will covid-19 vaccination enthusiasm last?

canadian enthusiasm for covid-19 vaccination is impressive. after repeated lockdowns, long separations from friends and family and economic losses, canadians are lining up overnight at  pop-up clinics  and  crashing websites  with their eagerness to book appointments.

canada is currently a global leader  with over  75 per cent of the eligible population , as of june 25, having received their first dose.

does this mean we can stop worrying about vaccine uptake? experience from history suggests not. as historians  heather macdougall and laurence monnais  have argued, people do not get the recommended vaccines for a variety of reasons, including apathy. another reason is misinformation, like the  unfounded and discredited claim that the measles, mumps and rubella vaccine can cause autism .

some  are not convinced  that the disease in question will impact them or their families. others are deterred by the difficulty of accessing the vaccine. more than a few are scared of  needles . we have seen all of these factors play out in past epidemics.

the case of polio
parents were terrified by polio in the early decades of the 20th century. usually striking in the otherwise carefree summer months,  polio could leave children paralyzed . in some cases children were confined in  iron lungs  and in the very worst cases, death.

the first trial of the salk polio vaccine took place in the united states in 1954,  using a vaccine produced in toronto’s connaught laboratories .

the vaccine proved highly effective. other laboratories were licensed to product the vaccine, but one of them,  the cutter laboratories, failed to properly de-activate the polio virus  and 79 children contracted polio from the vaccine. the u.s.  halted the vaccination program  on may 7, 1955.

in canada, a trial using the vaccine produced at the connaught laboratories continued. health officials assured canadians that the connaught laboratories product  was safe and effective . by june 1956,  1.8 million canadian children had been vaccinated . but this did not eradicate polio — there were significant epidemics in the late 1950s and early 1960s.

many adults believed that polio only impacted children and were reluctant to take the vaccine.  only 10 per cent of canadian adults  had received the required three doses of the salk vaccine by june of 1959, compared to a rate of 90 per cent among school-aged children.

the year 1959 was one of the worst years for polio in canada, with nearly  2,000 paralytic cases . in montréal  there were over 950 cases and 51 fatalities . across canada, more young adults died than children between the ages of five and 19, most of the cases occurring among those who had not been vaccinated.

during the 1959 epidemic people swamped the vaccination clinics in montréal. and three years later, following  an outbreak in hull, que. , residents came to the vaccination clinics in droves.

introduction of oral vaccine
the introduction of the oral polio vaccine (sabin vaccine) in 1961 led to an uptick in polio vaccinations.

in just three months in 1962, over  four million canadians  received the oral polio vaccine. many adults who had resisted earlier appeals to get the salk vaccine  showed up to sip  the tasteless sabin vaccine, often served on a sugar cube.  newspapers raved  that no needles were necessary. and by the 1970s, polio had all but disappeared in canada.

h1n1 vaccination campaign
in spring of 2009, a novel h1n1 influenza virus began spreading in  mexico . the first cases were reported in  canada  that april.

in june, the  world health organization  declared h1n1 to be a global pandemic. like the flu of 1918-19, which killed as many as  50 million people  around the world, the 2009 flu had a disproportionate impact on  younger people .

that fall, vaccination clinics opened across canada for priority groups. early polls showed that only  one-third of canadians  planned to get the h1n1 vaccine, which was  on par with seasonal flu shot vaccination rates . less than  perfect efficacy rates  of the seasonal flu shot did little to inspire the canadian public to seek out the h1n1 vaccine.

but four days after vaccination clinics opened in ontario, a previously healthy  boy in toronto died . the tragic news stirred fear among ontarians, prompting thousands to  rush to clinics . many waited in line for hours, while others were turned away.

vaccines became available to all ontarians in november 2009, but by then, people’s fears had eased — it seemed that h1n1  was not as lethal as had originally been feared .

ultimately,  between 40 and 45 per cent  of the canadian population was vaccinated against h1n1.

lessons for covid-19
polio and h1n1 reveal the complexities of vaccine enthusiasm. people rush to get vaccines when they perceive an immediate health risk to themselves or their family members. but without that fear, it is easier to delay or avoid getting vaccinated.

the biggest challenge may be ensuring the continuing uptake of vaccines once the initial crisis has passed. in addition to measures to  combat vaccine misinformation , public health authorities need to ensure that vaccines are readily available and convenient to access.

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