Kundu is a physician and doctoral student specializing in global surgery. Glatter is an assistant professor of emergency medicine.
Over the past decade, the United States has seen an alarming resurgence of vaccine-preventable diseases, including measles, mumps, and, more recently, whooping cough.
Pertussis, which particularly affects infants and young children, was once on the brink of eradication thanks to the widespread use of the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, which protects against diphtheria, tetanus, and pertussis. But a recent spike in pertussis cases has reignited concerns among public health officials, and the root of the problem is more complex than simple anti-vaccine sentiment.
Rise of vaccine hesitancy
Vaccine hesitancy is different from the broader anti-vaccination movement. Anti-vaxxers existed before the COVID-19 pandemic and are likely to continue, driven by deeply held beliefs that often resist scientific evidence. But vaccine hesitancy is a newer and growing group born of confusion, mixed messages, and a general distrust of how public health agencies communicate. The COVID-19 pandemic, along with a barrage of conflicting information, has contributed significantly to this phenomenon.
Although skepticism is natural and even encouraged in scientific research, the public health community has largely failed to address it with empathy and clarity. Instead, hesitant people will be left navigating a complex landscape of misinformation without proper guidance, leading many to delay or refuse essential vaccines like DTaP. In the case of pertussis, this hesitancy has serious real-world implications. Infants, who are most vulnerable to severe cases of pertussis, suffer as a direct result.
Why is the DTaP vaccine important?
The DTaP vaccine has been a cornerstone of childhood immunization programs for decades and has significantly reduced the incidence of diphtheria, tetanus, and pertussis. Pertussis, in particular, is a highly contagious bacterial infection that can cause serious and life-threatening complications in infants, especially those who are too young to be fully vaccinated. Before widespread vaccination, whooping cough outbreaks occurred regularly, with thousands of deaths reported each year.
This vaccine is now highly effective, with studies showing it to be up to 90% effective in preventing severe pertussis in fully vaccinated children. The urgency to address vaccine hesitancy cannot be overstated. The United States is returning to its pre-pandemic pattern of typically reporting more than 10,000 pertussis cases a year.
Measures such as masks and distance learning likely helped reduce pertussis transmission during the pandemic. However, in 2024, there will be a sharp increase in pertussis cases, reflecting a return to normal trends. Preliminary data from the CDC as of mid-September 2024 shows the number of infections is five times higher than during the same period in 2023, exceeding pre-pandemic levels in 2019. This trend is especially dangerous because whooping cough can spread rapidly in the community, especially among people who: Not fully vaccinated.
According to CDC data, national DTaP vaccination rates for kindergartners have steadily declined in recent years. For the 2021-2022 school year, vaccination coverage for measles-mumps-rubella (MMR), DTaP, polio, and varicella will drop to approximately 93% for each vaccine, down from 94% the previous year and 95% in the 2019-2020 school year. did. (when children were vaccinated before the COVID-19 pandemic). Declines in vaccination rates during the pandemic are due in part to decreased vaccine access and increased vaccine hesitancy, with approximately 250,000 kindergarteners now fully vaccinated against vaccine-preventable diseases like whooping cough. This means that they are not receiving adequate protection.
This resurgence of vaccine-preventable diseases is a reminder that the work of public health is never completed and communication is key to preventing such outbreaks.
communication failure
The recent increase in pertussis cases reflects a broader public health crisis, one in which communications failures have left large segments of the population confused and distrustful. The proportion of children exempted from vaccines (for non-medical reasons) also increased to 2.6% in 2022-2023 from 2.2% the previous year, according to the report. This increase in exemptions is likely related to increased vaccine hesitancy due to misinformation and growing distrust of vaccines.
Experts agree that public health messaging during the pandemic has been flawed in many ways. Complex issues such as vaccine efficacy, herd immunity and viral transmission were oversimplified in some cases, and contradictory guidance further undermined trust. What we are seeing now is the long-term impact of these communication errors as preventable diseases like whooping cough are making a comeback.
learn from the past
The history of public health offers valuable lessons on how to address vaccine hesitancy. Consider the global fight against polio. In 2009, India faced significant vaccine hesitancy, especially in Muslim-majority regions, and there were rumors that the polio vaccine was part of a plan to restrict births among Muslims. India’s public health authorities were able to counter these claims through patience, dialogue, and respectful education, rather than force. They presented the evidence carefully and acknowledged people’s concerns without completely denying them.
A similar strategy should be adopted in the fight against whooping cough. Public health leaders cannot dismiss hesitancy as simply ignorance or stubbornness. We need to engage in evidence-based dialogue with patients that respects the concerns of parents and caregivers while providing clear and accessible information about the safety and effectiveness of vaccines like DTaP.
A call to rebuild trust in public health
In the field of public health, balancing activism and diplomacy is critical to rebuilding trust, especially in the face of vaccine hesitancy. As world leaders gather at the United Nations General Assembly (UNGA) to address pressing issues such as antimicrobial resistance, pandemic preparedness and universal health coverage, the resurgence of preventable diseases like whooping cough must not be overlooked. . These global health challenges highlight the need for a cohesive, trust-based public health approach that extends to all communities.
Vaccine hesitancy is a reminder that public health action must be based on thoughtful engagement, not coercion. Alienating people and denigrating skepticism will only deepen the divide. To rebuild trust, public health authorities must adopt a compassionate, evidence-based approach that respects the concerns of vaccine-hesitant individuals, similar to the international community’s approach to broader global health challenges at UNGA. need to be adopted. Effective public health strategies must avoid countering opposition through force and instead build bridges through transparent communication and trust. Only then can we prevent future outbreaks and protect the most vulnerable, especially children.
Shreenik Kundu (MBBS, MSc) is a PhD student at McGill University and a Jean-Martin Laberge Global Pediatric Surgery Fellow with extensive clinical experience. He previously completed a fellowship at the Global Surgery Foundation in Geneva, Switzerland, and a two-year research fellowship at Harvard University’s Global Surgery and Social Change Program in Boston. Robert Glatter, MD, is an assistant professor of emergency medicine at Hofstra/Northwell’s Zucker School of Medicine, Lenox Hill Hospital, and Northwell Health in New York.
The authors declare no conflicts of interest or financial disclosures related to this article.
