Restoring trust in vaccines
Vaccines prevent disease, illness and premature death, saving between 2 and 3 million human lives each year, making them one of the greatest achievements in public health. Following the eradication of smallpox o e of the deadliest and most feared viral infections — in 1980, there was optimism among global health policymakers that other vaccine-preventable diseases like polio and measles would soon follow.
This positive outlook, however, has been tempered of late, in part due to the rise of vaccine hesitancy — defined as “delay in acceptance or refusal of vaccination despite availability of vaccination services” (MacDonald 2015), and identified by the World Health Organization as a top global health threat.
This prognosis is hardly surprising given the worldwide outbreaks of vaccine-preventable diseases. Just this year, the Philippines experienced a measles outbreak that affected over 20,000 individuals and claimed the lives of hundreds, most of them children. After being polio-free for almost two decades, the country has also seen polio’s comeback, prompting the Department of Health to start a massive polio vaccine campaign with community health workers and volunteers going door to door to give kids droplets of the oral vaccine.
The poor performance can be explained by a myriad of factors, including supply chain issues and lack of local health personnel.
But vaccine hesitancy definitely has a significant impact, as evidenced by the sharp drop in all already-low immunization programs in the aftermath of the dengue vaccine scandal in 2017.
How can we solve this problem and increase what scholars call “vaccine confidence”?
First, we need to be more inclusive in designing and implementing our immunization programs. That is, we need to bring together patient groups, civic organizations, academic institutions, local governments and other immunization stakeholders, to listen to (and act on) their concerns to help identify gaps in vaccine knowledge and sources of mistrust.
Second — and no apologies to Sen. Cynthia Villar — we need to pursue more research, from epidemiology to ethnography. Which areas and demographics are particularly affected by low rates of immunization? How is vaccination done in practice: Are parents properly oriented, and are potential side effects disclosed? Also, how did the dengue vaccine scandal affect people’s attitudes? Only by knowing people’s (mis)conceptions, and their underlying sources, can we begin to address them.
Third, we need to support everyone involved in immunization programs, from doctors and nurses to barangay health workers and even public school teachers. Physician recommendations have been cited as being most effective in helping parents make decisions about vaccinating their children, but the curricula of health professionals often leave them unprepared to communicate to patients (and parents) about vaccines, elicit community concerns, or deal with vaccine-related issues.
Fourth, we need to pursue more effective communication strategies. In this age of fake news and antivaccination movements, it is important for government and nongovernment organizations to mobilize offline and online channels to reach the public and counter misinformation. If celebrities can endorse beauty products, can they also not be the face of a life-saving program? Surely, too, health literacy in schools can go a long way.
Finally, we need to exact accountability from political actors, health officials and vaccine manufacturers alike for any acts of mismanagement, corruption or misinformation. Even if vaccines work, the prudence in implementing immunization programs or approving certain vaccines should not be immune from criticism or investigation; sometimes, the public’s mistrust has to do with legitimate concerns.
Ultimately, then, if we are to restore Filipinos’ trust in vaccines, we need to restore their faith in our institutions. And if we are to restore their faith in our institutions, we need to work on improving those institutions’ inclusivity, efficiency, transparency and accountability.
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Melvin Sanicas (@Vaccinologist) is a public health physician specializing in vaccines and infectious diseases. Gideon Lasco (@gideonlasco) is a medical anthropologist and Philippine Daily Inquirer columnist.
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