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The importance of vaccinations.

Last Updated August 2023 | This article was created by familydoctor.org editorial staff and reviewed by Deepak S. Patel, MD, FAAFP, FACSM

What are vaccines?

A vaccine (or immunization) is a way to build your body’s natural immunity to a disease before you get sick. This keeps you from getting and spreading the disease.

For some vaccines, a weakened form of the disease germ is injected into your body. This is usually done with a shot in the leg or arm. Your body detects the invading germs (antigens) and produces antibodies to fight them. Those antibodies then stay in your body for a long time. In many cases, they stay for the rest of your life. If you’re ever exposed to the disease again, your body will fight it off without you ever getting the disease.

Some illnesses, like strains of cold viruses, are fairly mild. But some, like COVID-19, smallpox or polio, can cause life-altering changes. They can even result in death. That’s why preventing your body from contracting these illnesses is very important.

How does immunity work?

Your body builds a defense system to fight foreign germs that could make you sick or hurt you. It’s called your immune system. To build up your immune system, your body must be exposed to different germs. When your body is exposed to a germ for the first time, it produces antibodies to fight it. But that takes time, and you usually get sick before the antibodies have built up. But once you have antibodies, they stay in your body. So, the next time you’re exposed to that germ, the antibodies will attack it, and you won’t get sick.

Path to improved health

Everyone needs vaccines. They are recommended for infants, children, teenagers, and adults. There are widely accepted immunization schedules available. They list what vaccines are needed, and at what age they should be given. Most vaccines are given to children. It’s recommended they receive 12 different vaccines by their 6th birthday. Some of these come in a series of shots. Some vaccines are combined so they can be given together with fewer shots.

The American Academy of Family Physicians (AAFP) believes that immunization is essential to preventing the spread of contagious diseases. Vaccines are especially important for at-risk populations such as young children and older adults. The AAFP offers vaccination recommendations, immunization schedules , and information on disease-specific vaccines.

Being up to date on vaccines is especially important as children head back to school. During the 2021 school year, state-required vaccines among kindergarteners dropped from 95% to 94%. In the 2021-2022 year it fell again to 93%. Part of this was due to disruptions from the COVID-19 pandemic.

Is there anyone who can’t get vaccines?

Some people with certain immune system diseases should not receive some types of vaccines and should speak with their health care providers first. There is also a small number of people who don’t respond to a particular vaccine. Because these people can’t be vaccinated, it’s very important everyone else gets vaccinated. This helps preserve the “herd immunity” for the vast majority of people. This means that if most people are immune to a disease because of vaccinations, it will stop spreading.

Are there side effects to vaccines?

There can be side effects after you or your child get a vaccine. They are usually mild. They include redness or swelling at the injection site. Sometimes children develop a low-grade fever. These symptoms usually go away in a day or two. More serious side effects have been reported but are rare.

Typically, it takes years of development and testing before a vaccine is approved as safe and effective. However, in cases affecting a global, public health crisis or pandemic, it is possible to advance research, development, and production of a vaccine for emergency needs. Scientists and doctors at the U.S. Food and Drug Administration (FDA) study the research before approving a vaccine. They also inspect places where the vaccines are produced to make sure all rules are being followed. After the vaccine is released to the public, the FDA continues to monitor its use. It makes sure there are no safety issues.

The benefits of their use far outweigh any risks of side effects.

What would happen if we stopped vaccinating children and adults?

If we stopped vaccinating, the diseases would start coming back. Aside from smallpox, all other diseases are still active in some part of the world. If we don’t stay vaccinated, the diseases will come back. There would be epidemics, just like there used to be.

This happened in Japan in the 1970s. They had a good vaccination program for pertussis (whooping cough). Around 80% of Japanese children received a vaccination. In 1974, there were 393 cases of whooping cough and no deaths. Then rumors began that the vaccine was unsafe and wasn’t needed. By 1976, the vaccination rate was 10%. In 1979, there was a pertussis epidemic, with more than 13,000 cases and 41 deaths. Soon after, vaccination rates improved, and the number of cases went back down.

Things to consider

There have been many misunderstandings about vaccines. There are myths and misleading statements that spread on the internet and social media about vaccines. Here are answers to 5 of the most common questions/misconceptions about vaccines.

Vaccines do NOT cause autism.

Though multiple studies have been conducted, none have shown a link between autism and vaccines. The initial paper that started the rumor has since been discredited.

Vaccines are NOT too much for an infant’s immune system to handle.

Infants’ immune systems can handle much more than what vaccines give them. They are exposed to hundreds of bacteria and viruses every day. Adding a few more with a vaccine doesn’t add to what their immune systems are capable of handling.

Vaccines do NOT contain toxins that will harm you.

Some vaccines contain trace amounts of substances that could be harmful in a large dose. These include formaldehyde, aluminum, and mercury. But the amount used in the vaccines is so small that the vaccines are completely safe. For example, over the course of all vaccinations by the age of 2, a child will take in 4mg of aluminum. A breast-fed baby will take in 10mg in 6 months. Soy-based formula delivers 120mg in 6 months. In addition, infants have 10 times as much formaldehyde naturally occurring in their bodies than what is contained in a vaccine. And the toxic form of mercury has never been used in vaccines.

Vaccines do NOT cause the diseases they are meant to prevent.

This is a common misconception, especially about the flu vaccine. Many people think they get sick after getting a flu shot. But flu shots contain dead viruses—it’s impossible to get sick from the shot but mild symptoms can occur because the vaccine may trigger an immune response, which is normal. Even with vaccines that use weakened live viruses, you could experience mild symptoms similar to the illness. But you don’t actually have the disease.

We DO still need vaccines in the U.S., even though infection rates are low.

Many diseases are uncommon in the U.S. because of our high vaccination rate. But they haven’t been eliminated from other areas of the world. If a traveler from another country brings a disease to the U.S., anyone who isn’t vaccinated is at risk of getting that disease. The only way to keep infection rates low is to keep vaccinating.

Questions to ask your doctor

Why does my child need to be vaccinated?
What are the possible side effects of the vaccination?
What do I do if my child experiences a side effect from the vaccine?
What happens if my child doesn’t get all doses of the recommended vaccines? Will he or she be able to go to daycare or school?
We missed a vaccination. Can my child still get it late?
Are there new vaccines that aren’t on the immunization schedules for kids?
What should I do if I don’t have health insurance, or my insurance doesn’t cover vaccinations?
What vaccinations do I need as an adult?
Why do some people insist they became sick after getting the flu vaccine?

Centers for Disease Control and Prevention: Vaccines & Immunizations

Last Updated: August 10, 2023

This article was contributed by familydoctor.org editorial staff.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Most schools and daycares require certain childhood vaccines, but they’re also good for your child’s health.

Certain immunizations are important at every age to reduce illness, hospitalization, or death.

A preventive service might be a test, an immunization or vaccine, or advice from your doctor. These services can…

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Hum Vaccin Immunother
v.16(8); 2020

Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination

Arindam nandi.

a Center for Disease Dynamics, Economics & Policy, Washington, DC, USA

b Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Associated Data

World Health Organization . World Health Organization: 10 facts on immunization ; 2018. [accessed 2019 April9]. https://www.who.int/features/factfiles/immunization/en/ .

The direct benefits of childhood vaccination in reducing the burden of disease morbidity and mortality in a cost-effective manner are well-established. By preventing episodes of vaccine-preventable diseases, vaccination can also help avert associated out-of-pocket medical expenses, healthcare provider costs, and losses in wages of patients and caregivers. Studies have associated vaccines positively with cognition and school attainment, suggesting benefits of long-term improved economic productivity. New evidence suggests that the measles vaccine may improve immunological memory and prevent co-infections, thereby forming a protective shield against other infections, and consequently improving health, cognition, schooling and productivity outcomes well into the adolescence and adulthood in low-income settings. Systematically documenting these broader health, economic, and child development benefits of vaccines is important from a policy perspective, not only in low and middle-income countries where the burden of vaccine-preventable diseases is high and public resources are constrained, but also in high-income settings where the emergence of vaccine hesitancy poses a threat to benefits gained from reducing vaccine-preventable diseases. In this paper, we provide a brief summary of the recent evidence on the benefits of vaccines, and discuss the policy implications of these findings.

