As I’ve written recently, vaccine uptake rates have dropped since the pandemic, and disease cases like pertussis (whooping cough) have reappeared among our children. This shows the direct consequences of vaccine hesitancy to increases in diseases like pertussis, measles, and mumps.

This post will review what is pertussis and the current situation with the disease. Moreover, I want to focus on vaccine hesitancy and how we might fix it.

What is pertussis?

Pertussis, or whooping cough, is an infectious bacterial disease caused by the Bordetella pertussis bacteria. The infection leads to uncontrollable coughing, with a “whooping” sound when you take a breath after the coughing spell. The disease is very contagious and although it is more common in infants and children, it can attack adults.

The coughing can be so difficult for infants and babies that they can choke or vomit. The coughing spells can be so problematic that it can be difficult for infants to eat, drink, or breathe.

The treatment for whooping cough is usually antibiotics. Early treatment is critical. It may make your infection less serious, and it can also help prevent spreading the disease to others.

Whooping cough is a dangerous disease with serious complications. According to the CDC, the most dangerous complications for babies younger than one year old who are treated in in the hospital are:

• 1 out of 5 (22%) get pneumonia (lung infection)
• 1 out of 50 (2%) will have convulsions (violent, uncontrolled shaking)
• 2 out of 3 (68%) will have apnea (slowed or stopped breathing)
• 1 out of 150 (0.6%) will have encephalopathy (disease of the brain)
• 1 out of 100 (1%) will die

About 1 in 3 babies younger than 1 year old who get whooping cough need hospital care. The younger the baby, the more likely they will need hospital treatment.

I know that a lot of the anti-vaccine world would try to convince you that whooping cough is a trivial disease making the vaccine unnecessary – they’d be wrong.

Pertussis vaccine and increasing cases

There is one easy way to prevent pertussis, and it is the pertussis vaccine. The DTaP vaccine, which prevents diphtheria, tetanus, and pertussis), is usually given in five doses at 2 months, 4 months, 6 months, 15-18 months, and 4-6 years of age. Children older than six years and adults receive a different version of the vaccine called Tdap.

The vaccine is over 98% effective in preventing whooping cough in children who have received all five doses. Unfortunately, there is waning immunity from the vaccine especially compared to the previous versions of the vaccine that were available up through the 1990s. Nevertheless, even with waning immunity the vaccine is still very effective in preventing and reducing hospitalization from the disease.

Before widespread vaccination, whooping cough epidemics were a regular occurrence, with thousands of deaths reported each year. Once again, nearly all vaccine-preventable diseases are dangerous and with increases in cases of pertussis, we could go back to the pre-vaccine epidemics.

Unfortunately, the CDC reported that even though pertussis cases were lower than usual over the past few years because of COVID pandemic mitigation measures (masking and remote learning) they have returned to pre-pandemic patterns where more than 10,000 cases are typically reported annually.

It is probable that the higher level of vaccine hesitancy, borne out of the pandemic, has led to this increase in pertussis cases.

Vaccine hesitancy is a different belief set from the broader anti-vaccine movement, which is opposed to all vaccines. Anti-vaxxers have been around since vaccines were first used, and they seem to be driven by deep-seated beliefs that contradict the vast body of scientific evidence.

Vaccine hesitancy is a newer group that appears to be growing, especially since the COVID pandemic. This group is reluctant to or refuses to vaccinate despite the availability of safe and effective vaccines. Their hesitancy is not based on a fundamentalist dislike of vaccines but arises from confusion, mixed messaging, and distrust in medical and public health institutions. As opposed to the positions of hard-core anti-vaxxers, vaccine hesitancy is less of a belief system and more of confusion from a barrage of conflicting information. Vaccine-hesitant parents are the fence-sitters of the vaccine world.

That being said, the net effect is the same — vaccine hesitancy leads to lower vaccination rates and increased cases of vaccine-preventable diseases like pertussis.

As I wrote recently, the vaccination rate for DTaP has dropped from 95.3% in 2017-18 to 91.7% in 2023-24. That leaves the overall vaccination rate for pertussis at just above the herd immunity level. Worse yet, the non-medical exemption rate among US children entering school has nearly doubled from 2.0% to 3.7% in the same time frame.

Summary

If we assume that some, or possibly most, of the drop in vaccination rates results from vaccine hesitancy, rather than outright anti-vaccine beliefs, then bludgeoning these people with scientific facts and dismissing their concerns will not be the best way to move forward. Of course, I will continue to bludgeon the crackpot anti-vaccine activists, because their lies and disinformation must be stopped.

However, healthcare and public health professionals probably have to revise their methods of discussing vaccines to counteract the misinformation and confusion, realizing that vaccine hesitancy is less about a deep-seated anti-vaccine belief and more about misunderstanding. Writers like me need to focus less on the anti-vaccine crackpots and focus on the vaccine-hesitant group by providing clear, accessible information on the safety and effectiveness of vaccines like DTaP, MMR, and many others.

I have actually tried to slowly move the focus of this blog from attacking anti-vaxxers to presenting solid scientific evidence about the safety and effectiveness of all vaccines. I will still write about anti-vaxxers like Robert F Kennedy Jr, since they use the bully pulpit to push their nonsense, but I’m going to concentrate more on the science.

I hope it helps in moving the vaccine-hesitant to the side of vaccines.

Citations

• Decker MD, Edwards KM. Pertussis (Whooping Cough). J Infect Dis. 2021 Sep 30;224(12 Suppl 2):S310-S320. doi: 10.1093/infdis/jiaa469. PMID: 34590129; PMCID: PMC8482022.