Vaccine hesitancy a major obstacle to health

BAVINA SOOKDEO

As World Immunisation Week 2025 approaches (April 24-30), emphasis is placed on one of the most powerful tools in modern medicine – vaccination. This year’s theme, Immunisation for All is Humanly Possible, highlights the importance of widespread vaccine access. Despite its success in controlling and eradicating deadly diseases, vaccine hesitancy and misinformation remain major obstacles.

Newsday spoke with Dr Mitra Maharaj, occupational medicine physician and public health advocate to learn more about immunisation.

Since graduating from medical school in 2017, Maharaj's experience includes roles in intensive care and emergency medicine. For the past five years, he has been working in occupational medicine in both public and private sectors. He practises privately at Trinity Medical Centre and serves in the public sector at the Occupational Medicine Unit within the South-West Regional Health Authority. He is also a certified occupational hearing conservationist and medical review officer.

Beyond his clinical work, Maharaj is deeply committed to community health education and advocacy. He co-founded the Healthy Mind Foundation, an NGO focused on raising awareness of critical health issues in TT, through which he actively participates in outreach and educational initiatives to promote healthier lifestyles.

He said immunisation plays a major role in public health and that vaccination is an essential preventive measure, not only protecting individuals but also safeguarding entire communities.

“From a medical perspective, immunisation is an indispensable tool in the fight against infectious diseases, providing multiple layers of protection and benefits to individuals and communities alike.”

Vaccines, he explained, work by stimulating the immune system to recognise and combat pathogens, thereby preventing severe infections. He noted that diseases such as measles, diphtheria, and hepatitis B have seen drastic reductions in incidence rates thanks to widespread immunisation programmes.

“Beyond individual protection, immunisation serves a critical role in safeguarding community health through the concept of herd immunity which occurs when a significant portion of the population is vaccinated, creating a protective barrier that prevents the transmission of disease,” which is crucial for vulnerable populations, such as infants, the elderly, and immunocompromised individuals with medical conditions that contraindicate vaccination.

“When high vaccination coverage is maintained, it reduces the likelihood of outbreaks, thereby indirectly shielding those most at risk.

“Moreover, from a healthcare systems perspective, immunisation is one of the most cost-effective interventions available. By preventing diseases before they occur, vaccines reduce the economic burden on healthcare systems, families and societies.”

Treating severe infectious diseases often requires intensive medical care, hospitalisation, long-term rehabilitation, and ongoing management of chronic complications.

“These costs far outweigh the relatively minimal expense of vaccination programmes. Furthermore, widespread immunisation contributes to global health security by minimising the risk of reintroducing diseases that have been eradicated or controlled, such as polio or measles.”

Maharaj said despite the proven benefits of vaccines, vaccine hesitancy remains a growing concern.

“Vaccine hesitancy is an emerging public health issue, even in countries with historically high coverage like TT.”

He identified several contributing factors:

Safety concerns: Fear of side effects or adverse reactions, often fuelled by misinformation on social media.

Mistrust in health authorities: A lack of trust in government agencies or pharmaceutical companies.

Cultural beliefs and alternative medicine: Some communities prefer herbal or traditional remedies over modern vaccines.

Low perceived risk: Some individuals believe they are not at risk of vaccine-preventable diseases.

Religious or personal beliefs: A small segment of the population may have religious beliefs that are opposed to vaccines.

A decline in vaccination rates can have dire consequences, including the resurgence of previously controlled diseases.

“Herd immunity relies on a high percentage of the population being vaccinated to prevent the spread of infectious diseases. When coverage drops, diseases like measles, which require about 95 per cent vaccination coverage to maintain community protection can resurface and spread rapidly among unvaccinated populations.

"This can lead to localised outbreaks or even larger epidemics, causing preventable illnesses and straining healthcare resources,” as is currently happening in Texas with a measles outbreak. The southern US state has reported over 561 cases of measles so far this year, with two recorded deaths of unvaccinated children.

To address vaccine hesitancy, Maharaj said, the Ministry of Health and related stakeholders have implemented several key strategies:

Public awareness campaigns – educating the population on the safety and benefits of vaccines.

