Vaccine refusal and the endgame: walking the last mile first. Público

Abstract

As multiple papers within this special issue illustrate, the dynamics of disease eradication are different from disease control. When it comes to disease eradication, "the last mile is longest". For social and ecological reasons such as vaccine refusal, further ending incidence of a disease when it has reached low levels is frequently complex. Issues of noncompliance within a target population often influence the outcome of disease eradication efforts. Past eradication efforts confronted such obstacles towards the tail end of the campaign, when disease incidence was lowest. This article provides a comparison of noncompliance within polio, measles and smallpox campaigns, demonstrating the tendency of vaccine refusal to rise as disease incidence falls. In order to overcome one of the most intractable challenges to eradication, future disease eradication efforts must prioritize vaccine refusal from the start, i.e. "walk the last mile first".

Table of Contents

Table of Contents

Introduction........... 4

The First Eradication: Smallpox............ 4

Vaccines are Indispensable to Global Disease Eradication............ 4

Vaccine Refusal is a Significant Obstacle to Disease Eradication............ 5

History of Vaccine Refusal........... 5

Smallpox Eradication: Differences, Similarities, and Reasons for Success........... 6

Vaccine Preventable Disease Awareness in Non-Endemic Countries........... 7

The Role of Emotion and Experience in Shaping Cultural Memory............ 7

The Role of Media Reporting in VPD Awareness and Risk Communication............ 7

Risk Perception and Vaccine Decision-Making............ 7

Vaccine Refusal and the Polio Eradication Campaign........... 8

Perceived Necessity and Demand for Social Amenities............ 8

Religious and Cultural Objections............ 9

Passive Refusal and 'Missing Children'............ 9

Vaccine Refusal and the Measles & Rubella Initiative........... 10

Concerns About Vaccine Safety............ 10

Religious and Moral Concerns............ 10

Specific Challenges of Disease Eradication........... 10

Control versus Eradication............ 10

Walking the Last Mile First: Prioritizing Vaccine Refusal in 21^st Century Disease Eradication Efforts........... 11

Strategies to Address Vaccine Refusal in Eradication Campaigns........... 12

Social Mobilization............ 12

Effective Communication with Public Figures............ 12

Empowering Health Professionals to Address Refusals............ 12

Monitoring and Surveillance............ 12

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Education Health Sciences, General Health Sciences, Immunology
Palabra Clave	polio vaccine refusal disease eradication measles
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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