Dealing with measles outbreaks in areas of high anti-vaccination sentiment

Research just published in BMC Public Health identifies the key priorities and concerns of Australian public health practitioners when managing an outbreak of measles in regions with low vaccination coverage. The findings provide an understanding of the challenges faced during an outbreak and priorities for communicating with communities where there is a high level of anti-vaccination sentiment. Author Penelope Robinson tells us more about the research in this blog.

Managing the spread of infectious diseases has taken on heightened significance over the last year, as COVID-19 swept the world. Terms like ‘contact tracing’ and ‘vaccine trials’ have become hot discussion topics for the general population, not just those who work in public health or medical research. But the research I want to share here was research conducted before coronavirus was even ‘a thing’.

Back in 2019, we set out to uncover what the top priorities are when dealing with a measles outbreak, particularly in a region where there might be lower than average vaccination rates. We conducted a multi-round survey (an interactive method known as a Delphi survey) with a range of Australian health professionals who are responsible for managing and responding to a disease outbreak: public health officials, infectious disease experts, immunization program staff, and others involved in delivering vaccinations.

Our goal was to find out what they see as the priority issues when trying to contain an outbreak. We asked our participants to imagine a measles outbreak in a hypothetical region known for its low levels of childhood vaccination coverage. We asked them what practical issues and challenges they would face, and what they would need from non-vaccinating members of the community to effectively manage the outbreak.

The study we undertook is part of a broader project called UPCaV for short – ‘Understanding, Parenting, Communities and Vaccination’. This project has been examining vaccine refusal and hesitancy in Australia from a range of different perspectives.

Not all parents who refuse vaccines for their children are “anti-vaxxers”

An earlier phase of the project involved in-depth interviews with Australian parents who refuse some or all vaccines for their children. Some of the findings from that phase have been published by Wiley et al (2020). Parents reported feeling stigmatized, bullied, disrespected and misunderstood. Notably, not all parents who refuse vaccines for their children are “anti-vaxxers”, a label that has become increasingly used in media reporting and one that tends to close down conversation rather than open it up.

Trying to combat misinformation, while considered important by the people we surveyed, was deemed a longer-term strategy

One thing that stood out the most for me from our Delphi survey, was that trying to combat misinformation, while considered important by the people we surveyed, was deemed a longer-term strategy. Trying to change the minds of vaccine-refusers was not considered a priority during an outbreak, nor was offering vaccination. Participants’ first priority was to contact potentially infected people and isolate vulnerable members of the community in order to halt the spread of the disease.

Another thing I found compelling in our findings, were the responses to a question about what strategies are most successful for countering mistrust among non-vaccinating parents during an outbreak. Recurring responses to this question were the need for patience and calm education. Panellists suggested it was important to highlight to parents the serious complications that can arise from measles. And they suggested that it is important not to get into arguments with non-vaccinating members of the community, but instead to offer reassurance, provide accurate information and to acknowledge different beliefs. These comments were exciting to see because they align so well with previous research I’ve been involved with, called Sharing Knowledge About Immunisation (SKAI).

The following two quotes from participants struck a chord with me:

“Reassurance, patience, education may help with those people that are still ‘sitting on the fence’ about vaccination.”

“Recognizing and acknowledging people’s beliefs, however conveying facts and not getting drawn into a discussion or arguments.”

Although these participants were talking about an imagined measles outbreak, their perspectives have significance for how we respond to other disease threats and how we communicate effectively with diverse populations. As I write this (April 2021), the COVID-19 vaccines have begun to be rolled out in Australia. While the questions in our survey were about measles, the implications for how best to manage the threat of disease, while also communicating in an open, thoughtful and compassionate way, especially with people who might be feeling nervous about vaccinations, is timely.

Further reading:

Wiley KE, Leask J, Attwell K, Helps C, Degeling C, Ward P et al. Parenting and the vaccine refusal process: A new explanation of the relationship between lifestyle and vaccination trajectories. Social Science & Medicine. 2020;263. doi:

SKAI (Sharing Knowledge About Immunisation) website, National Centre of Immunisation Research and Surveillance,, Australia.

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