Badge of shame

We are in the middle of a global resurgence of vaccine-preventable diseases. On the heels of an increase in measles cases followed by dengue fever, poliomyelitis has followed suit. The World Health Organization has gone so far as to call vaccine hesitancy — a refusal or reluctance to vaccinate — one of the top threats to global health this year.

With regard to measles and dengue cases, many blame the Dengvaxia scare for disruptions in a local vaccination program that has enjoyed reasonable success for years. Certainly, the fearmongering surrounding the dengue vaccine has done our country no favors, and this skepticism has bled onto other essential vaccines. Unfortunately however, we seem not to be an isolated case: Pakistan, one of the few countries in the world where polio had yet to be completely eradicated, saw a troubling increase in the number of cases of children testing positive for polio, higher this year than any year since 2014.

Previously, approval of vaccines was lowest in more affluent countries. According to a global survey this year by the Wellcome Trust and Gallup, those in higher income countries are more likely to distrust vaccines compared to those in developing areas. The loudest and most popular voices of the antivaxx movement, as it is today, are rooted in North America, but the rhetoric has spread and been transformed to gain traction elsewhere, ultimately undermining long-standing efforts to increase vaccine coverage in children in developing countries—thus leading to outbreaks of preventable diseases in those areas least equipped to manage them. One of the most worrying comments I read following this week’s polio scare adopts some of that classic antivaxx thinking; a Filipino Facebook user was seen to comment that he’d rather have his child develop polio than inoculate, because we “never know” what’s in the vaccines. It’s a heady mix of miseducation and distrust of “Big Pharma.” Vaccine distrust has also been heavily driven by social media. News of few cases of adverse reactions to vaccination drives can be enough to dismantle years of public health work.

Pakistan also shows us a daunting example of how politics can heavily impact public health efforts to eradicate preventable diseases. As with other developing areas, deficiencies in health infrastructure play a role in access to vaccination, and misinformation campaigns by militant and religious groups continue to perpetuate antivaccine myths in select areas. However, vaccines have also been used by other groups as blackmail against the government, with some refusing to inoculate their children unless political demands, like the withdrawal of sales taxes, are met. Health workers bringing polio vaccines door to door risk being met by violence. The Pakistani government seems to be taking aggressive measures to combat these efforts, but they’re still facing a major setback in polio eradication for a country which, a few years ago, had been on the verge of eliminating the disease.

Polio in Pakistan, called its “badge of shame,” is a cautionary tale for us — if local measles and dengue outbreaks were not enough of a wake-up call. It is a prime example of how drastically political divides can influence public health to terrible extremes, with the health of a country’s children at stake. It’s unconscionable that vaccines should be used to advance any political agenda other than public health ones. It’s unconscionable that those who should suffer are the most vulnerable group of all — young children in developing areas, who may already have limited access to vaccine coverage, and who also have limited resources to manage the consequences of infection. While the Department of Health bears the burden of combating vaccine hesitancy and complacency, leaders with any influence at all, whether militant, religious, political or otherwise, should take extreme care to cooperate with the global campaign to eradicate vaccine-preventable diseases, and have the moral burden of making sure that children don’t suffer as a consequence of political games.

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