Introduction

Childhood vaccines save an estimated 2–3 million lives worldwide every year, which has contributed substantially to the reduction in global infant mortality rate from 65 per 1,000 live births in 1990 to 29 in 2018. 1, 2 Vaccines are found to be the most cost-effective approach for reducing childhood disease burden, especially when compared with interventions such as clean water and improved sanitation which can also reduce disease transmission but require expensive and time-consuming infrastructural investment. 3 Cross-national policy efforts such as the World Health Organization’s (WHO) Expanded Programme on Immunization (EPI) of 1974, and the multi-agency Global Alliance for Vaccines and Immunization (Gavi), established in 1999, have supported several countries with research, logistical planning, supply chain management, and financing of national vaccination programs. In recent times, routine vaccination has been supplemented with additional efforts to optimize community coverage. An example is the government of India’s Mission Indradhanush campaign initiated in 2015, that resulted in an increase of full vaccination coverage in target districts by 10 percentage points in just six months. 4 As a result of these combined in-country and international initiatives, full vaccination rates of children in low-income countries have increased from under 50% to close to 80% during the past two decades. 5

With such improvements in vaccination rates and reduction in child mortality, future changes in the global child health policy can be envisaged in three broad areas. First, as vaccine coverage improves, and there is increasing protection of both vaccinated and unvaccinated populations through the phenomenon of community immunity, we are likely to see fewer vaccine-preventable diseases in the general population. For example, polio has been eliminated from almost all countries and is at the verge of complete global eradication. However, the growing recognition of the importance of health equity has shown that clusters of susceptible populations within vaccinated societies can preempt disease outbreaks, such as the reemergence of diphtheria infections in Bangladesh and India. 6 , 7 Second, the decreasing incidence of vaccine-preventable diseases has diminished the public’s memory of the devastation caused by the diseases, leading to a rise in vaccine hesitancy. Therefore, national programs will have to refocus on maintaining the momentum, although in a world with limited government resources, health policymakers may find it difficult to financially and operationally justify large vaccination programs. Third, the shifting focus from child mortality to morbidity will lead to a greater emphasis on children’s physical, cognitive, and socioemotional development as compared with survival. 8 , 9

Due to changing focus from child survival benefits of vaccines to child development benefits, along with greater reliance on multi-criteria decision-making tools, it is more important than ever before to quantify the broader social and individual benefits of vaccination. In this paper, we discuss evidence from a few key studies, and summarize the benefits of childhood vaccines beyond the intended reduction in disease burden and child mortality.

Economic, equity, and global health benefits of vaccines

Vaccines can have several economic benefits. 3 , 10 One of the most discernible benefits is averted medical expenditure. By preventing an episode of the disease through a vaccine, the economic costs of treatment, such as physician fees, drugs and hospitalization expenses, and associated travel costs and wage loss of caregivers could be averted. This is particularly important for low and middle-income countries (LMICs) where a large part of medical expenditure is out-of-pocket. A clear example is the situation in India, where 65% of health expenditure is private, with extreme costs in some cases, which thrusts 51 million people into poverty every year. 2 , 11 , 12 It is estimated that the measles, rotavirus, and pneumococcal conjugate vaccines could help avert $4.6 billion (2016 US$, adjusted for purchasing power parity) in out-of-pocket medical expenses in 41 Gavi-eligible LMICs during 2016–2030. 13 Vaccines could also reduce the number of people who fall into poverty due to a catastrophic medical expense which is defined as a large proportion (typically, more than 10% to 25%) of household income or expenditure. 12 , 14 - 20

The protection which vaccines provide against the financial risk from a large medical expense can be measured in additional ways. The so-called extended cost-effectiveness (ECEA) studies have estimated large money-metric value of insurance provided by vaccines. 13 , 14 , 16 , 19 The value of insurance is equivalent to risk premium, which is defined as the amount of money one would be willing to pay in order to avoid the financial uncertainty from a vaccine-preventable disease. 21 Paying for vaccines, in this context, is akin to paying for a health insurance premium.

Benefit-cost analysis (BCA) studies of vaccines consider a full range benefits as measured by gains in economic productivity. Several alternative BCA methods exist, including a human capital approach which uses the average annual economic contribution of workers, and a friction cost approach which considers productivity lost during the period when a job position remains unfilled due to sickness. 22 , 23 Mortality and morbidity risk reduction benefits of vaccines have also been measured in terms the value of statistical life year (VSLY). 24 , 25 VSLY is equivalent to the willingness to pay in order to avoid one disability adjusted life year (DALY) from the disease. 26 , 27 It is typically measured as a multiple (approximately 2–4 times) of the per capita national income of a country. 28 - 30 Newer studies such as those commissioned by the Copenhagen Consensus Center have considered a fixed value of either $1,000 or $5,000 per DALY across all countries and contexts. 29 - 31

One of the most comprehensive vaccine BCA studies published recently used the VSLY method and examined the economic benefits of 10 vaccines – for Haemophilus influenzae type b, hepatitis B, human papillomavirus, Japanese encephalitis, measles, Neisseria meningitidis serogroup A, rotavirus, rubella, Streptococcus pneumoniae , and yellow fever – in 73 LMICs. 10 The authors considered averted medical expenses, transportation costs, and productivity gains in their analysis, and estimated that during 2001–2020, the vaccines together would provide a social and economic value of $820 billion (2010 US$). 10 During 2011–2020, the rate of return for investment on these vaccines was estimated to be up to 44 times of the initial cost. 32 Routine vaccination has a positive effect on social and health equity among populations. Infectious disease incidence and mortality are often associated with poverty, and exacerbated by lack of access to clean water, sanitation, and basic hygiene among the poor. Routine childhood vaccinations are, thus, estimated to avert the largest burden of diseases, associated medical expenses, and loss in economic productivity in the poorest segments of the society. 13 , 14 , 17 - 19 , 33 , 34 A recent study in 41 Gavi-eligible LMICs found that universal coverage of the measles, rotavirus, and pneumococcal conjugate vaccines would avert a total of 12.6 million cases of catastrophic health expenditure which might have otherwise propelled patients into poverty. 13 Of those, 75%, 40%, and 22% of cases respectively for the three diseases were from the poorest wealth quintile. 13

New research shows that vaccines can also tackle global health threats such as antimicrobial resistance (AMR). If left unchecked, AMR-related infections are estimated to result in as many as 10 million deaths per year worldwide by 2050, with an associated global economic cost of US$100 trillion. 35 Vaccines could prevent infections – either sensitive or resistant – and also reduce the use of antimicrobials, which in turn could slow the growth of AMR. 36 - 46

Child development benefits of vaccines

Persistent or recurrent infections in early life can lead to poor growth and stunting, which in turn can adversely affect adult health, cognitive capacity, and economic productivity. 47 - 49 The theoretical basis of the long-term benefits of vaccines is anchored in the widely accepted “fetal origins” hypothesis 50 , 51 which links conditions in utero and during early childhood with later life outcomes. 48 , 49 , 52 - 66 Malnutrition, infection, pregnancy and birth complications, and under-stimulation during the first 1000 days of life can have lasting impact on health, cognitive, and economic outcomes well into the old age. In addition to appropriate nutrition and nurturing, health interventions such as routine vaccinations could reduce infectious disease burden in early childhood and thereby help break the intergenerational cycle of poverty, poor health, and low income.

There is a small but growing literature on the potential child development benefits of routine vaccines. The measles vaccine is especially important in this context as episodes of measles could damage protective immune memory for a period of 2–3 years, increasing susceptibility to future measles and non-measles infections. 67 - 69 Using sophisticated techniques, scientists have showed that measles infection in children wipes out preexisting antibodies to different pathogens in the months after the infectious episode, leaving them vulnerable to multiple other infections and possible death. 70 A recent longitudinal study of approximately 2,000 children each in Ethiopia, India, and Vietnam has linked measles vaccination at ages 6–18 months of life with 0.1–0.2 higher anthropometric z-scores, 1.7–4.5 percentage points higher scores on standardized cognition tests, and 0.2–0.3 additional schooling grades at ages 7–8 and 11–12 years. 71 The vaccine has also been associated with 0.2 more schooling grade attainment among South African children and 7.4% higher school enrollment rate among children in Bangladesh. 72 , 73

Similar growth, cognition, and schooling benefits have been observed among Haemophilus influenzae type B (Hib) vaccinated children in India, 74 , 75 and fully vaccinated children in the Philippines. 76 Another study found that exposure to tetanus vaccination in utero increased schooling attainment by 0.3 years for some children in Bangladesh. 77 At the aggregate level, India’s national vaccination program has been associated with 0.3–0.5 higher height-for-age and weight-for-age z-scores at ages 0–4 years, 78 and 0.2 additional schooling grades among adults. 79

Concluding remarks

Childhood vaccines have numerous positive effects beyond disease prevention. The concept of broader benefits of vaccines which would include cognition, schooling, economic productivity, fertility, and related outcomes was first proposed by a key 2005 article. 80 During the present decade, researchers have utilized and expanded this framework across several dimensions and country contexts. 76 , 77 , 81 - 85

A new online database called the Value of Immunization Compendium Evidence (VoICE), created and maintained by the International Vaccine Access Center at the Johns Hopkins University, Bloomberg School of Public Health, now tracks research on the broader benefits of vaccines on health, educational, economic, and equity outcomes worldwide. 86 The Immunization Economics community of research and practice compiles similar and related information. 87 Finally, the World Health Organization is developing an approach for systematically measuring the broader benefits, known as the Full Public Health Value Propositions (FPHVP), in the context of LMICs. 88 , 89 Regardless of income level, countries around the world are facing a crises in the acceptance of the societal benefits of routine vaccines. Going forward, we hope that these new frameworks will be widely used for child health policy globally.

