When talking about the damages of the corona virus, it is common to think of phenomena such as long covid, persistent breathing difficulties or impaired memory. It is also understood that it is impossible to ignore the damage of the crisis management policy, the closures and the restrictions, which are reflected in difficulties in children's studies, an increase in addictions and eating disorders in teenagers, in economic damage to businesses, and more.
But the Ministry of Health is currently mapping another and threatening damage related to the corona epidemic, and it is a violation of public trust in vaccines of all kinds and an increase in exposure to "fake news" and negative publications about vaccines.
The results are already visible today, with data showing a decrease in compliance with routine vaccinations for babies, and there is a fear that in the future the phenomenon will expand to other vaccines as well.
First, the numbers: a survey of parents' attitudes commissioned by the Ministry of Health shows that there has been a dramatic and clear increase in the rate of those exposed to claims against vaccines in the media and social networks in recent years - from 59% in 2016 to 77% in 2022.
Also, about a tenth of the parents see such vaccines as potentially harmful to children (11% in the general sector, 24% in the Bedouin sector).
At the same time, despite the heated discussion and criticism - in particular regarding corona vaccines - the absolute majority of children are still vaccinated: 86% of the parents of children up to the age of 13 testified that they are fully vaccinated, only 11% of the children are partially vaccinated, and only 3% were not vaccinated at all.
But the Ministry of Health, as mentioned, recognizes deep processes of eroding public trust in vaccines, alongside a serious problem in the Bedouin sector, where vaccination rates are in a dramatic decline - only two-thirds (65%) of children up to the age of 13 are fully vaccinated.
"There is a red flag here for us in terms of the impact of fake news," says Dr. Sharon Elrai Price, head of public health services at the Ministry of Health and who led the vaccination campaigns against the corona virus, polio and monkeypox in the past two and a half years. "The survey shows that there is an increasing exposure to messages of vaccine opponents, and this raises the concern of parents.
The consequences of the increasingly widespread perception that vaccines are harmful will take their toll, and we may see the data deteriorate further."
But the survey shows that in practice there is no significant difference in the vaccination rates of children in recent years.
"True, but we see an increase in exposure to the content of anti-vaccines and how much the corona virus has undermined trust. This is very disturbing. The response to vaccines may decrease because there is a significant impact of incorrect, unproven content. There is a fundamental undermining of trust in one of the important tools that have extended life expectancy and prevented Morbidity and damage. We, at the Ministry of Health, are troubled by the fact that everything that has happened in the last three years with Corona 'colors' the routine vaccines. We hear more and more statements that a vaccine is neither positive nor protective, that doctors are 'killers in white', and this causes damage."
Tired of dealing
In Israel, as in the rest of the world, in the last two years there has been a decrease in compliance with routine vaccinations for babies, and UNICEF notes that this is a "red light on children's health". In vaccination with the triple vaccine against rubella, measles and measles, for example, there has been a decrease from 73% of infants up to the age of 13 months in 2019 to 67% in 2021. The tetanus-diphtheria-pertussis (TDAP) vaccine decreased from 96% to 87.7%. The vaccination rate against hepatitis A was 90.5% in 2018 - compared to 71.3% in 2021.
Elrai Price: "We are starting to see a decrease in routine vaccinations. At the beginning of the corona virus, we attributed this to the problem of accessibility and closed schools, and we set out on this survey to understand what this is due to - is it just an accessibility problem or also resistance to vaccinations? Is it fundamental or technical? We have to deal with two The things, both with the technical side and with parents' concerns."
The reason for the decline is the so-called "pandemic fatigue", or the effect of the discourse on the networks?
"I think it's both. People are tired of dealing with an infectious disease. What's troubling is the fact that Pike, who can run very easily, suddenly creates reluctance, mistrust, or doubts about something called vaccines, and that's what I think should be taken from this survey. Many findings have not changed, but What has changed is related to the exposure to the content and also to the concerns that have arisen, and these are related to each other.
