Local infectious disease experience influences vaccine refusal rates: a natural experiment

Angelopoulos, K. , Stewart, G. and Mancy, R. (2023) Local infectious disease experience influences vaccine refusal rates: a natural experiment. Proceedings of the Royal Society B: Biological Sciences, 290(1992), 20221986. (doi: 10.1098/rspb.2022.1986) (PMID:36722077) (PMCID:PMC9890117)

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Vaccination has been critical to the decline in infectious disease prevalence in recent centuries. Nonetheless, vaccine refusal has increased in recent years, with complacency associated with reductions in disease prevalence highlighted as an important contributor. We exploit a natural experiment in Glasgow at the beginning of the twentieth century to investigate whether prior local experience of an infectious disease matters for vaccination decisions. Our study is based on smallpox surveillance data and administrative records of parental refusal to vaccinate their infants. We analyse variation between administrative units of Glasgow in cases and deaths from smallpox during two epidemics over the period 1900–1904, and vaccine refusal following its legalization in Scotland in 1907 after a long period of compulsory vaccination. We find that lower local disease incidence and mortality during the epidemics were associated with higher rates of subsequent vaccine refusal. This finding indicates that complacency influenced vaccination decisions in periods of higher infectious disease risk, responding to local prior experience of the relevant disease, and has not emerged solely in the context of the generally low levels of infectious disease risk of recent decades. These results suggest that vaccine delivery strategies may benefit from information on local variation in incidence.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Mancy, Dr Rebecca and Angelopoulos, Professor Konstantinos and Stewart, Gillian
Authors: Angelopoulos, K., Stewart, G., and Mancy, R.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
College of Social Sciences > Adam Smith Business School > Economics
Journal Name:Proceedings of the Royal Society B: Biological Sciences
Publisher:Royal Society of London
ISSN (Online):1471-2954
Published Online:01 February 2023
Copyright Holders:Copyright © 2023 The Authors
First Published:First published in Proceedings of the Royal Society B: Biological Sciences 290(1992): 20221986
Publisher Policy:Reproduced under a Creative Commons License
Data DOI:10.5061/dryad.rbnzs7hfx

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048230041Places and healthRich MitchellMedical Research Council (MRC)MC_UU_00022/4HW - MRC/CSO Social and Public Health Sciences Unit
3048230091Places and healthRich MitchellOffice of the Chief Scientific Adviser (CSO)SPHSU19HW - MRC/CSO Social and Public Health Sciences Unit
311208Assessing policy to address the medium-run impact of COVID-19 on income and health inequality with models informed by the history of disease outbreakKonstantinos AngelopoulosUK Research and Innovation ( UKRI) (UKRI)ES/V005898/1BS - Economics
303166Scottish Graduate School Science Doctoral Training Partnership (DTP)Mary Beth KneafseyEconomic and Social Research Council (ESRC)ES/P000681/1SS - Academic & Student Administration