Funding Statement

This work was supported by the Value of Vaccination Research Network (VoVRN) through a grant from the Bill & Melinda Gates Foundation (Grant OPP1158136). The content is solely the responsibility of the authors and does not necessarily reflect the views of the VoVRN or the foundation.

Disclosure of potential conflicts of interest

No potential conflicts of interest were disclosed.

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The COVID-19 Vaccination Challenge: Lessons From History

By Claire Klobucista

Last updated July 28, 2021 1:20 pm (EST)

Vaccines are a major public health success story, but the COVID-19 pandemic underscores the many challenges involved in getting a vaccine to everyone who needs it.

The COVID-19 pandemic has highlighted the challenges of not only developing vaccines, but also making sure everyone who should get them does. Though more than a dozen COVID-19 vaccines are now being distributed around the world, vaccination campaigns face many hurdles: limited availability, public mistrust, and dosage and storage requirements can all jeopardize vaccination coverage. A look at previous vaccine distribution efforts showcases some of the main challenges.

How do rates for routine vaccines stack up?

Public health experts worldwide consider vaccines to be among medicine’s most important achievements, helping to reduce the prevalence of some diseases, such as polio, to near zero. Yet, even for diseases with vaccines, achieving and maintaining high coverage can be difficult. The World Health Organization (WHO) has warned of a “ dangerous stagnation ” of vaccination rates in recent years.

There are many factors that affect a vaccine’s coverage rate. These include:

Pharmaceuticals and Vaccines

Public Health Threats and Pandemics

Health Policy and Initiatives

Maternal and Child Health

Availability . Countries can face vaccine shortages for a range of reasons, including conflict and insufficient production capacity. The WHO has noted a global shortage [PDF] of the human papillomavirus (HPV) vaccine in recent years due to limited manufacturing capacity amid rising demand. In the case of the COVID-19 crisis, production capacity is being tested on an unprecedented scale. Amid a devastating outbreak in India in mid-2021, the Serum Institute of India—the world’s largest vaccine manufacturer—announced it would not be able to meet its commitments to deliver doses to other low-income countries.

Distribution also presents a hurdle, particularly for rural or remote areas. Some vaccines, such as that for chickenpox (varicella), must be kept at very low temperatures when transported and stored, a process known as the cold chain. Similarly, the Pfizer-BioNTech COVID-19 vaccine initially required storage in ultra-cold freezers; however, following the release of new data, it can now be kept in standard refrigerators for up to one month, making the vaccine more accessible .

A boy receives polio vaccine drops during an immunization campaign in Karachi, Pakistan.

Public understanding and trust . Health officials can build trust in their communities through clear and transparent communication about vaccines. This includes information about their effectiveness, any expected side effects, and when to return for booster shots. Experts have raised alarm about increasing vaccine skepticism, which has led to measles outbreaks in a number of countries. Mistrust similarly undermined efforts to fight Ebola outbreaks in the Democratic Republic of Congo. There is also mounting concern about what health officials have termed an “infodemic” of misinformation and campaigns to deliberately spread false information about COVID-19 vaccine effects. Hesitancy about COVID-19 vaccines remains high in the United States, with nearly 30 percent of Americans surveyed saying they will not get vaccinated or are unsure about getting vaccinated, according to a July 2021 poll by the Economist and YouGov.

Complexity of the vaccine series . Sometimes two or more doses are recommended for maximum protection , with weeks or even months between doses. The Moderna and Pfizer-BioNTech vaccines both require two doses, and individuals are required to receive the same vaccine for both doses.

Recommendations . Health authorities often designate a vaccine for particular age groups or for people that share certain health risks. In the United States and some other countries, visits to the pediatrician are largely determined by vaccination schedules, making it much easier to achieve high coverage among infants and toddlers. Teens and adults typically don’t make routine doctor visits, lowering their coverage. Ahead of the COVID-19 vaccine rollout, health agencies in many countries issued guidance for phased vaccination campaigns , with health-care workers and residents of nursing homes and long-term care facilities first in line.

How do these variables affect coverage globally?

Recommendations for a particular vaccination can vary significantly across countries. For example, in the United States, an annual flu vaccine is recommended for anyone six months or older, while in some European countries , such as Belgium and Lithuania, it is only recommended for high-risk groups, which include health-care workers, pregnant women, and people with weakened immune systems. As a result, coverage rates can look very different around the globe.

The WHO’s Europe office has expressed concern about the declining use of influenza vaccines across the region, citing limited procurement of vaccines, health-care providers not advising the vaccination, out-of-pocket costs, and low public confidence.

How is the pandemic affecting vaccination coverage?

Amid the pandemic, a major concern among health experts has been drops in coverage for routine vaccinations, as some families avoided visits to health-care facilities and resources and personnel were diverted to focus on the COVID-19 crisis. In 2020, twenty-three million children globally missed basic vaccinations , according to the WHO and the UN Children’s Fund (UNICEF).

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Health officials likewise urged citizens to get their flu shot to avoid a “twindemic” of seasonal influenza and COVID-19. Yet, in the United States, Europe, and elsewhere, the number of flu cases appeared unusually low, with health experts mainly crediting social distancing and other pandemic-related measures.

Where do COVID-19 vaccination rates stand?

Even in the best of times, effective vaccination policy involves many moving parts. Despite the successful development of COVID-19 vaccines, just 14 percent of the world’s population is fully vaccinated against the disease and less than 30 percent has received at least one dose. In Africa, the share of fully vaccinated is dramatically lower, at under 2 percent.

The sluggish global rollout has raised alarm as new, more infectious variants of the coronavirus have emerged. Now, officials are implementing or considering vaccination mandates to keep their countries trending in the right direction. For instance, Indonesia mandated in February that all eligible citizens be vaccinated, threatening fines or suspended social services for those who refuse. Starting in August, Saudi citizens will be required to show proof of vaccination to enter many public and private spaces. France and Greece are requiring all health-care workers to be vaccinated by September. A growing number of U.S. public-sector organizations are also mandating vaccination.

Will Merrow and Zachary Rosenthal created the graphics for this In Brief.

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Why Childhood Immunizations Are Important

Childhood vaccines or immunizations can seem overwhelming when you are a new parent. Vaccine schedules recommended by agencies and organizations, such as the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians cover about 14 different diseases.

Vaccinations not only protect your child from deadly diseases, such as polio, tetanus, and diphtheria, but they also keep other children safe by eliminating or greatly decreasing dangerous diseases that used to spread from child to child.

A vaccine is a dead, or weakened version, or part of the germ that causes the disease in question. When children are exposed to a disease in vaccine form, their immune system, which is the body's germ-fighting machine, is able to build up antibodies that protect them from contracting the disease if and when they are exposed to the actual disease.

Over the years, vaccines have generated some controversy over safety, but no convincing evidence of harm has been found. And although children can have a reaction to any vaccine, the important thing to know is that the benefits of vaccinations far outweigh the possible side effects.

Keeping track of immunizations

Most of your child’s vaccinations are completed between birth and 6 years. Many vaccines are given more than once, at different ages, and in combinations. This means that you’ll need to keep a careful record of your child's shots. Although your doctor's office will also keep track, people change doctors, records get lost, and the person ultimately responsible for keeping track of your child's immunizations is you.

Ask your child's doctor for an immunization record form. Think about your child's record as you would a birth certificate and keep it with your other essential documents. You can also download an easy-to-read immunization schedule and record form at the CDC website .

Even though most parents and doctors do a good job of keeping up with immunizations, studies show that about one-fourth of preschool children are missing at least one routine vaccination. Most states will not let your child start school without a complete immunization record. Sometimes a vaccination is missed when a child is sick. No matter what the reason, it’s important to make up missed immunizations.

If your child has missed an immunization, you don't have to go back and start over for most vaccines. The previous immunizations are still good. Your doctor will just resume the immunization schedule. If, for any reason, your child receives additional doses of a vaccine, this is also not a concern, although your child will still need any future doses according to the recommended schedule.

How many shots do children need?

Although vaccines are combined to reduce the number of shots needed, the list is still long.

Here is a common immunization schedule recommended by age 2:

One vaccination for measles, mumps, and rubella (MMR)

Four vaccinations for Haemophilus influenza (Hib), a common upper respiratory infection that can also cause meningitis

Three to four polio vaccinations (IPV)

Four vaccinations for diphtheria, tetanus, and pertussis (DPT)

Three vaccinations for hepatitis B

One vaccination for varicella (chickenpox) no earlier than age 12 months and only if your child does not develop chickenpox on his or her own (must be verified by a health care provider)

Three vaccinations for rotavirus, a type of infection that causes severe diarrhea

Four vaccinations for pneumococcal disease, a common cause of ear infections and pneumonia

From age 4 to 6, your child will need booster shots for DPT, IPV, MMR, and chickenpox. Children should also start receiving a yearly flu shot after age 6 months. A vaccination for hepatitis A is recommended for all children. This is a lot to keep track of and why you need an immunization records form.