"The changing of the diskette happened here, from fake news. Instead of talking about how vaccines are a benevolent and helpful thing, the discourse is that it is something bad, that causes fertility problems and more. We try as much as possible to pursue this and say that it is not true, but it is very challenging. The further we go By responding to routine vaccinations, this is how we see more outbreaks of infectious diseases. We have had outbreaks of measles and rubella in unvaccinated people. This is the place to stop and look at what is happening, check parents' attitudes, understand what are the barriers to access and information, what are the barriers in terms of medical teams. Doctors and nurses may not have There is enough information on the subject, for example on a question such as why it is important not to postpone vaccinations. In the end, most people trust their doctors."
Demonstration of vaccine opponents during the Corona period, photo: Oren Ben Hakon
In the survey, as mentioned, the attitudes of parents regarding the vaccinations were examined, but if they had been asked about the availability of appointments and access to the drops of milk, the answers would probably have been disturbing.
In 2023 - you will be surprised - it is still not possible to book appointments online for Tipat Halav clinics, and this alongside a shortage of about 300 standards.
15 years ago, there were 1,227 Tifat Halab nurses, and in 2019 only about 900, and in the meantime the population has grown and the tasks and vaccinations added to the nurses have only increased.
How do you increase the vaccination rate with routine vaccinations with such an accessibility problem?
"We are working towards the opening of the nurses' salary agreements. We will put the public health nurses at the top of the priority list because it is a skilled, professional resource that needs to be rewarded in a proper way. We will work to enable a better service - opening milk drops in the afternoons, on Fridays and on a second shift. For all of these Another compensation is required. We want to keep the public health nurses and attract more nurses."
A drop of milk, the new generation
In addition to handling the salary agreements, an app for calling appointments is expected to start operating in the first quarter of this year ("a revolution", Elrai Price defines it), which will make it easier for both the public and the nurses, who until now had to devote time to this as well.
"We want to use nurses where their skill and knowledge are needed," says Dr. Elrai Price.
It's a shame that nurses do secretarial things.
We are trying to recruit other parties, such as maids, to answer the phones and do secretarial work."
And how is it possible without flu vaccines - the annual catalyst for public response to vaccines.
Here, at least, there is no significant deterioration at this stage, and according to the data of the Ministry of Health there is only a slight decrease - 17.3% until the end of December, compared to 17.8% in the corresponding period last year.
Among children up to the age of 12, 15.9% were vaccinated, and among toddlers and children from six months to 5 years of age, 10.7% were vaccinated for the flu.
The flu vaccine was given to 2nd-4th graders in schools, a step that significantly increased coverage at these ages.
The Ministry of Health asked to add more age groups to the vaccination program, but were unable to do so due to a lack of budget and nurses.
"In the classes where the vaccine is given in classes, there is a greater response and it is easier," says Elrai Price, "Most parents want the vaccines. Many are interested in vaccination, and the more we increase accessibility, without the need to make time and make an appointment - the simpler it will be.
"Each yearbook addition requires more resources and school nurses. We are going to a pilot in which we will restore the role of school nurses. It seems that this model, which was used once and was stopped, can bring value, will expand the provision of flu vaccines to other age groups and will pay off financially."
The pilot will be carried out in the North, South and Ashkelon districts, where the service is provided by nurses of the Ministry of Health (in the other districts, the service has been privatized and provided by Natalie and Femi companies).
According to her, "The intention is that each nurse will have one school where she works, and then she will take on more things. We have the support of the Ministry of Education, which is very interested."
Rina Tiori, chairwoman of the Public Health Nurses Division of the Nurses' Association, warns: "There is an increase in the number of students, and the standards are not adapted to this.
Today, a nurse is responsible for six to seven schools, and in the private companies Natalie and Pami, it is sometimes about 14 schools.
