated program improvements were followed by substantial catch‐up vaccination activity, particularly in young people from families of lower socio‐economic status