Twenty years ago, three-quarters of media reports on the measles, mumps and rubella (MMR) vaccine were negative; journalists gave endless column inches to the latest anti-MMR theory without checking the scientific virtues of the claims being made. Those supporting the MMR vaccine were confronted on television by parents who were convinced that their children’s problems were vaccine induced, even when it was clear that they were not. Much changed when Brian Deer reported in The Sunday Times and on his website about his investigation into the research by Andrew Wakefield, who claimed that the MMR vaccine was linked to autism and bowel disease. When Dr Wakefield was struck off the UK’s Medical Register for serious professional misconduct, where he was described as ”dishonest, irresponsible and showed callous disregard”, many journalists appreciated that they had contributed to creating harm. Since then, the notion that reporting balance always requires equal coverage, whatever the virtues of either side, has been appreciated to be inappropriate.
Today, anti-vaccine coverage in mainstream media is rare in the UK, and the reporting flavour is strongly pro-vaccine. Yet over recent years uptake for all childhood vaccines in England (and certainly in some other parts of the world) has been slipping. The role of social media has been blamed frequently, with Matt Hancock, who is the secretary of state for health in England, wanting new legislation to force social media companies to remove content promoting false information about vaccines. Simon Stevens, the head of NHS England, reporting on school-gate gossip, has also blamed social media.
Other voices have instead called for compulsory vaccination despite its failure when it was tried before in the UK. There is also a lack of evidence that coverage is higher in countries with compulsion. One recent commentator suggested that non-compliant parents should be fined. These initiatives would make doctors, practice nurses and health visitors into the agents of the police and judiciary, who clearly have more important things to do than clog up the courts while making martyrs of those who sought publicity for their anti-vaccine choices. Fining non-compliers would discriminate between those who could afford their choice and those who for whatever other reason had not vaccinated their children. And who is going to be tasked with this bureaucracy?
Social media are not entirely innocent in this regard, and it is all too easy to find anti-vaccine material on websites and other platforms. In Ireland, an aggressive anti-human-papillomavirus vaccine campaign on social media did much harm despite the now widespread evidence of the vaccine’s safety and ability to prevent cancer. Parents who chose to deny their daughters protection against cancer because of the influence of social media will carry a heavy responsibility for the consequences of their ill-informed choices. But before we act in haste, we should ask whether there is evidence that the decline in vaccine coverage in England that affects all vaccines is caused by social media or whether there might be other factors at play.
At the time of the worst of the MMR frenzy in the early 2000s, 40% of parents said that they weighed up the pros and cons of vaccination, while the remainder automatically vaccinated their children when the vaccines were due. In 2017, 10% weighed up the pros and cons (now only 7%, according to Public Health England (PHE) data) and the rest automatically vaccinate. This doesn’t point to much negative impact from social media.
As parents do appear to be strongly supportive of childhood vaccination, there may be other reasons why fewer children are being vaccinated or not being recorded as having been vaccinated.
In 2012, health secretary Andrew Lansley’s health reforms enacted in the Health and Social Care Act 2012 changed the way that the immunisation programme was implemented and managed in England. Immunisation Coordinators, responsible for the programme at the local level, were mostly dislocated from the public health environments in which they had worked highly effectively. At the same time, the long-established coterminous geographical boundaries of public health and general practitioner services were redrawn such that earlier data on vaccine coverage no longer applied to the children in the newly mapped localities, and PHE needed to negotiate any initiatives through NHS England that had little immunisation expertise or capacity.
A 2016 review of the impacts of the Lansley reforms on immunisation said that the changes brought in fragmentation, ambiguity about organisational responsibilities and hindered data-sharing. While making immunisation managers responsible for larger areas supported equitable resource distribution and strengthened service commissioning, it also reduced their ability to apply clinical expertise, and support and evaluate immunisation providers’ performance.
So, what can be done?
Scaring parents over threats of diseases that they do not see as threats can be counterproductive. Choosing to vaccinate should be a normal behaviour. Clear information on the benefits as well as the very few adverse events that can occur must be widely available. In a way, the less attention we draw to unhelpful material on social media, the better, as long as there is a voice for the positive aspects. And a review of the management of immunisation and the NHS in England wouldn’t go amiss, as the 2012 reforms may have done more harm to the immunisation programme than vaccine hesitancy.
