The season of deadly respiratory viruses is here. While some people suffer minor inconveniences from respiratory infections, others can experience life-threatening events resulting in hospitalization, ICU admission or worse. Respiratory viruses like influenza, COVID-19 and respiratory syncytial virus (RSV) are more prevalent in the months from fall to spring and can have very serious consequences for the very young, the elderly, and those with underlying medical conditions.
Influenza is one of the top 10 causes of death in Canada, causing more than 12,000 hospitalizations and approximately 3,500 deaths a year. While the peak of the COVID-19 pandemic may have passed, more than 4,000 people are still dying every month globally. RSV is another respiratory virus that tends to have serious consequences for young children and older adults. While RSV symptoms of runny nose, cough, sneezing and fever are similar to the common cold, in some people RSV can also lead to severe lower respiratory infections and RSV is a leading cause of hospitalization in Canadian children under five.
The economic burden of respiratory illnesses is not insignificant – the common cold costs 1.4 billion to our economy in lost productivity and influenza costs $1 billion. Taken together, all respiratory viruses reduce production in our country by $2.8 billion.
Fortunately, we have safe and effective vaccines for influenza, COVID-19 and RSV. We also have a good vaccine supply and an effective distribution system in our country. Influenza and COVID-19 vaccines are free in all provinces and territories, and public coverage of RSV vaccines is available for high-risk groups in certain areas. Yet, only 42 per cent of Canadians received the influenza vaccine last season and 39 per cent received the COVID-19 vaccine. Why are vaccine uptake rates so low?
Convenience, complacency and conspiracy are a few readily apparent reasons. If obtaining seasonal vaccines does not conveniently fit into one’s workday, or requires travel and effort, it may not get done. With the darkest days of the COVID-19 pandemic behind us, believing that it is no longer necessary to protect ourselves from respiratory viruses may also lead to not getting vaccinated. And with rampant misinformation on social media, many people are deterred by unfounded conspiracy theories and fail to take action to protect themselves and their loved ones.
But there is another very important reason for low vaccine uptake – trust in the product, the provider and the institution is key to vaccine acceptance. To get our shots every fall, we have to trust that the vaccines are safe and will not cause dangerous side effects. We need to remember that vaccine approval requires stringent methods to prove safety and to monitor for ongoing ill effects. Next, there needs to be trust that the vaccines will work and be effective in preventing the infections that they are designed to ward off. Again, the requirements for vaccine developers to demonstrate vaccine efficacy is a high bar that must be met to get approval in Canada.
Interpersonal trust between individuals and professionals who recommend and administer vaccines may be the most important kind of trust for protecting the public against vaccine preventable diseases and deaths. The relationship between individuals and their healthcare professionals usually rests on a strong foundation of respect and trust. When a trustworthy doctor, nurse or pharmacist recommends seasonal vaccination, people feel confident in the advice and act on it. Healthcare professionals also play an important role in addressing concerns about vaccines and providing reliable answers to legitimate questions that patients have.
Studies have shown that higher levels of trust in governments and institutions lead to more vaccine acceptance. Leaders at all levels of government have a role to play in encouraging the public to get their seasonal vaccines as do religious, social and cultural leaders who have earned the trust and confidence of their communities.
Vaccine uptake is also higher when there is trust in the institutions that are recommending the vaccines such as the World Health Organization or the Public Health Agency of Canada. Vaccine mandates, on the other hand, circumvent trust and result in lower vaccine uptake. A policy of free and voluntary vaccination results in increased vaccine acceptance.
Finally, we don’t want to shun those who have strong anti-vaccine convictions. The more we discount their conspiracy theories or reject them entirely, the more firmly they become entrenched in their position. People or communities with anti-vaccine views tend to be isolated from mainstream society and we need to find ways to include them and find common ground in our shared values. Building trust through engagement with respected religious or cultural leaders from these communities can go a long way to improving health outcomes and building trust. And when we trust each other, we remember that we are still all in this together.
Vamini Selvanandan is a family physician and public health practitioner in the Bow Valley. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.
