Vaccine Hesitancy

As a mother of three young children and a public health doctor as well, the first reported case of polio shocked me. We have not had a polio case in Malaysia for 28 years. Just weeks after the first reported case, we hear the devastating news of two more unvaccinated children falling ill due to polio, one of whom is now reported to be on a ventilator.

Vaccine Prevents Diseases. Vaccines save lives.
Pic source: Freepik

This is sad news indeed, especially when we know that polio is a purely vaccine preventable disease (VPD). It was reported that the vaccine coverage in the area where the children lived was sub-par and those involved were immigrants.

While in these cases they were undocumented immigrants who didn’t qualify for vaccinations under the National Immunisation Programme, there is also a broader hovering issue that needs to be addressed when it comes to VPDs.

And it’s not just polio. Measles outbreaks, for example, have been on the rise. In 2018, the incidence rate for measles was 5.96 per 100,000 population. In 2015,2016 and 2017, it was 4.32,5.01 and 5.28 respectively. At the same trajectory, we can see the Measles-Mumps-Rubella (MMR) immunisation coverage of children coming down. In 2018, it fell to a low of 87.75%.

Vaccines prevent diseases. Vaccines save lives. If you’re not vaccinated for a VPD, you carry a risk of getting ill, passing it on to others and even dying from that disease.

The risks of side effects due to vaccinations are very, very low. There is data proving this since vaccine side effects are indicators that are monitored globally across nations. And yet vaccine hesitancy is real. It is known as the reluctance or refusal to vaccinate despite the availability of vaccines. It is so real that the World Health Organisation (WHO) listed it as one of the 10 threats to global health in 2019, along with Ebola and other high threat pathogens.

In Malaysia, we know there are rapidly growing communities who openly oppose the administration of vaccination of their children. They cite multiple dubious literature gathered from the Internet to back their claims. They even have a manual of compilations of these references. They call themselves pro-choice but are better known as anti-vaxxers. There is always an ongoing war between the so-called pro-choice community and the pro-vaccine community.

What can we do to convert the pro-choice communities? Firstly, the berating and name-calling have to stop. These people truly believe that they are doing the best for their children based on their false understanding.

Secondly, we need to validate that it is okay to have questions on vaccines. Healthcare providers, front liners and community members alike have to be equipped with the right knowledge and attitude to advocate pro-vaccine messages, just like the pro-choice gurus are equipped with their manual. There are proven methods to do this.

For example, motivational interviewing is a client-centred method to dissect and explore concerns of vaccine-hesitant parents. Research has also shown that people are more likely to adhere to advice when there is mutual trust between the client and the provider.

Parents must also be treated as partners in the vaccination programme and have convenient and simple access to authorities to discuss and resolve concerns.

Framing the message in a language and context that fit the needs of the parents is also key. An excellent example would be the message that was coined when the HPV (human papillomavirus) vaccination was first introduced in the National Immunisation Programme as part of the campaign to prevent cervical cancer.

The cancer prevention campaign became a target of misinformation, with the vaccine-hesitant group even raising the issue of sexual promiscuity and HPV Vaccination. The eventual message that went out was “HPV immunisation, given when your daughters are young, will protect them when they eventually get married”. This message avoided association between vaccine protection and early sexual activity.

At a time when thousands are getting ill due to cervical cancer together with the re-emergence of measles, mumps, diphtheria, polio and other VPDs, we must consolidate our actions and find a way to mount an action plan and vigorous response to rebuild public trust in vaccinations and improve our herd immunity. It’s our children’s lives that are at stake here!

For now, the government’s decision to work with WHO and Unicef to vaccinate children below the age of five in Sabah, including the undocumented and non-citizens, is most welcomed.

This article was published in The Star, on the 13th January 2020. The link:

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