Final tips on immunizations

Keep this information in mind to help your child’s immunizations go more smoothly:

Common side effects of immunizations include swelling at the site of the injection, soreness, and fever. Discuss these side effects with your doctor and ask what symptoms deserve an office call.

Ask your doctor's office if it participates in an immunization registry. This is a source you can go to if your immunization records get lost.

Ask your doctor's office if it has an immunization reminder or recall system. This type of system will call to remind you when immunizations are due and will warn you if an immunization has been missed.

Always bring your immunizations record with you to all of your child's office visits and make sure the doctor signs and dates every immunization.

Vaccines are some of the safest and most effective medicines we have, and they have made many dangerous childhood diseases rare today.

Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation

Sarah Kreps 1 ,
Nabarun Dasgupta 2 ,
John S. Brownstein 3 , 4 ,
Yulin Hswen 5 &
Douglas L. Kriner ORCID: orcid.org/0000-0002-9353-2334 1

npj Vaccines volume 6 , Article number: 73 ( 2021 ) Cite this article

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While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still undermine efforts to combat the pandemic. Employing a survey of 1096 adult Americans recruited via the Lucid platform, we examined the relationships between vaccine attributes, proposed policy interventions such as financial incentives, and misinformation on public vaccination preferences. Higher degrees of vaccine efficacy significantly increased individuals’ willingness to receive a COVID-19 vaccine, while a high incidence of minor side effects, a co-pay, and Emergency Use Authorization to fast-track the vaccine decreased willingness. The vaccine manufacturer had no influence on public willingness to vaccinate. We also found no evidence that belief in misinformation about COVID-19 treatments was positively associated with vaccine hesitancy. The findings have implications for public health strategies intending to increase levels of community vaccination.

Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA

Vaccine hesitancy and monetary incentives

Providing normative information increases intentions to accept a COVID-19 vaccine

Introduction.

In less than a year, an array of vaccines was developed to bring an end to the SARS-CoV-2 pandemic. As impressive as the speed of development was the efficacy of vaccines such as Moderna and Pfizer, which are over 90%. Despite the growing availability and efficacy, however, vaccine hesitancy remains a potential impediment to widespread community uptake. While previous surveys indicate that overall levels of vaccine acceptance may be around 70% in the United States 1 , the case of Israel may offer a cautionary tale about self-reported preferences and vaccination in practice. Prospective studies 2 of vaccine acceptance in Israel showed that about 75% of the Israeli population would vaccinate, but Israel’s initial vaccination surge stalled around 42%. The government, which then augmented its vaccination efforts with incentive programs, attributed unexpected resistance to online misinformation 3 .

Research on vaccine hesitancy in the context of viruses such as influenza and measles, mumps, and rubella, suggests that misinformation surrounding vaccines is prevalent 4 , 5 . Emerging research on COVID-19 vaccine preferences, however, points to vaccine attributes as dominant determinants of attitudes toward vaccination. Higher efficacy is associated with greater likelihood of vaccinating 6 , 7 , whereas an FDA Emergency Use Authorization 6 or politicized approval timing 8 is associated with more hesitancy. Whether COVID-19 misinformation contributes to vaccine preferences or whether these attributes or policy interventions such as incentives play a larger role has not been studied. Further, while previous research has focused on a set of attributes that was relevant at one particular point in time, the evidence and context about the available vaccines has continued to shift in ways that could shape public willingness to accept the vaccine. For example, governments, employers, and economists have begun to think about or even devise ways to incentivize monetarily COVID-19 vaccine uptake, but researchers have not yet studied whether paying people to receive the COVID-19 vaccine would actually affect likely behavior. As supply problems wane and hesitancy becomes a limiting factor, understanding whether financial incentives can overcome hesitancy becomes a crucial question for public health. Further, as new vaccines such as Johnson and Johnson are authorized, knowing whether the vaccine manufacturer name elicits or deters interest in individuals is also important, as are the corresponding efficacy rates of different vaccines and the extent to which those affect vaccine preferences. The purpose of this study is to examine how information about vaccine attributes such as efficacy rates, the incidence of side effects, the nature of the governmental approval process, identity of the manufacturers, and policy interventions, including economic incentives, affect intention to vaccinate, and to examine the association between belief in an important category of misinformation—false claims concerning COVID-19 treatments—and willingness to vaccinate.

General characteristics of study population

Table 1 presents sample demographics, which largely reflect those of the US population as a whole. Of the 1335 US adults recruited for the study, a convenience sample of 1100 participants consented to begin the survey, and 1096 completed the full questionnaire. The sample was 51% female; 75% white; and had a median age of 43 with an interquartile range of 31–58. Comparisons of the sample demographics to those of other prominent social science surveys and U.S. Census figures are shown in Supplementary Table 1 .

Vaccination preferences

Each subject was asked to evaluate a series of seven hypothetical vaccines. For each hypothetical vaccine, our conjoint experiment randomly assigned values of five different vaccine attributes—efficacy, the incidence of minor side effects, government approval process, manufacturer, and cost/financial inducement. Descriptions of each attribute and the specific levels used in the experiment are summarized in Table 2 . After seeing the profile of each vaccine, the subject was asked whether she would choose to receive the vaccine described, or whether she would choose not to be vaccinated. Finally, subjects were asked to indicate how likely they would be to take the vaccine on a seven-point likert scale.

Across all choice sets, in 4419 cases (58%) subjects said they would choose the vaccine described in the profile rather than not being vaccinated. As shown in Fig. 1 , several characteristics of the vaccine significantly influenced willingness to vaccinate.

Circles present the estimated effect of each attribute level on the probability of a subject accepting vaccination from the attribute’s baseline level. Horizontal lines through points indicate 95% confidence intervals. Points without error bars denote the baseline value for each attribute. The average marginal component effects (AMCEs) are the regression coefficients reported in model 1 of Table 3 .

Efficacy had the largest effect on individual vaccine preferences. An efficacy rate of 90% increased uptake by about 20% relative to the baseline at 50% efficacy. Even a high incidence of minor side effects (1 in 2) had only a modest negative effect (about 5%) on willingness to vaccinate. Whether the vaccine went through full FDA approval or received an Emergency Use Authorization (EUA), an authority that allows the Food and Drug Administration mechanisms to accelerate the availability and use of treatments or medicines during medical emergencies 9 , significantly influenced willingness to vaccinate. An EUA decreased the likelihood of vaccination by 7% compared to a full FDA authorization; such a decline would translate into about 23 million Americans. While a $20 co-pay reduced the likelihood of vaccination relative to a no-cost baseline, financial incentives did not increase willingness to vaccinate. Lastly, the manufacturer had no effect on vaccination attitudes, despite the public pause of the AstraZeneca trial and prominence of Johnson & Johnson as a household name (our experiment was fielded before the pause in the administration of the Johnson & Johnson shot in the United States).

Model 2 of Table 3 presents an expanded model specification to investigate the association between misinformation and willingness to vaccinate. The primary additional independent variable of interest is a misinformation index that captures the extent to which each subject believes or rejects eight claims (five false; three true) about COVID-19 treatments. Additional analyses using alternate operationalizations of the misinformation index yield substantively similar results (Supplementary Table 4 ). This model also includes a number of demographic control variables, including indicators for political partisanship, gender, educational attainment, age, and race/ethnicity, all of which are also associated with belief in misinformation about the vaccine (Supplementary Table 2 ). Finally, the model also controls for subjects’ health insurance status, past experience vaccinating against seasonal influenza, attitudes toward the pharmaceutical industry, and beliefs about vaccine safety generally.

Greater levels of belief in misinformation about COVID-19 treatments were not associated with greater vaccine hesitancy. Instead, the relevant coefficient is positive and statistically significant, indicating that, all else being equal, individuals who scored higher on our index of misinformation about COVID-19 treatments were more willing to vaccinate than those who were less susceptible to believing false claims.

Strong beliefs that vaccines are safe generally was positively associated with willingness to accept a COVID-19 vaccine, as were past histories of frequent influenza vaccination and favorable attitudes toward the pharmaceutical industry. Women and older subjects were significantly less likely to report willingness to vaccinate than men and younger subjects, all else equal. Education was positively associated with willingness to vaccinate.

