‘The children who didn’t die’

HANOI—My last visit to this city was in the 1990s, and to say that it has changed a lot since then is to make an understatement. And yet, while the “xyclos” or trikes which used to dominate the streets have largely been replaced by motorcycles, as they have been in Beijing, and the city skyline has been changed inexorably by high-rises and gleaming hotels, there is still about Hanoi something of the slow-moving, rustic capital it was when I first walked its streets.

During my earlier visit, we were housed by the Vietnamese News Agency in a state guest house which I remember in particular because it was just across the street from a small lake. I saw some lakes as we made our rounds of Hanoi, but it was difficult to spot the exact lake because most of the weeping willows and pagodas had been replaced by kiosks and small shops.

Now, on our last night here, the three of us Filipinos—Ana Santos of Rappler, Karen Galarpe of GMA News Online and myself—with an Indonesian journalist from the newspaper Kompas, visited the Night Market in the “old town” and found a bustling Hanoi, with entire resident families and tourists weaving in and out of the hundreds of stalls peddling everything from Vietnamese handicraft, clothing, toys and electronic gadgets to Vietnamese coffee and tea, spices and even pho, the ubiquitous noodle soup that is served by both sidewalk stalls and posh hotels.

I didn’t visit the Night Market during that earlier time. Instead, our hosts brought us to small shops that specialized in specific types of native ware: embroidered bed sheets and pillow cases, woven baskets and hats, silk costumes, jade carvings, and even modern art. In many ways, I missed this “old” Hanoi, but the new one seems to have retained many of the charms of old, especially the colonial-era homes and town houses which lend the city a whiff of the quaint past.

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In this brief visit, I took part in what has been dubbed a “Media Workshop and Idea Exchange” focusing on vaccines, particularly the “big switch” scheduled to take place when world health authorities gear up for the eradication of polio.

By way of introducing our workshop, our facilitator noted that even as we, representatives of nine countries from Asia and elsewhere, would be meeting for our one-day session, “9,000 children from these countries will die.”

Lois Privor-Dumm, director of Advocacy and Communications of the International Vaccine Access Center and the Johns Hopkins Bloomberg School of Public Health, sought to situate our meeting in the global context. “How do you get across the numbers? The need for equity?” Privor-Dumm asked.

Talking on “The Value of Vaccines,” Dr. Tony Nelson of the Chinese University of Hong Kong pointed out that often lost in the debates over cost-efficiency, safety and effectivity is “the child who didn’t die.”

While news outlets might focus a laser eye on children who die due to causes linked to vaccination, rightly or wrongly, Nelson said “deaths prevented by vaccines are not really news.”

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In a way, vaccines may be said to be victims of their own success. After decades in which the lives of millions of children (and adults) have been saved as part of “routine” immunization, the good that has been done is no longer new or novel.

Instead, the so-called “anti-vaxxers”—doctors, activists and parents who declare that having a child vaccinated is akin to introducing “poison”—have made use of the media spotlight to present their contrary opinion.

And because the media are expected to be “objective” and thus obliged to present both (or all) sides of the story, the media often operate on what seems to be an “equity of expertise,” as if anti-vaxxers, who have little evidence or tendency to present these, are given equal coverage, their opinions given equal weight against those of vaccine experts, public health officials and even the World Health Organization.

It is also useful to make a distinction between “cause and effect” (as when a child gets sick or dies after receiving a vaccine dose) and “association.” It’s useful to point out that the child’s death or illness may be entirely unrelated to the vaccine.

Indeed, said Nelson, vaccines have long proven to be cost-effective, with $63 billion in health and other costs saved by the use of vaccines. “Five to six million [possible] deaths have been averted,” he added, while so-called “hidden costs”—like the time taken by parents to care for an ill child or to ferry him or her to the hospital, the lost potential of a child’s future, the continuing expenses of children affected by disease—are not accounted for.

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Part of the problem is that, as Nelson put it, “no vaccine is 100-percent effective, no vaccine is 100-percent safe.”

A case in point: the deaths of infants as a consequence of “intestinal twisting,” which takes place soon after a child receives a dose of antirotavirus vaccine. An international study was conducted to weight the negative consequences against the gains made by protecting a child from the rotavirus that causes diarrheal disease.

The finding was that, while the risk is real, illness and death are rare, compared to the great number of sickness and dying that had been averted.

“Tell that to the parents whose children died,” I said to myself, and indeed, another parent would later talk to us about the personal and emotional toll that childhood illnesses—especially vaccine-preventable illnesses—could have on a family and its future.