The rising tide of “vaccine hesitancy” has become impossible to ignore. There have been a number of big news headlines surrounding this controversy this year: the World Health Organisation's classification of vaccine refusal as one of the top 10 global health threats in 2019, the Italian government's decision to exclude unvaccinated children from school, and Youtube's pulling of adverts on anti-vax videos, not to mention numerous outbreaks of diseases that had previously been all but eradicated. We've reached a point where the conversation about this issue never seems to cease, but why are we having it, and does it really reflect the scale of the problem?

Our medically-minded readers will probably need little convincing of the safety of vaccinations, their benefit to individuals and society, and the fraudulence of Dr Andrew Wakefield. Our greater challenge is trying to understand why some parents question what we see as facts. Indeed, it could be argued that anti-vaxxers on the whole are less concerned with science than with morality. For example, much of the resistance to the HPV vaccination hinged on concerns about the implications for sexual activity among teenagers. Jemima Lewis writes in The Telegraph that anti-vaxxers are generally liberal types who “trail an odour of sanctity and superior wisdom”, justifying their choice not to vaccinate as an unwillingness to “take chances” when it comes to their child's health. Those in favour of immunisation become increasingly frustrated by seeing how convinced anti-vaxxers are of their own virtue, but condemning them only adds to their sense of martyrdom. We end up stuck on a merry-go-round of recrimination.

It's not just middle-class New Age metropolitans who are vaccine refusers, according to David Aaronovitch in The Times. The distrust of experts and state intervention that has driven the rise in political populism has also engendered the conditions for vaccine hesitancy. Unfortunately, for now it seems that just like in politics, there is a tendency to reject respectful debate in favour of becoming more entrenched on one side of the fence.

However, the framing of the issue in such black-and-white, militaristic terms may in part be contributing to the fervour surrounding it, writes Samantha Vanderslott on theconversation.com. Anti-vaxxers make for sensational headlines, but little attention is paid to those in the grey area who are simply “hesitant” - delaying vaccination or picking and choosing which they accept. Media coverage has also sidelined other important reasons for low vaccination rates, including poverty and lack of access. It is important to bear in mind that anti-vaxxers are still very much in the minority (around 2% in the US and Europe), and that beliefs don't necessarily translate into actions. Social pressure, parental disagreement and potential repurcussions could all mean that a sceptical parent eventually chooses to vaccinate their child.

Healthcare professionals are rightly worried about the threat to herd immunity posed by falling vaccination rates. However, in the current climate it seems likely that shouting about the importance of immunisation will only add to the noise and further polarise the debate. Our efforts should focus on addressing the myriad reasons for low vaccination rates as well as the misconceptions and grievances that underlie vaccine hesitancy.