This research offers a comprehensive examination of attitudes toward COVID-19 vaccination, particularly the role of vaccine attributes, potential policy interventions, and misinformation. Several previous studies have analyzed the effects of vaccine characteristics on willingness to vaccinate, but the modal approach is to gauge willingness to accept a generic COVID-19 vaccine 10 , 11 . Large volumes of research show, however, that vaccine preferences hinge on specific vaccine attributes. Recent research considering the influence of attributes such as efficacy, side effects, and country of origin take a step toward understanding how properties affect individuals’ intentions to vaccinate 6 , 7 , 8 , 12 , 13 , but evidence about the attributes of actual vaccines, debates about how to promote vaccination within the population, and questions about the influence of misinformation have moved quickly 14 .

Our conjoint experiment therefore examined the influence of five vaccine attributes on vaccination willingness. The first category of attributes involved aspects of the vaccine itself. Since efficacy is one of the most common determinants of vaccine acceptance, we considered different levels of efficacy, 50%, 70%, and 90%, levels that are common in the literature 7 , 15 . Evidence from Phase III trials suggests that even the 90% efficacy level in our design, which is well above the 50% threshold from the FDA Guidance for minimal effectiveness for Emergency Use Authorization 16 , has been exceeded by both Pfizer’s and Moderna’s vaccines 17 , 18 . The 70% efficacy threshold is closer to the initial reports of the efficacy of the Johnson & Johnson vaccine, whose efficacy varied across regions 19 . Our analysis suggests that efficacy levels associated with recent mRNA vaccine trials increases public vaccine uptake by 20% over a baseline of a vaccine with 50% efficacy. A 70% efficacy rate increases public willingness to vaccinate by 13% over a baseline vaccine with 50% efficacy.

An additional set of epidemiological attributes consisted of the frequency of minor side effects. While severe side effects were plausible going into early clinical trials, evidence clearly suggests that minor side effects are more common, ranging from 10% to 100% of people vaccinated depending on the number of doses and the dose group (25–250 mcg) 20 . Since the 100 mcg dose was supported in Phase III trials 21 , we include the highest adverse event probability—approximating 60% as 1 in 2—and 1 in 10 as the lowest likelihood, approximating the number of people who experienced mild arthralgia 20 . Our findings suggest that a the prevalence of minor side effects associated with recent trials (i.e. a 1 in 2 chance), intention to vaccinate decreased by about 5% versus a 1 in 10 chance of minor side effects baseline. However, at a 25% rate of minor side effects, respondents did not indicate any lower likelihood of vaccination compared to the 10% baseline. Public communications about how to reduce well-known side effects, such as pain at the injection site, could contribute to improved acceptance of the vaccine, as it is unlikely that development of vaccine-related minor side effects will change.

We then considered the effect of EUA versus full FDA approval. The influenza H1N1 virus brought the process of EUA into public discourse 22 , and the COVID-19 virus has again raised the debate about whether and how to use EUA. Compared to recent studies also employing conjoint experimental designs that showed just a 3% decline in support conditional on EUA 6 , we found decreases in support of more than twice that with an EUA compared to full FDA approval. Statements made by the Trump administration promising an intensely rapid roll-out or isolated adverse events from vaccination in the UK may have exacerbated concerns about EUA versus full approval 8 , 23 , 24 , 25 . This negative effect is even greater among some subsets of the population. As shown in additional analyses reported in the Supplementary Information (Supplementary Fig. 5 ), the negative effects are greatest among those who believe vaccines are generally safe. Among those who believe vaccines generally are extremely safe, the EUA decreased willingness to vaccinate by 11%, all else equal. This suggests that outreach campaigns seeking to assure those troubled by the authorization process used for currently available vaccines should target their efforts on those who are generally predisposed to believe vaccines are safe.

Next, we compared receptiveness as a function of the manufacturer: Moderna, Pfizer, Johnson and Johnson, and AstraZeneca, all firms at advanced stages of vaccine development. Vaccine manufacturers in the US have not yet attempted to use trade names to differentiate their vaccines, instead relying on the association with manufacturer reputation. In other countries, vaccine brand names have been more intentionally publicized, such as Bharat Biotech’s Covaxin in India and Gamaleya Research Institute of Epidemiology and Microbiology Sputnik V in Russia. We found that manufacturer names had no impact on willingness to vaccinate. As with hepatitis and H. influenzae vaccines 26 , 27 , interchangeability has been an active topic of debate with coronavirus mRNA vaccines which require a second shot for full immunity. Our research suggests that at least as far as public receptiveness goes, interchangeability would not introduce concerns. We found no significant differences in vaccination uptake across any of the manufacturer treatments. Future research should investigate if a manufacturer preference develops as new evidence about efficacy and side effects becomes available, particularly depending on whether future booster shots, if needed, are deemed interchangeable with the initial vaccination.

Taking up the question of how cost and financial incentives shape behavior, we looked at paying and being paid to vaccinate. While existing research suggests that individuals are often willing to pay for vaccines 28 , 29 , some economists have proposed that the government pay individuals up to $1,000 to take the COVID-19 vaccine 30 . However, because a cost of $300 billion to vaccinate the population may be prohibitive, we posed a more modest $100 incentive. We also compared this with a $10 incentive, which previous studies suggest is sufficient for actions that do not require individuals to change behavior on a sustained basis 31 . While having to pay a $20 co-pay for the vaccine did deter individuals, the additional economic incentives had no positive effect although they did not discourage vaccination 32 . Consistent with past research 31 , 33 , further analysis shows that the negative effect of the $20 co-pay was concentrated among low-income earners (Supplementary Fig. 7 ). Financial incentives failed to increase vaccination willingness across income levels.

Our study also yields important insights into the relationship between one prominent category of COVID-19 misinformation and vaccination preferences. We find that susceptibility to misinformation about COVID-19 treatments—based on whether individuals can distinguish between factual and false information about efforts to combat COVID-19—is considerable. A quarter of subjects scored no higher on our misinformation index than random guessing or uniform abstention/unsure responses (for the full distribution, see Supplementary Fig. 2 ). However, subjects who scored higher on our misinformation index did not exhibit greater vaccination hesitancy. These subjects actually were more likely to believe in vaccine safety more generally and to accept a COVID-19 vaccine, all else being equal. These results run counter to recent findings of public opinion in France where greater conspiracy beliefs were negatively correlated with willingness to vaccinate against COVID-19 34 and in Korea where greater misinformation exposure and belief were negatively correlated with taking preventative actions 35 . Nevertheless, the results are robust to alternate operationalizations of belief in misinformation (i.e., constructing the index only using false claims, or measuring misinformation beliefs as the number of false claims believed: see Supplementary Table 4 ).

We recommend further study to understand the observed positive relationship between beliefs in COVID-19 misinformation about fake treatments and willingness to receive the COVID-19 vaccine. To be clear, we do not posit a causal relationship between the two. Rather, we suspect that belief in misinformation may be correlated with an omitted factor related to concerns about contracting COVID-19. For example, those who believe COVID-19 misinformation may have a higher perception of risk of COVID-19, and therefore be more willing to take a vaccine, all else equal 36 . Additional analyses reported in the Supplementary Information (Supplementary Fig. 6 ) show that the negative effect of an EUA on willingness to vaccinate was concentrated among those who scored low on the misinformation index. An EUA had little effect on the vaccination preferences of subjects most susceptible to misinformation. This pattern is consistent with the possibility that these subjects were more concerned with the disease and therefore more likely to vaccinate, regardless of the process through which the vaccine was brought to market.

We also observe that skepticism toward vaccines in general does not correlate perfectly with skepticism toward the COVID-19 vaccine. Therefore, it is important not to conflate people who are wary of the COVID-19 vaccine and those who are anti-vaccination, as even medically informed individuals may be hesitant because of the speed at which the COVID-19 vaccine was developed. For example, older people are more likely to believe vaccines are safe but less willing to receive the COVID-19 vaccine in our survey, perhaps following the high rates of vaccine skepticism among medical staff expressing concerns regarding the safety of a rapidly-developed vaccine 2 . This inverse relationship between age and willingness to vaccinate is also surprising. Most opinion surveys find older adults are more likely to vaccinate than younger adults 37 . However, most of these survey questions ask about willingness to take a generic vaccine. Two prior studies, both recruiting subjects from the Lucid platform and employing conjoint experiments to examine the effects of vaccine attributes on public willingness to vaccinate, also find greater vaccine hesitancy among older Americans 6 , 7 . Future research could explore whether these divergent results are a product of the characteristics of the sample or of the methodological design in which subjects have much more information about the vaccines when indicating their vaccination preferences.

An important limitation of our study is that it necessarily offers a snapshot in time, specifically prior to both the election and vaccine roll-out. We recommend further study to understand more how vaccine perceptions evolve both in terms of the perceived political ownership of the vaccine—now that President Biden is in office—and as evidence has emerged from the millions of people who have been vaccinated. Similarly, researchers should consider analyzing vaccine preferences in the context of online vaccine controversies that have been framed in terms of patient autonomy and right to refuse 38 , 39 . Vaccination mandates may evoke feelings of powerlessness, which may be exacerbated by misinformation about the vaccines themselves. Further, researchers should more fully consider how individual attributes such as political ideology and race intersect with vaccine preferences. Our study registered increased vaccine hesitancy among Blacks, but did not find that skepticism was directly related to misinformation. Perceptions and realities of race-based maltreatment could also be moderating factors worth exploring in future analyses 40 , 41 .