Community engagement – involving local leaders and influencers to promote vaccine acceptance.

Combating misinformation – actively addressing false claims circulating online and other platforms.

Healthcare worker training – ensuring healthcare professionals are well-equipped to discuss vaccine safety and efficacy with patients.

As an occupational medicine physician, Maharaj highlighted the importance of workplace immunisation programmes.

“Occupational medicine plays a crucial role in promoting immunisation by identifying workers at higher risk of vaccine-preventable diseases, such as healthcare workers exposed to blood-borne pathogens or respiratory illnesses, providing vaccinations at workplaces to ensure accessibility and convenience.

“It also plays a crucial role in implementing workplace immunisation policies that encourage or mandate vaccinations to reduce the risk of disease transmission depending on the industry and exposures of the workers; informing workers about the benefits of vaccines and addressing common concerns or myths; monitoring vaccination status and disease incidence to identify gaps and take corrective actions at the company level.”

He highlighted some of the major successes in global and local immunisation efforts:

Smallpox eradication: due to a global vaccination campaign, smallpox was officially eradicated in 1980, with the last natural case reported in Somalia 1977.

Polio near-eradication: Polio has been eliminated in most parts of the world. Today, wild polio virus remains endemic only in a few countries (Afghanistan and Pakistan). The Americas, Europe, South-East Asia, and Africa have been declared polio-free.

Measles reduction: The first licensed measles vaccine was introduced in 1963. It is often given as part of the MMR (measles, mumps, rubella) vaccine. Immunisation programmes have led to a significant decline in global measles mortality, with WHO reporting a 73 per cent reduction in measles deaths between 2000 and 2018. In the Americas, measles was declared eliminated in 2016, although sporadic outbreaks still occur due to declining vaccination rates and importation from other regions.

Asked about legal requirements in Trinidad and Tobago on immunisations for children or specific populations, Maharaj said, “While there are no explicit legal mandates requiring vaccination for all citizens, under the Public Health (Nursery Schools and Primary Schools Immunization) Act, all children are required to be fully immunised before they are allowed admission into school. Additionally, some occupational roles, especially healthcare and public service jobs, may also mandate specific vaccines, such as Hepatitis B or influenza.”

He said community members and policymakers play a key role in overcoming vaccine challenges by building public trust, improving access, and promoting proactive healthcare.

“Communities can actively engage in awareness campaigns to educate the public about the importance of vaccines. Local leaders, religious figures, and community influencers can play a significant role in promoting vaccination by sharing accurate information and addressing myths directly. This is especially important in communities where vaccine hesitancy is fuelled by cultural or religious beliefs.”

He suggested that policymakers allocate funding to healthcare facilities, invest in digital health records, and implement policies like school entry and workplace immunisation requirements.

“Clear, evidence-based messaging and collaboration with social media platforms can combat misinformation, while training healthcare workers to address concerns boosts public confidence. Partnerships with private healthcare providers and NGOs can further expand vaccine accessibility.”

To further improve vaccine accessibility and acceptance, Maharaj suggests:

Digital health records: Automating vaccination tracking for better follow-up.

Mobile vaccination units: Reaching underserved communities with on-site immunisation.

Flexible vaccination hours: Extending clinic hours to accommodate busy individuals.

Public-private partnerships: Collaborating with private healthcare providers to expand vaccine reach.

“Immunisation for All is Humanly Possible is not just a slogan; it’s a call to action. It reminds us that every person, regardless of age, background, or circumstance, deserves the protection that vaccines provide.

“This year let’s make it our collective goal to close the immunity gaps that persist in our communities. Whether you’re a parent, a healthcare worker, a community leader, or simply a concerned citizen, your role is crucial. Stay informed, get vaccinated, and encourage others to do the same. Share accurate information, support immunisation programmes, and challenge misinformation whenever you see it.

"Let’s create a culture where vaccination is embraced as a responsibility, we owe to ourselves and to each other. Because when we all take action, we save lives.”