Transforming public health through vaccinations

Vaccinations have profoundly transformed public health, marking one of the most significant advancements in medical science. From Edward Jenner’s pioneering work in the late 18th century to the development of modern vaccines, immunization has drastically reduced the incidence of many diseases and saved millions of lives.¹

In 1796, Edward Jenner developed the smallpox vaccine, successfully combating a deadly and highly contagious disease. This earliest use of variolation not only introduced the concept of vaccination but also led to the eventual eradication of smallpox in 1980, making it the first and only human disease to be eradicated. Since then, vaccines for diseases such as rabies, diphtheria, tetanus, polio, measles, mumps, and rubella have been developed. More recently, vaccines for hepatitis B (1981), human papillomavirus (2006), and COVID-19 (2020-2021) have made transformative impacts on global health.¹

However, in recent years and particularly since the COVID-19 pandemic, vaccination rates have waned and vaccine hesitancy has risen.^1,2 The spread of false information through social media platforms has fueled skepticism and hesitancy, and the politicization of vaccines, particularly those for COVID-19, has polarized opinions and affected vaccine acceptance across infectious disease types, racial and ethnic groups, and education levels. This trend has significant implications for public health strategies, but the drivers of vaccine hesitancy are complex and diverse across sociocultural groups, suggesting that understanding and reversing these trends will take diverse groups and efforts.^2,3

Pregnancy is a critical time for vaccination to protect both the mother and the neonate before a robust immune system is fully developed. The Advisory Committee on Immunization Practices (ACIP) recommends that all women who are or might be pregnant during the influenza season receive the influenza vaccine. Additionally, the ACIP advises administering Tdap vaccines during pregnancy between 27 and 36 weeks to maximize transfer of maternal IgG to the fetus and prevent neonatal whooping cough (pertussis), a potentially deadly disease. Respiratory syncytial virus (RSV) vaccination is now available and recommended for pregnant individuals at 32 and 36 weeks of gestation from September through January, when neonates are most vulnerable to RSV, which is the leading cause of infant hospitalization in the United States. Finally, an updated COVID-19 vaccine is now available and recommended for all people 6 months or older (inclusive of pregnant individuals) to target the latest circulating variants.^4,5

Thus, vaccines are used for both maternal and neonatal protection. COVID-19 and influenza vaccinations are crucial to reduce pulmonary infection that can lead to pneumonia, maternal death, and preterm birth. Tdap and RSV vaccines are also essential for protecting the fetus and newborn in the most vulnerable neonatal period.⁵ Despite these recommendations, vaccine hesitancy has notably increased among pregnant women. Vaccination rates for influenza in pregnant women have declined by 32% since 2020 (Figure 1).⁶ The RSV vaccine, approved for use in pregnant women in 2023, has seen higher uptake compared with the COVID-19 vaccine (Figure 2).⁷ Tdap vaccination rates are higher than influenza vaccination rates, likely due to its targeted protection for infants.

The World Health Organization’s 3 C’s model of vaccine hesitancy (confidence, convenience, and complacency) can be used to frame factors contributing to decreasing vaccination rates. In underdeveloped countries, issues of cost and access (convenience) are primary barriers to vaccination program success. In the developed world, confidence and complacency play a significant role, with convenience a barrier for underserved populations and areas. To achieve the Healthy People 2030 vaccination goals, much research will be needed to understand these complex factors and then demonstrate effectiveness of interventions tailored to populations most at risk.

Combating misinformation is one area that is crucial for improving vaccine uptake. As primary care providers for women, our role is vital to offer accurate, evidence-based information about the benefits of vaccination and equip ourselves with strategies to counter misinformation and myths about vaccines. With the upcoming influenza and RSV seasons, continued COVID-19 surges, and climbing neonatal pertussis numbers, now is the time to be proactive in efforts to boost vaccine confidence for all our patients.

References

1. Gollust SE, Nagler RH, Fowler EF. The Emergence of COVID-19 in the US: A Public Health and Political Communication Crisis. J Health Polit Policy Law. 2020;45(6):967-981. doi:10.1215/03616878-8641506
2. Latkin CA, Dayton L, Yi G, Colon B, Kong X. Mask usage, social distancing, racial, and gender correlates of COVID-19 vaccine intentions among adults in the US. PLoS One. 2021;16(2):e0246970. 2021. doi:10.1371/journal.pone.0246970
3. Paltiel AD, Zheng A, Zheng A. Assessment of SARS-CoV-2 vaccination trends and hesitancy in the United States.” JAMA Network Open. 2022.
4. Kharbanda EO, Vazquez-Benitez G. Trends in influenza vaccination during pregnancy and associated factors. American Journal of Obstetrics and Gynecology. 2023.
5. Bianchi SM, et al. Tdap vaccination in pregnancy: Current recommendations and practices.” Journal of Obstetrics and Gynecology. 2021.
6. Flu vaccination coverage update for the 2023-2024 season. Centers for Disease Control and Prevention. February 23, 2024. Accessed September 3, 2024. https://www.cdc.gov/flu/spotlights/2023-2024/vaccination-coverage-update.htm
7. Weekly respiratory syncytial virus (Rsv) vaccination coverage among pregnant persons by race and ethnicity. Centers for Disease Control and Prevention. Accessed September 3, 2024. https://data.cdc.gov/Pregnancy-Vaccination/Weekly-Respiratory-Syncytial-Virus-RSV-Vaccination/g4jn-64pd/about_data