Overall, we found that the most important factor influencing vaccine preferences is vaccine efficacy, consistent with a number of previous studies about attitudes toward a range of vaccines 6 , 42 , 43 . Other attributes offer potential cautionary flags and opportunities for public outreach. The prospect of a 50% likelihood of mild side effects, consistent with the evidence about current COVID-19 vaccines being employed, dampens likelihood of uptake. Public health officials should reinforce the relatively mild nature of the side effects—pain at the injection site and fatigue being the most common 44 —and especially the temporary nature of these effects to assuage public concerns. Additionally, in considering policy interventions, public health authorities should recognize that a $20 co-pay will likely discourage uptake while financial incentives are unlikely to have a significant positive effect. Lastly, belief in misinformation about COVID-19 does not appear to be a strong predictor of vaccine hesitancy; belief in misinformation and willingness to vaccinate were positively correlated in our data. Future research should explore the possibility that exposure to and belief in misinformation is correlated with other factors associated with vaccine preferences.

Survey sample and procedures

This study was approved by the Cornell Institutional Review Board for Human Participant Research (protocol ID 2004009569). We conducted the study on October 29–30, 2020, prior to vaccine approval, which means we captured sentiments prospectively rather than based on information emerging from an ongoing vaccination campaign. We recruited a sample of 1096 adult Americans via the Lucid platform, which uses quota sampling to produce samples matched to the demographics of the U.S. population on age, gender, ethnicity, and geographic region. Research has shown that experimental effects observed in Lucid samples largely mirror those found using probability-based samples 45 . Supplementary Table 1 presents the demographics of our sample and comparisons to both the U.S. Census American Community Survey and the demographics of prominent social science surveys.

After providing informed consent on the first screen of the online survey, participants turned to a choice-based conjoint experiment that varied five attributes of the COVID-19 vaccine. Conjoint analyses are often used in marketing to research how different aspects of a product or service affect consumer choice. We build on public health studies that have analyzed the influence of vaccine characteristics on uptake within the population 42 , 46 .

Conjoint experiment

We first designed a choice-based conjoint experiment that allowed us to evaluate the relative influence of a range of vaccine attributes on respondents’ vaccine preferences. We examined five attributes summarized in Table 2 . Past research has shown that the first two attributes, efficacy and the incidence of side effects, are significant drivers of public preferences on a range of vaccines 47 , 48 , 49 , including COVID-19 6 , 7 , 13 , 50 . In this study, we increased the expected incidence of minor side effects from previous research 6 to reflect emerging evidence from Phase III trials. The third attribute, whether the vaccine received full FDA approval or an EUA, examines whether the speed of the approval process affects public vaccination preferences 6 . The fourth attribute, the manufacturer of the vaccine, allows us to examine whether the highly public pause in the AstraZeneca trial following an adverse event, and the significant differences in brand familiarity between smaller and less broadly known companies like Moderna and household name Johnson & Johnson affects public willingness to vaccinate. The fifth attribute examines the influence of a policy tool—offsetting the costs of vaccination or even incentivizing it financially—on public willingness to vaccinate.

Attribute levels and attribute order were randomly assigned across participants. A sample choice set is presented in Supplementary Fig. 1 . After viewing each profile individually, subjects were asked: “If you had to choose, would you choose to get this vaccine, or would you choose not to be vaccinated?” Subjects then made a binary choice, responding either that they “would choose to get this vaccine” or that they “would choose not to be vaccinated.” This is the dependent variable for the regression analyses in Table 3 . After making a binary choice to take the vaccine or not be vaccinated, we also asked subjects “how likely or unlikely would you be to get the vaccine described above?” Subjects indicated their vaccination preference on a seven-point scale ranging from “extremely likely” to “extremely unlikely.” Additional analyses using this ordinal dependent variable reported in Supplementary Table 3 yield substantively similar results to those presented in Table 3 .

To determine the effect of each attribute-level on willingness to vaccinate, we followed Hainmueller, Hopkins, and Yamamoto and employed an ordinary least squares (OLS) regression with standard errors clustered on respondent to estimate the average marginal component effects (AMCEs) for each attribute 51 . The AMCE represents the average difference in a subject choosing a vaccine when comparing two different attribute values—for example, 50% efficacy vs. 90% efficacy—averaged across all possible combinations of the other vaccine attribute values. The AMCEs are nonparametrically identified under a modest set of assumptions, many of which (such as randomization of attribute levels) are guaranteed by design. Model 1 in Table 3 estimates the AMCEs for each attribute. These AMCEs are illustrated in Fig. 1 .

Analyzing additional correlates of vaccine acceptance

To explore the association between respondents’ embrace of misinformation about COVID-19 treatments and vaccination willingness, the survey included an additional question battery. To measure the extent of belief in COVID-19 misinformation, we constructed a list of both accurate and inaccurate headlines about the coronavirus. We focused on treatments, relying on the World Health Organization’s list of myths, such as “Hand dryers are effective in killing the new coronavirus” and true headlines such as “Avoiding shaking hands can help limit the spread of the new coronavirus 52 .” Complete wording for each claim is provided in Supplementary Appendix 1 . Individuals read three true headlines and five myths, and then responded whether they believed each headline was true or false, or whether they were unsure. We coded responses to each headline so that an incorrect accuracy assessment yielded a 1; a correct accuracy assessment a -1; and a response of unsure was coded as 0. From this, we created an additive index of belief in misinformation that ranged from -8 to 8. The distribution of the misinformation index is presented in Supplementary Fig. 2 . A possible limitation of this measure is that because the survey was conducted online, some individuals could have searched for the answers to the questions before responding. However, the median misinformation index score for subjects in the top quartile in terms of time spent taking the survey was identical to the median for all other respondents. This may suggest that systematic searching for correct answers is unlikely.

To ensure that any association observed between belief in misinformation and willingness to vaccinate is not an artifact of how we operationalized susceptibility to misinformation, we also constructed two alternate measures of belief in misinformation. These measures are described in detail in the Supplementary Information (see Supplementary Figs. 3 and 4 ). Additional regression analyses using these alternate measures of misinformation beliefs yield substantively similar results (see Supplementary Table 4 ). Additional analyses examining whether belief in misinformation moderates the effect of efficacy and an FDA EUA on vaccine acceptance are presented in Supplementary Fig. 6 .

Finally, model 2 of Table 3 includes a range of additional control variables. Following past research, it includes a number of demographic variables, including indicator variables identifying subjects who identify as Democrats or Republicans; an indicator variable identifying females; a continuous variable measuring age (alternate analyses employing a categorical variable yield substantively similar results); an eight-point measure of educational attainment; and indicator variables identifying subjects who self-identify as Black or Latinx. Following previous research 6 , the model also controlled for three additional factors often associated with willingness to vaccinate: an indicator variable identifying whether each subject had health insurance; a variable measuring past frequency of influenza vaccination on a four-point scale ranging from “never” to “every year”; beliefs about the general safety of vaccines measured on a four-point scale ranging from “not at all safe” to “extremely safe”; and a measure of attitudes toward the pharmaceutical industry ranging from “very positive” to “very negative.”

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

All data and statistical code to reproduce the tables and figures in the manuscript and Supplementary Information are published at the Harvard Dataverse via this link: 10.7910/DVN/ZYU6CO.

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Acknowledgements

S.K. and D.K. would like to thank the Cornell Atkinson Center for Sustainability for financial support.

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Sarah Kreps & Douglas L. Kriner

Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA

Nabarun Dasgupta

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John S. Brownstein

Computational Epidemiology Lab, Boston Children’s Hospital, Boston, MA, USA

Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

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S.K. and D.K. designed the experiment/survey instrument and conducted the statistical analysis. S.K., N.D., J.B., Y.H., and D.K. all contributed to the conceptual design of the research and to the writing of the paper.

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Correspondence to Douglas L. Kriner .

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Kreps, S., Dasgupta, N., Brownstein, J.S. et al. Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation. npj Vaccines 6 , 73 (2021). https://doi.org/10.1038/s41541-021-00335-2

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The Anti-Vax Movement Isn’t Going Away. We Must Adapt to It

Pattern of syringes with a vaccine on yellow background. Concept of medical treatment or vaccination.

A merica’s immunization policies are facing a bleak future. Political polarization about vaccine policies is likely to cause outbreaks of previously controlled infectious diseases. If we cannot prevent these disasters, we should pivot our focus towards managing them.

