Vaccination rates are declining across the country, and recent media coverage has amplified the voices of ideological “anti-vaxxers." Public health professionals caution that there are other reasons related to poverty and lack of health education that contribute to these low numbers, but media by and about anti-vaxxers make them seem like the bigger problem. As a result, we focus less on resolving health disparities.

The United States news media over-represent the anti-vaxxer population (meaning folks who refuse vaccinations due to distrusting doctors or pharmaceutical companies). In reality, people forgo vaccines for a variety of reasons. A recent story from NPR found, for example, that disparities in American health policy play a significant role in under-vaccination, although health researchers still disagree on quite how significant that role is.

“Certainly, vaccine refusal gets the attention, but CDC data show that immunization rates are lowest among those with no insurance/on Medicaid and/or in rural areas, indicating that these factors may play a bigger role," Catherine Troisi , PhD, MS, associate professor of epidemiology at the UTHealth School of Public Health in Houston, told Step Up.

NPR reported that parents often miss their children’s vaccinations due to lack of access to transportation, missing insurance, inability to leave work, and more.

Troisi said that even when kids do make it to the doctor’s office, a host of other issues can prevent vaccine access.

“Another barrier is missed opportunities. If a child is seen at a pediatrician for something that does not contraindicate vaccination, but their immunization records are not checked, then missed doses can’t be given," she said. “Sometimes doctors think they can’t give vaccines if the child has a cold, for example. Complicating this are immunization registries–there is no national registry, only local or in some cases, state-level. If families move around, providers may not have access to registries and so can’t check on current immunization status and so can’t administer missed doses."

Troisi said one reason vaccine hesitancy has picked up stems from a misunderstanding of how they save lives.

“The fact that today’s parents haven’t seen vaccine-preventable diseases also plays a role," she said. “Parents in the 1950s and ’60s had seen the devastation these diseases can cause and so were anxious to get their children immunized. That’s not the case today, so misinformation that says these diseases are not dangerous can spread."

Katie Foss , an associate professor in the School of Journalism and Strategic Media at Middle Tennessee State University who researches health communication, told Step Up that media attention to anti-vaxxers makes it easier for the public to ignore health disparities, preventing us from eliminating obstacles to healthcare.

“Rates for non-vaccinating due to beliefs versus access have increased, but there's still a significant disparity between those who refuse and those who would like to vaccinate but can't due to hardship," Foss said. “Historically, single mothers of color and/or those with lower income are less likely to fully vaccinate due to access. Access to a pediatrician, transportation, lack of flexibility for work, and knowledge of vaccine (or) wellness check-up schedules can all contribute to an undervaccinated child."

She said media outlets cover ideological anti-vaxxers more than the flaws in our healthcare system, and social media has permitted them to circulate their own messages.

“The ‘right’ to refuse vaccines is in itself, a privileged position. Since the first groups opposed to immunization in the early 19th century, anti-vaxxers have always created their own media content, designed to persuade audiences through shocking anecdotal evidence (such as) select stories of complications from vaccines," Foss said.

Much of this misinformation circulates on social media, such as Facebook . After pressure from health and news-literacy entities, the company has recently vowed to crack down on anti-vaxx content and remove the misleading information they spread that puts lives at risk.

Still, one in 10 American parents report vaccine hesitancy, another 10% report distrusting medical scientists, and a whopping half are suspicious of pharmaceutical companies. That’s just part of a web of distrust in health professionals and the companies that manufacture and profit from prescription drugs, according to Harvard epidemiologist Eric Ding .

Ding told Step Up that anti-vaxx attitudes escalate “due to (pharmaceutical companies’) bad reputation of having previously marketed dangerous drugs knowingly, including opioids, and price gouging in the name of profit."

Ding is also a health economist and the founder of Health Justice For All , a nonprofit advocacy group for affordable medicines. In 2018, he ran a science-based campaign in the Pennsylvania 10th Congressional District midterm, campaigning to reduce sky-high pharmaceutical costs and increase public trust in scientists, doctors, and the government.

He said legal and monetary relationships between government officials and pharmaceutical companies concern many parents.

“I think politicians need to stop taking Pharma PAC money in order to restore the public trust in our elected officials when they say 'vaccinate your kids,’" Ding said. “Many people skeptical of Pharma don't believe elected leaders when at the same time they take corporate Pharma money. Telling elected leaders to refuse Pharma money is a good way to help restore their reputation, so that more people can credibly believe our leaders who advocate for vaccination."

Further, he said policies within the healthcare system as a whole need to change. Greater access to healthcare lends itself to greater access to vaccines and immunization information.

Experts are still unsure exactly how much health disparities influence vaccination rates versus anti-vaxxers, but Foss said journalists have the opportunity to reframe the discussion on vaccines regardless. Giving less media space to anti-vaxxers, more attention to the complexities of vaccination and health education, and up-to-date information about access and accountability could help overcome some of the obstacles.

“Media portray vaccination as cut-and-dry, as in one is either vaccinated or is not. In reality, vaccination is much more complex," she said. “We need more media portrayals that provide realistic depictions of not vaccinating or under-vaccinating, showcasing, for example, the importance of herd immunity. We also need more stories of those who cannot be immunized and the effects that others' vaccine refusal has on this group."

At the end of our conversations, I asked each of these experts what else I should emphasize or mention in this piece. Troisi summed it up best: “Vaccines are safe and save lives."

Emily Rose Thorne is a junior at Mercer University and an aspiring multimedia journalist. She’s been involved with Step Up Magazine since 2017 and is now helping guide the editorial team as Senior Editor. Previously, she interned as a journalist for both Atlanta Magazine and Girls Rock Athens. She’s also served as Staff Writer, Lead News Writer and News Editor of her campus publication, The Cluster. She is currently the Digital Editor of The Cluster and a 2019 John M. Couric Fellow at the Center for Collaborative Journalism. This summer, she'll start producing audio and writing copy for Georgia Public Broadcasting in Macon.