Why is distrust in vaccines growing?

Covid vaccines have saved lives. Many lives.

Research by the World Health Organization (WHO) now shows that the number in the UK is as high as 475.000, and many more were spared hospital treatment or ventilators.

Vaccines were a "scientific miracle," we were told back then, our best hope for returning our lives to normal after months of quarantine and restrictions.

But something happened in the years that followed.

Research shows that trust in all types of vaccines has taken a significant hit.

"That's the great paradox of the pandemic," says Dr Simon Williams, a public health researcher at Swansea University.

"One of the most successful innovations in public health history, the rapid development of Covid vaccines, has actually had the effect of reducing public confidence in vaccination."

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Around 70% of adults in the UK said vaccines were safe and effective in 2023, a sharp drop from 90% in 2018, according to research by the Vaccine Confidence Project, led by the London School of Hygiene and Tropical Medicine (LSHTM).

This is very much part of a global trend, according to which 52 out of 55 countries surveyed saw a decline in trust in vaccines compared to 2019.

And regular surveys, conducted by JuGov, show that adults are increasingly likely to say that vaccines have harmful side effects that are not being disclosed to the public.

The percentage saying that statement is "probably" or "definitely" true jumped to 30 percent in 2024, up from 19 percent in 2019.

At the same time, childhood vaccination rates have fallen even further below recommended levels in the last five years, continuing a long-standing trend.

"Vaccines are always our best defense against infectious, communicable diseases," adds Dr. Williams.

"Even a small drop in the percentage of children vaccinated can make a big difference."

So why has there been a rise in distrust of vaccines, and can anything be done to change it?

A sudden change in attitudes

During the long-running Covid inquiry, there is already talk of pandemic preparedness planning and its impact on the National Health Service in England (NHS).

However, this week, the inquiry began hearings on vaccination across the UK - from the administration of vaccines, to their safety, to the way they are presented to the public.

Dr Helen Wall, a GP from Bolton, has seen first-hand the change in attitudes towards vaccines during the pandemic.

In May 2021, her city came into the spotlight nationwide - the number of infections more than quadrupled within three weeks due to the emergence of a new delta strain of the coronavirus.

Mass vaccination was ordered in mobile units led by military medics.

Dr. Wall led the mass vaccination drive, as clinical director of the local NHS Commissioning Board.

"People were coming out and making tea and coffee for those standing in lines," she says.

"There was a really great sense of solidarity."

But sometime in mid-2021, she noticed a sudden shift in people's attitudes.

"Patients would start telling me, 'Why should we trust you, you work for them, they pay you, you're part of the government.'"

"We quickly went from being lifesavers to just another cog in a system that no one trusted in certain areas."

Not long after, protesters began appearing outside local clinics with placards trying to convince people not to get vaccinated, and Dr. Wall says she began receiving death threats.

Almost four years later, she says: "I think Covid has only accentuated the trust issues that already existed and reinforced the doubts and concerns that people had."

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From smallpox to MMR

But the distrust in vaccines certainly didn't start with this pandemic.

The current wave of skepticism is just the latest revival of a heated debate that dates back to vaccination in 1796, when Edward Jenner developed a vaccine against smallpox.

A large number of people protested in Leicester in the 1890s against compulsory smallpox vaccination.

Then in the 1970s, diphtheria, tetanus, and whooping cough vaccines were linked to brain injuries in children, before they were later declared safe.

In 1998, British doctor Andrew Wakefield published a now-infamous study that falsely claimed that the combined measles, mumps, and rubella (MMR) vaccine was responsible for increased rates of autism in children.

Wakefield's research, described as the most damaging scientific fraud of all time, has since been thoroughly refuted, and he has been struck off the medical register.

But the damage was already done.

The number of measles cases in England and Wales jumped to 2012 in 2.032 from just 56 in 1998.

It took more than a decade for MMR vaccination to return to near normal, and that debunked link to autism is still mentioned today.

It was the first serious medical scandal of the internet age, and a foreshadowing of what was to come.

The era of the internet and disinformation

Since the emergence of social media in the early 2000s, with sites like Friendstar and MySpace, there has been growing concern about the spread of health-related rumors and misinformation.

Research by the UK Health Safety Agency (UKHSA) showed that 20 percent of parents surveyed in 2023 said they had come across some information online that made them worried about vaccines, a sharp jump from just six percent the previous year.

As social networks have become an established part of the media space over time, the risk of disinformation has also changed.

"Now someone in one corner of the world can post something and suddenly millions of people in another part of the world can see it within seconds," says Dr Williams from Swansea University.

"It's not just about the speed, but also the reach of disinformation, which takes us into completely uncharted territory."

What do young people think?

Research consistently shows that young adults are the group most likely to use social media to make decisions about their personal health and are most susceptible to misinformation.

Quarantines and other restrictions meant that many of them in their late teens lost out on schooling, early job opportunities, and social life during the pandemic.

At the same time, they, unlike the elderly, were much less likely to become seriously ill after contracting the virus.

"They were the ones who felt like they paid the highest price for something that was primarily an older people's problem," says Professor Heidi Larson, former head of global communications for immunization at UNICEF and director of the Vaccine Confidence Project at LSHTM.

The data also suggests that younger groups have experienced the biggest decline in confidence in vaccines over the past four years, which she says is "most concerning" in her research.