Resistance to vaccination is not a new problem , but the COVID-19 pandemic exacerbated it. It should be clear by now that neither persuasion nor coercion is sufficient to change the minds or the behavior of people who are determined to refuse vaccines. Education and research cannot defeat coordinated misinformation. And government efforts—at federal, state, and local levels—are stymied by a combination of inadequate power, insufficient political will, and a lack of perceived legitimacy by vaccine refusers. One of America’s core lessons from the COVID-19 pandemic is that a heavy-handed response to vaccine refusal can make things worse.

Many U.S. states have ended their COVID-19 vaccine mandates. But America’s childhood vaccine mandates for school entry are also vulnerable. As researchers of vaccination social science, ethics, and policy, we have sometimes encountered an optimistic view that immunization in America will soon snap back to a pre-pandemic “normal.” But this hope ignores the cracks that were already present in America’s immunization social order before the pandemic, cracks that COVID-19 only widened. State-based conflicts over school enrollment vaccine mandates became increasingly political and contentious during the 2010s. Continued political polarization about vaccine mandates is likely to reduce immunization rates and precipitate the return of previously controlled diseases. That’s why it’s time to adapt to vaccine refusal and prepare to manage these outbreaks, rather than hope they can be prevented.

More From TIME

All American states require vaccines for school enrollment, but most permit parents to opt out of vaccinating by obtaining a nonmedical exemption. Nonmedical exemptions may be available based upon religious or personal beliefs, depending on the state. Attempts to change these exemption policies have emerged as polarizing flashpoints for Democrats and Republicans. In 2015, California took the unprecedented first step of eliminating nonmedical exemptions to its vaccine requirements to reduce rates of vaccine refusal. Since 2015, Democrats, major physician organizations like the American Medical Association, and pro-vaccine parent activists have tried to remove nonmedical exemptions in many other states.

Democratic lawmakers have now eliminated nonmedical exemptions in California, New York , Washington State (for measles vaccine), Maine, and Connecticut. New national organizations, like the Safe Families Coalition, are pushing for similar changes in many other states. Where Democrats organized to abolish vaccine opt-outs, Republicans fought to protect or expand them. The fight continues, as Republicans look for ways to further weaken childhood vaccine mandates. A case in point: on 17 April this year a Republican judge in Mississippi reinstated a religious exemption to that state’s vaccine mandates that courts had overturned in 1979.

Attempts to scrap nonmedical exemptions inject new kinds of coercion into a fracturing immunization social order. This intensifies the politicization of school vaccine mandates and erodes public support for these critical policies. Conflicts about COVID-19 pandemic control measures were not outliers, but instead signs of a crumbling immunization consensus. The bitter truth is that nonpartisan vaccine policy was dead before the world had heard of COVID-19.

Removing nonmedical vaccine exemptions will not overcome vaccine refusal or prevent outbreaks. Only in states where Democrats control all levers of state power can such bills pass, given unified Republican opposition. These policies can deliver local increases in immunization rates. However, even in Democrat-led states, enforcement is likely to be uneven at best, and to be worse in communities where immunization rates are already low. For example, the leadership of private schools is unlikely to enforce strict vaccine mandates that they believe are inconsistent with their values, or that will cause them to lose substantial tuition revenue.

Local successes in Democrat-led states are likely to be overshadowed by immunization policy failures in Republican-led states. In the current political climate, Democrats own the issue of eliminating nonmedical exemptions. In contrast, Republicans have emerged as champions of preserving and expanding them, or even of eliminating mandates altogether. Republicans will weaken existing mandates in the states that they control, and this will lead to lower immunization rates in those places, and perhaps beyond, as vaccination policy embeds more deeply in America’s culture wars.

Read More : How the Anti-Vax Movement Is Taking Over the Right

The implications are significant. The near future likely portends escalating disputes about immunization policy, lower vaccination rates, and a resurgence of diseases once tamed by vaccines. Our response should be to adapt to widespread vaccine refusal rather than to nurture naïve hopes of overcoming it. If we can’t prevent outbreaks, we will need to learn to live with them.

Public health institutions have a crucial role in this shift towards adaptation. They must enhance their capacities, extending COVID-19 surveillance techniques like sewage sampling to encompass other diseases. This method helped New York State Department of Health detect polio virus in wastewater samples in 2022. There is also an urgent need to train medical professionals in diagnosing and treating vaccine-preventable diseases that were once thought to be controlled or eliminated. And governments should prepare to rapidly deploy mobile clinics and response teams to areas hit by outbreaks.

Community-level planning is essential for adapting to more frequent outbreaks in schools and other institutions. Strategies should include the ability to move between in-person and online schooling and the provision of daycare services for essential workers’ children, especially to safeguard the capacities of health care institutions.

Private institutions, from businesses to cultural organizations, must plan their own disease control measures. These may include private vaccine mandates, although state legislatures may outlaw such policies, as some did for COVID-19. However, businesses will be able to keep the assembly lines going and the service counters staffed only if they can reduce the impact of disease on their workforce.

Given the prospect of uneven state and institutional support for vaccination, individuals and families must also brace themselves for more frequent disease outbreaks. Some new parents already prevent unvaccinated relatives from visiting their babies. Families will need to consider extending these forms of private immunization governance when states can no longer protect them.

We are not talking about “giving up.” Governments should continue to promote vaccine acceptance and enforce vaccine mandates. The right kinds of outreach can sway some people who are on the fence about vaccinating. But these efforts alone are unlikely to be sufficient to prevent future outbreaks. Adapting to the times we live in is the only way forward.

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The Morning Newsletter

Vaccine Persuasion

Many vaccine skeptics have changed their minds.

By David Leonhardt

When the Kaiser Family Foundation conducted a poll at the start of the year and asked American adults whether they planned to get vaccinated, 23 percent said no.

But a significant portion of that group — about one quarter of it — has since decided to receive a shot. The Kaiser pollsters recently followed up and asked these converts what led them to change their minds . The answers are important, because they offer insight into how the millions of still unvaccinated Americans might be persuaded to get shots, too.

First, a little background: A few weeks ago, it seemed plausible that Covid-19 might be in permanent retreat, at least in communities with high vaccination rates. But the Delta variant has changed the situation. The number of cases is rising in all 50 states .

Although vaccinated people remain almost guaranteed to avoid serious symptoms, Delta has put the unvaccinated at greater risk of contracting the virus — and, by extension, of hospitalization and death. The Covid death rate in recent days has been significantly higher in states with low vaccination rates than in those with higher rates:

(For more detailed state-level charts, see this piece by my colleagues Lauren Leatherby and Amy Schoenfeld Walker. The same pattern is evident at the county level, as the health policy expert Charles Gaba has been explaining on Twitter.)

Nationwide, more than 99 percent of recent deaths have occurred among unvaccinated people, and more than 97 percent of recent hospitalizations have occurred among the unvaccinated, according to the C.D.C. “Look,” President Biden said on Friday, “the only pandemic we have is among the unvaccinated.”

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How do vaccines work?

This article is part of a series of explainers on vaccine development and distribution. Learn more about vaccines – from how they work and how they’re made to ensuring safety and equitable access – in WHO’s Vaccines Explained series .

Germs are all around us, both in our environment and in our bodies. When a person is susceptible and they encounter a harmful organism, it can lead to disease and death.

The body has many ways of defending itself against pathogens (disease-causing organisms). Skin, mucus, and cilia (microscopic hairs that move debris away from the lungs) all work as physical barriers to prevent pathogens from entering the body in the first place.

When a pathogen does infect the body, our body’s defences, called the immune system, are triggered and the pathogen is attacked and destroyed or overcome.

The body's natural response

A pathogen is a bacterium, virus, parasite or fungus that can cause disease within the body. Each pathogen is made up of several subparts, usually unique to that specific pathogen and the disease it causes. The subpart of a pathogen that causes the formation of antibodies is called an antigen. The antibodies produced in response to the pathogen’s antigen are an important part of the immune system. You can consider antibodies as the soldiers in your body’s defense system. Each antibody, or soldier, in our system is trained to recognize one specific antigen. We have thousands of different antibodies in our bodies. When the human body is exposed to an antigen for the first time, it takes time for the immune system to respond and produce antibodies specific to that antigen.

In the meantime, the person is susceptible to becoming ill.

Once the antigen-specific antibodies are produced, they work with the rest of the immune system to destroy the pathogen and stop the disease. Antibodies to one pathogen generally don’t protect against another pathogen except when two pathogens are very similar to each other, like cousins. Once the body produces antibodies in its primary response to an antigen, it also creates antibody-producing memory cells, which remain alive even after the pathogen is defeated by the antibodies. If the body is exposed to the same pathogen more than once, the antibody response is much faster and more effective than the first time around because the memory cells are at the ready to pump out antibodies against that antigen.

This means that if the person is exposed to the dangerous pathogen in the future, their immune system will be able to respond immediately, protecting against disease.