A public health nurse starts with NIS 8,000 per month, and young nurses do not enter the field because of the salary structure that is based on incentives given to nurses in hospitals."
According to Tiori, one of the main problems with vaccine compliance is the fact that there are no answers to parents' questions: "There are explanatory sheets that are distributed to parents before vaccination, but today the school nurse does not have time to answer questions, to explain and get down to the nitty-gritty or to refute conspiracy theories. The Ministry of Health should provide measures that will allow parents to receive Answering questions".
According to her, the service is indeed provided one-on-one and with the option of answering parents' questions, but the standards have not been updated since the late 1970s.
"It's a paradox that so many standards have been added to Corona, but not to the milk drop nurses. I support Dr. Elrai Price and think that a significant reform is needed that is important for parents, children and to increase vaccination coverage in the State of Israel."
Not a catastrophe, but...
The survey conducted by the Ministry of Health did not examine whether the closures, the green sign and the tests in schools damaged (or perhaps strengthened) trust in vaccines, but an indication of this can be found in a single question, which shows a significant change in the years in question: if in 2016 two thirds of parents supported (66 %) in presenting vaccination records at the entrance to schools, in the current survey there was a drop to 52% who support it.
"Should we have examined the effect of the policy on vaccine compliance? That's a good question," answers Dr. Elrai Price diplomatically. "Did the Ministry of Health's policy hurt compliance?
Obviously we could, and always can, do things better.
There was a significant attempt to be transparent and make the information accessible.
Regarding the students - it is certain that what has happened in the last three years has an effect.
Children went into isolation due to exposure when they were unvaccinated, and there was a feeling that they should be in school.
Perhaps the answer reflects a desire not to impose restrictions and to see children visiting the schools as much as possible."
There were attempts to promote in legislation an initiative to introduce a " vaccination
certificate" as a condition for entering school, as is customary in the US and other countries.
choice.
It had broad support from MKs, and there is a chance that such a private initiative will come up. In my opinion, we are now in a different world. I, personally, am against forcing vaccinations. The way is not to force but to make it accessible and explain and let people make a decision. If such a law says 'come Forced' - I will have a problem supporting it. If the law is 'let's make sure that whoever made the decision chose not to get vaccinated' - that's something else. It's not right to force or prevent entry to kindergarten."
Prof. Nadav Davidovich, Head of the School of Public Health at Ben-Gurion University and Chairman of the Public Health Forum, is also concerned: "In principle, vaccines are part of the Israeli DNA, but there is erosion. We cannot continue as if vaccines are self-evident, And for the younger generation of parents, you have to invest dramatically. You can't continue like 30 years ago when parents didn't ask questions. Parents do ask, and you have to be ready for that.
"There are doctors and health professionals who do not understand vaccines, and there is no reason for them to say baseless things. The big failure is that there are doctors who say incorrect and harmful things. We saw in Corona how people from specialties that are not related to the matter start to express an unfounded position."
In the matter of advocacy, Prof. Davidovich recommends "to take things that come up on social networks more seriously, to act more on social media, and not to leave it to the public. The Medat organization does an excellent job, but they are a voluntary body. It should be funded by the Ministry of Health, And the messages should be delivered by family doctors and children."
What are the consequences of the decrease in public confidence in vaccines?
"We are not in a catastrophe, but in a better situation than most countries in the world, but there are tens of thousands of children who are not vaccinated against polio, for example. It is a combination of vaccine resistance, vaccine hesitancy, and accessibility that is not always convenient in terms of milk drop clinics that do not receive enough resources.
"Regarding diseases for which there is a vaccine, such as measles and measles - herd immunity is extremely important, otherwise 'pockets' of populations that are less vaccinated and there will be an outbreak. It is sad if a child dies or becomes severely ill with neurological symptoms for life, when there is a vaccine that can prevent this ".
Photographs: Danny Machels, Ben-Gurion University, Yossi Zeliger, Hertzi Shapira
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