Dealing with measles outbreaks in areas with strong anti-vaccination sentiment

Research just posted in BMC Public Health identifies the top priorities and concerns of Australian public health practitioners when managing a measles outbreak in areas with low immunization coverage. The results provide insight into the challenges faced during an epidemic and the priorities for communicating with communities where anti-vaccination sentiment is high. Author Penelope Robinson tells us more about the research in this blog.

Managing the spread of infectious diseases has taken on increased importance over the past year as COVID-19 has swept the world. Terms like “contact tracing” and “vaccine trials” have become hot topics of discussion for the general population, and not just for those working in public health or medical research. But the research I want to share here was research conducted before the coronavirus was even ‘a thing’.

In 2019, we decided to find out what the top priorities are regarding measles epidemic, especially in an area where vaccination rates may be below average. We conducted a multi-round survey (an interactive method known as the Delphi survey) with a range of Australian healthcare professionals responsible for managing and responding to an outbreak of disease: public health officials, infectious disease experts, immunization program staff, etc. involved in the delivery of vaccinations.

Our goal was to find out what they see as the top priority issues when trying to contain an outbreak. We asked our participants to imagine a measles epidemic in a hypothetical region known for its low levels of childhood immunization coverage. We asked them what practical issues and challenges they would face, and what they would need from unvaccinated members of the community to effectively manage the epidemic.

The study we undertook is part of a larger project called UPCaV for short – “Understanding, Parenting, Communities and Immunization”. This project looked at refusal to be vaccinated and reluctance in Australia from different angles.

Parents who refuse vaccines for their children are not all “anti-vaxxers”

An earlier phase of the project involved in-depth interviews with Australian parents who refused all or some vaccines for their children. Some of the findings from this phase have been published by Wiley et al (2020). Parents reported feeling stigmatized, intimidated, looked down upon and misunderstood. In particular, not all parents who refuse vaccines for their children are “anti-vaxxers”, a label which is increasingly used in media reports and which tends to close the conversation rather than open it. .

Trying to tackle disinformation, while viewed as important by those we interviewed, was seen as a longer-term strategy.

One of the things that stood out to me the most about our Delphi survey was that tackling disinformation, while viewed as important by those we interviewed, was seen as a longer-term strategy. Trying to change the minds of those who refused to be vaccinated was not seen as a priority during an outbreak, nor was it offering vaccination. The first priority of the participants was to contact potentially infected people and isolate vulnerable members of the community in order to stop the spread of the disease.

Another thing that I found compelling in our results was the responses to a question about the most effective strategies to counter mistrust among unvaccinated parents during an epidemic. The recurring answers to this question were the need for patience and quiet education. Panelists suggested that it was important to emphasize to parents the serious complications that can result from measles. And they suggested it’s important not to argue with unvaccinated members of the community, but rather to offer reassurance, provide accurate information, and recognize different beliefs. These comments were exciting to see because they align so well with previous research I’ve been involved in called Share knowledge about immunization (SKAI).

The following two quotes from the participants struck a chord with me:

“Comfort, patience, and education can help people who are still ‘sitting on the fence’ about immunization.”

“Recognize and acknowledge people’s beliefs, but convey facts and not get caught up in discussion or arguments.”

While these participants were talking about an imaginary measles outbreak, their perspectives are important to how we respond to other disease threats and how we communicate effectively with diverse populations. As of this writing (April 2021), COVID-19 vaccines have started rolling out in Australia. While the questions in our survey focused on measles, the implications for how best to manage the threat of disease, while communicating in an open, thoughtful, and compassionate manner, especially with people who might be nervous about vaccinations, are timely.

Further reading:

Wiley KE, Leask J, Attwell K, Helps C, Degeling C, Ward P et al. Parenthood and the Vaccine Refusal Process: A New Explanation of the Relationship Between Lifestyle and Vaccination Trajectories. Social sciences and medicine. 2020; 263. do I:

SKAI (Sharing Knowledge About Immunization) website, National Center for Immunization Research and Surveillance,, Australia.

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