Vaccines Antibody illustration 01_29 Oct

How vaccines help

Vaccines contain weakened or inactive parts of a particular organism (antigen) that triggers an immune response within the body. Newer vaccines contain the blueprint for producing antigens rather than the antigen itself. Regardless of whether the vaccine is made up of the antigen itself or the blueprint so that the body will produce the antigen, this weakened version will not cause the disease in the person receiving the vaccine, but it will prompt their immune system to respond much as it would have on its first reaction to the actual pathogen.

Vaccines Antibody illustration 02_29 Oct

Some vaccines require multiple doses, given weeks or months apart. This is sometimes needed to allow for the production of long-lived antibodies and development of memory cells. In this way, the body is trained to fight the specific disease-causing organism, building up memory of the pathogen so as to rapidly fight it if and when exposed in the future.

Herd immunity

When someone is vaccinated, they are very likely to be protected against the targeted disease. But not everyone can be vaccinated. People with underlying health conditions that weaken their immune systems (such as cancer or HIV) or who have severe allergies to some vaccine components may not be able to get vaccinated with certain vaccines. These people can still be protected if they live in and amongst others who are vaccinated. When a lot of people in a community are vaccinated the pathogen has a hard time circulating because most of the people it encounters are immune. So the more that others are vaccinated, the less likely people who are unable to be protected by vaccines are at risk of even being exposed to the harmful pathogens. This is called herd immunity.

This is especially important for those people who not only can’t be vaccinated but may be more susceptible to the diseases we vaccinate against. No single vaccine provides 100% protection, and herd immunity does not provide full protection to those who cannot safely be vaccinated. But with herd immunity, these people will have substantial protection, thanks to those around them being vaccinated.

Vaccinating not only protects yourself, but also protects those in the community who are unable to be vaccinated. If you are able to, get vaccinated.

Throughout history, humans have successfully developed vaccines for a number of life-threatening diseases, including meningitis, tetanus, measles and wild poliovirus.

In the early 1900s, polio was a worldwide disease, paralysing hundreds of thousands of people every year. By 1950, two effective vaccines against the disease had been developed. But vaccination in some parts of the world was still not common enough to stop the spread of polio, particularly in Africa. In the 1980s, a united worldwide effort to eradicate polio from the planet began. Over many years and several decades, polio vaccination, using routine immunization visits and mass vaccination campaigns, has taken place in all continents. Millions of people, mostly children, have been vaccinated and in August 2020, the African continent was certified wild poliovirus free, joining all other parts of the world except Pakistan and Afghanistan, where polio has not yet been eradicated.

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COMMENTS

Vaccines and immunization: What is vaccination?
The vaccine is therefore a safe and clever way to produce an immune response in the body, without causing illness. Our immune systems are designed to remember. Once exposed to one or more doses of a vaccine, we typically remain protected against a disease for years, decades or even a lifetime. This is what makes vaccines so effective.
The Importance of Vaccinations
Vaccines prevent the spread of contagious, dangerous, and deadly diseases. These include measles, polio, mumps, chicken pox, whooping cough, diphtheria, HPV, and COVID-19. The first vaccine discovered was the smallpox vaccine. Smallpox was a deadly illness. It killed 300 million to 500 million people around the world in the last century.
The Importance of Vaccination in the Context of the COVID-19 Pandemic
The vaccines BNT162b2 (brand name Comirnaty), mRNA-1273 (brand name Spikevax), CoronaVac, BBIBP-CorV, AZD-1222 (brand name Vaxzevria or Covishield), and Ad26.COV2-S (brand name Janssen COVID-19 Vaccine) are the most widely used around the world for COVID-19 prophylaxis, since all of them use the S protein as the main activator of the immune ...
Vaccination Essay
Vaccination. production of antibodies and provide immunity against one or several diseases, prepared from the causative agent of a disease, its products, or a synthetic substitute, treated to act as an antigen without inducing the disease. What is the purpose of Vaccinations? To produce immunity.
Vaccines and immunization
Vaccines and immunization are vital for preventing and controlling many diseases that threaten global health. Learn more about the benefits, safety and challenges of vaccination from the World Health Organization, the leading authority on health issues. Explore the latest information on COVID-19 vaccines, polio eradication, maternal and child health, and more.
How to talk about vaccines
1. Listen with empathy. Start by listening with empathy to those who have questions around vaccination. Don't dismiss them, and acknowledge how they're feeling (without necessarily agreeing, for example "it's okay to have questions, or want more information before getting a vaccine"). 2. Ask open-ended questions.
Why vaccines matter: understanding the broader health, economic, and
Economic, equity, and global health benefits of vaccines. Vaccines can have several economic benefits. 3, 10 One of the most discernible benefits is averted medical expenditure. By preventing an episode of the disease through a vaccine, the economic costs of treatment, such as physician fees, drugs and hospitalization expenses, and associated travel costs and wage loss of caregivers could be ...
Importance Of Vaccination Essay
Importance Of Vaccination Essay. A vaccination is a treatment that increases immunity to a specific illness. It is a biologically produced item that includes typical components resembling a disease-causing bacteria, generated from weak or dead versions of the microbe. It aids in immune system stimulation, identifies invasive bacteria as foreign ...
Covid-19 Vaccines
In the United States, four vaccines have been authorized for either full approval or emergency use: the mRNA vaccines BNT162b2 and mRNA-1273, the adenovirus vector-based vaccine Ad26.COV2.S, and ...
Vaccine Hesitancy Is About Trust and Class
Guest Essay. Behind Low Vaccination Rates Lurks a More Profound Social Weakness. Dec. 3, 2021. ... With persistent vaccine avoidance and unequal access to vaccines, unvaccinated pockets could act ...
PDF Vaccinations: Weighing the Risks and Benefits
vaccine-induced passive immunity, fears of harm secondary to vaccination loom. In the 21st Century, many people are unaware of diseases that still occur in undeveloped countries due to herd immunity through a majority vaccinated pop - ulation. The diseases, however, are only a plane ride away. Due to globalization, vaccine preventable diseases ...
Vaccine Innovations
Vaccination is a powerful method of disease prevention that is relevant to people of all ages and in all countries, as the Covid-19 pandemic illustrates. Vaccination can improve people's chances ...
PDF Should vaccines be compulsory?
Hence, from this ethical justification of vaccination the call for compulsory vaccination is strengthened as a mode for agents to realise and achieve their moral obligation to vaccinate. 6 Andre, F E et al. 2008. ""Vaccination greatly reduces disease, disability, death and inequity worldwide."." Bulletin of the World Health Organization 140 ...
The COVID-19 Vaccination Challenge: Lessons From History
The COVID-19 pandemic has highlighted the challenges of not only developing vaccines, but also making sure everyone who should get them does. Though more than a dozen COVID-19 vaccines are now ...
Getting the COVID-19 Vaccine
Because of the urgent need for a COVID-19 vaccine, initial clinical trials of vaccine candidates were performed with the shortest possible duration between doses. Therefore an interval of 21-28 days (3-4 weeks) between doses is recommended by WHO. Depending on the vaccine, the interval may be extended for up to 42 days - or even up to 12 ...
Why Childhood Immunizations Are Important
Four vaccinations for pneumococcal disease, a common cause of ear infections and pneumonia. From age 4 to 6, your child will need booster shots for DPT, IPV, MMR, and chickenpox. Children should also start receiving a yearly flu shot after age 6 months. A vaccination for hepatitis A is recommended for all children.
Public attitudes toward COVID-19 vaccination: The role of vaccine
While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still ...
Opinion
This guest essay has been updated to reflect news developments. Vaccines to protect young children from Covid-19 are likely soon on their way.The Food and Drug Administration has authorized the ...
Vaccine Mandates Are Needed in the U.S.
Guest Essay. Vaccine Mandates Are Coming. Good. June 28, 2021. Smallpox vaccinations in the 1960s. ... The mRNA vaccines, made by Moderna and Pfizer-BioNTech, will likely get full approval for use ...
A Brief History of Vaccination
In 1872, despite enduring a stroke and the death of 2 of his daughters to typhoid, Louis Pasteur creates the first laboratory-produced vaccine: the vaccine for fowl cholera in chickens. In 1885, Louis Pasteur successfully prevents rabies through post-exposure vaccination. The treatment is controversial. Pasteur has unsuccessfully attempted to ...
The Anti-Vax Movement Isn't Going Away. We Must Adapt to It
One of America's core lessons from the COVID-19 pandemic is that a heavy-handed response to vaccine refusal can make things worse. Many U.S. states have ended their COVID-19 vaccine mandates ...
Vaccine Persuasion
Caroline Gutman for The New York Times. 2. Hearing pro-vaccine messages from doctors, friends and relatives. For many people who got vaccinated, messages from politicians, national experts and the ...
How do vaccines work?
Vaccines contain weakened or inactive parts of a particular organism (antigen) that triggers an immune response within the body. Newer vaccines contain the blueprint for producing antigens rather than the antigen itself. Regardless of whether the vaccine is made up of the antigen itself or the blueprint so that the body will produce the antigen ...