The percentage of 18- to 24-year-olds, for example, who say vaccines are safe and effective fell below 60 percent in 2023, down from 2019 percent in 80.

"They really should be a priority, because they are potential young parents and if they question the importance of vaccines, then we are really in trouble," says Professor Larson, who is participating in the long-running Covid inquiry as an expert witness.

"We have to accept that this happened because of the whole Covid experience and all the controls and pressures."

"These people are literally saying, 'Enough with the talk of what we should do, we don't want any more of your vaccines.'"

Concerns about speed and safety

The speed at which new Covid vaccines were being developed has also been at the center of some rumors, concerns, and mistrust online.

The data now shows that the vaccines have done their main job - helping our bodies clear the virus and reducing the risk of more severe illness, hospitalisation and death.

In early clinical trials, however, the vaccines were said to be effective – as much as 90 percent in the case of the Pfizer vaccine – in preventing you from getting infected with Covid in the first place.

In practice, this protection against infection and transmission declined within a few months, as immunity "weakened" and the virus mutated into other variants.

Crucially, however, protection against the severe form of the disease has proven to be much longer-lasting.

And then there were the security concerns.

AstraZeneca and Johnson & Johnson were linked to a rare but serious blood clot in the brain, and their use was restricted to certain groups only.

Pfizer and Moderna vaccines, meanwhile, were linked to a rare case of heart inflammation, which would usually resolve without any long-term damage.

The reality is that every vaccine, just like every medical treatment, always carries a small degree of risk, some more than others.

"The scientific and public health perspective is quite clear - not only were the Covid vaccines safe and effective, but we would be living in a very different world today if they had not been deployed so quickly," says Dr Williams from Swansea University.

"But we're in this complex, nebulous world right now where some people are publicly making the case that vaccines haven't been what they were promised."

Vaccine fatigue and "complacency"

Many in the UK no longer have direct experience of how dangerous viruses such as measles can be.

The UKHSA says it has been seriously concerned for some time about declining vaccination rates among children.

Dr. Mary Ramsey, director of the organization's public health program, believes that this trend, which began in the decade before Covid, is motivated more by complacency than a decline in confidence in the childhood vaccination program.

Modern lives are also busy and finding time to take a child to the GP for a series of vaccinations is not always an easy task, she says.

The number of children receiving their first dose of the MMR vaccine in 2024 fell to 88,9 percent in England, the lowest level in 14 years, and last year we saw significant measles outbreaks in London, Birmingham and Bristol.

High levels of measles vaccination are crucial, as they prevent transmission of the virus and protect not only those who receive the vaccine, but also those who cannot – young babies and children with weakened immune systems, for example.

Dr. Wall also thinks that the pandemic could be slowly causing "vaccine fatigue," with even some medical staff "tired, exhausted, and fed up" after years of vaccines, booster doses, regulations, and restrictions.

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Figures from NHS England, for example, show that the number of frontline healthcare workers receiving flu vaccines fell to 35% in November 2024, from 62% in the same month in 2019.

In late 2021, the government introduced mandatory COVID vaccination measures for staff in geriatric care facilities in England, and later attempted to extend this to NHS workers.

The public has also been told at times that they must be vaccinated against Covid (or have a recent negative test) in order to travel abroad, enter nightclubs or visit cinemas in parts of the UK.

These kinds of strict health measures can boost vaccination rates in the short term, argues Professor Larson of LSHTM, but there is a danger that we will now start to pay the "long-term price" of it.

There is concern that if people feel forced or coerced into getting vaccinated at certain times, broader trust in vaccines could be eroded.

Personal freedoms vs. government restrictions

For two hundred years, vaccination has been inextricably linked to personal freedoms, state control, and other political issues.

This is increasingly coming to the fore online, where a broader debate is also taking place about global warming, gun control, and immigration.

"It's always 'the people' against the political and financial elite, and medical and scientific experts are seen as part of the elite, speaking a different language and having connections to big companies and the pharmaceutical industry," says Professor Larson.

Meanwhile, President Trump's controversial nominee for US Secretary of Health, Robert Kennedy Jr., has resolutely brought vaccines back into political discourse.

He has in the past repeated false claims that vaccines cause autism, urged parents not to vaccinate their children, and had to apologize after claiming that so many children were harmed by vaccines that it amounted to a "holocaust."

On several occasions he has denied that he is against vaccination, instead claiming that he is "for safety".

'We need to be more confident'

Dr Simon Williams from Swansea University now thinks health authorities need to be clearer about the dangers of some infectious diseases, in the face of online misinformation that often exaggerates the small risks of vaccines.

"Part of the reason tobacco control campaigns have been so effective since the 1980s is because they have been extremely clear about how dangerous smoking is, and I think we can learn something from that," he says.

"We need to be much more confident in presenting the potential risks of refusing vaccination."

Another idea is "preemptive debunking" - teaching people to expect and recognize misinformation online before they encounter it in real life, rather than relying on fact-checking and boring public health videos.

Professor Heidi Larson also thinks that now is the time to focus attention on those most at risk from vaccine refusal, especially younger groups who data shows are most affected by misinformation.

"I would start with schools, I would start with science classes, I think we are losing the battle if we focus only on misinformation and if we don't start emphasizing the effectiveness and the benefits of vaccines," she says.

"Confidence in vaccines across Europe is currently in decline and we cannot simply assume that it will return without our collective efforts."

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