In March, an individual referred to as “patient zero,” traveled from New York, unaware that he had measles, and infected 39 people in Michigan.Reference Sun ¹ This event was the harbinger of an alarming number of new cases in Michigan, exposing gaps in preventive healthcare and highlighting important vaccine hesitancy issues. This highly infectious viral disease, which has an extremely high mortality rate in children, was almost eradicated in early 2000, but it is now emerging as an epidemic, sweeping across 19 of the 50 states.

Currently, Michigan has been hit hard by this health crisis, which has brought gaping holes in herd immunity caused by low vaccination rates to the spotlight once again. Why, despite the obtainability of a cheap and very effective vaccine, are people hesitant to get their children vaccinated? Let’s examine some of the socioeconomic, psychological, and awareness barriers. First, misinformation about vaccines is likely the leading cause of the extremely low vaccination rates. Although some nonsecular communities actively refuse the vaccine for religious and philosophical reasons, other religious organizations and churches can become active collaborators with public health officials to raise awareness, educate their congregations, assist in vaccine delivery, and effectively increase the immunization rates.Reference Wombwell, Fangman, Yoder and Spero ² This spiritual and medical partnership can be invaluable in persuading people and providing an additional “health touch point.”

Despite aggressive public health campaigns, the numbers of vaccine “self-seekers” are lower in less affluent socioeconomic areas. People living below the poverty line tend to focus on the basic necessities (eg, food, water, and shelter), as Maslow’s Hierarchy of Needs suggests.Reference Lester ³ The rigors of daily life, the struggle to make ends meet, and the lack of resources, such as transportation are barriers, must not be overlooked or underestimated.Reference Fuchs ⁴ These problems highlight the dire need for making vaccinations more accessible to underserved communities.

Various factors influence health, but many factors are significantly outweighed by the intense impact of social and economic conditions.Reference Marmot and Allen ⁵ The lack of food, clothing, housing, and employment are crucial and more pressing issues. However, they should not prevent any resident from accessing this preventive healthcare option. The socioeconomic determinants of health care are probably the most significant obstacles in a city like Detroit. We should seek to implement effective delivery methods that are sustainable and can overcome the “access obstacle.”

Some individuals in Detroit simply cannot get the measles vaccine because they do not have transportation to get to public health facilities. To increase the vaccination rate, we should look into ways that vaccines can reach these individuals where they are. For example, polio was recently eradicated in India using home vaccination visits.Reference John and Vashishtha ⁶ Until 2009, 60% of polio cases worldwide occurred in India. The government, alongside global partners, doubled down on immunization efforts to achieve eradiation in 2014, despite India’s vast population, poverty, and environmental challenges. As a part of a nationwide campaign, healthcare workers made home visits to administer the polio vaccine to people in remote areas.

With adequate funding, similar campaigns can take place locally in Detroit. Collaborative efforts among healthcare workers, religious leaders, highly esteemed peer leaders, and political candidates can intervene positively to improve vaccination rates. Community centers, churches, malls, as well as train and bus stations can be used to target and spread awareness of vaccination resources among residents who would normally not hear about them.

As a nation, we must adopt a proactive strategy to ensure that no child suffers from a vaccine-preventable disease. A legion of local health workers, parents, teachers, volunteers, and peer role models is needed to protect every child in the community. Initiatives such as going door to door in different communities, dispelling fears that parents may have, and trying to reach every last child, must be encouraged and supported.

In this age, media also plays a vital role in shaping public opinion—social media is a very powerful tool. Media coverage of antivaccine proponents has effectively increased public mistrust and has perpetuated damaging attitudes toward healthcare providers administering these immunizations. The global antivaccine movement has unfortunately gained momentum and has a massive online presence. However, provaccine stewards can permeate the community and spread the message as well. Initiatives such as targeted media campaigns, pro-vaccine blogs, and efforts that focus on the most vulnerable populations can turn this negative trend into an impactful positive one.

In conclusion, we feel that understanding the social determinants of health inequality and trying to eliminate vaccine hesitancy in our community is fundamental to improving the vaccination rates in underserved communities like Detroit. Collective efforts, partnerships starting at the grassroots level, and multilevel cooperation can improve the number of immunized people, strengthen herd immunity, and avert the measles health crisis.