Vaccine hesitancy is a concept as old as vaccines themselves. Are we seeing more of this issue, and is it opening doors for diseases close to elimination to resurge in India?
Reports of outbreaks of the oldest vaccine-preventable diseases such as measles, pertussis, diphtheria are becoming more frequent, despite these diseases being entirely vaccine-preventable. This may be due to more and more individuals opting out of receiving vaccines, reducing overall immunisation rates and once again allowing these diseases to flourish.
There have always been individuals sceptic of vaccines, but these may be growing in number
For those who have little knowledge of the concepts of vaccination, misinformation can easily sway an individual against the treatment. Injecting an individual with a diminished or dead version of a virus can easily be reworded into sounding like a sinister practice. As such, since the very beginning of the practice of vaccination, there have been those who campaign against it.
In India, vaccine scepticism has often been influenced by religious suspicions and rumours. A large-scale community resistance surfaced in India’s northern region of Uttar Pradesh and Bihar states prior to the eradication of polio. Similar patterns of resistance to the polio vaccine emerged in parts of Nigeria and Pakistan, the latter of which is one of only two regions in the world left where polio maintains a presence (the other being Afghanistan).
Major rumours included suggestions that the polio vaccine caused infertility. This line of thinking was prevalent among Muslims who frequently insisted that vaccination programmes were part of a larger government agenda to reduce high birth rates in the Muslim community.
Vaccine hesitancy refers to the effect rumours such as this have on uptake of vaccination. The World Health Organization (WHO) defines vaccines hesitancy as the “delay in acceptance or refusal of vaccines despite availability of vaccination services” and suggests, “It is influenced by factors such as complacency, convenience and confidence.”
Trust in vaccination is falling, despite clear successes of the past
India is a leading producer of vaccines. It has enjoyed numerous vaccination campaign successes in the past. Despite this, around 60,000 Indian children under five die of vaccine-preventable diseases every year.
India has demonstrated its capacity for successful vaccination campaigns in the past. On March 27, 2014, the World Health Organization (WHO) declared India polio-free. Due to sustained vaccination drives, India has remained polio free ever since. This success was built on the back of grassroots campaigns, all the way up to political willpower, as well as media outreach performed by well-known media personalities.
By comparison to these successful vaccination drives of the past — ones capable of driving diseases out of India — current campaigns can only be described as lacklustre. Faith in vaccines is shaking and little public discourse is being made to diminish these fears.
Homoeopathy and AYUSH therapies are being promoted, often at the expense of allopathic treatment. This may aid in the growing public mindset that “Western-style medicine” such as vaccinations may indeed be bad for them, and a natural approach is better for the body. This mindset does little to reduce the risk of measles, pertussis, diphtheria.
The Indian vaccine market is worth Rs 69 billion (approximately one billion USD) as of 2017, having grown eighteen percent since 2010. Of the total amount of vaccines produced, around two thirds are exported. The remaining third is used domestically.
The measles and rubella campaign
There is currently a campaign underway to vaccinate children across India for both measles and rubella. Unlike many other nations, the standard measles, mumps and rubella vaccine is not in use, as mumps is not viewed as a major threat by the Indian government. This is despite the disease’s potential to cause lifelong health issues.
Reports of parents refusing to allow their child to be vaccinated are becoming ever more common. A number of factors have increased the resistance of many communities to the campaign. Some schools opted to give the children vaccinations without the consent of the parents, sparking a backlash. This was taken to the courts and stalled the campaign in Delhi.
Frequent parent objections have forced the suspension of vaccination campaigns entirely at around seventy schools in Mumbai. This opens up the possibility of large numbers of children — all in close proximity — to become vulnerable to vaccine-preventable diseases, with ample opportunity to infect each other. This could potentially lead to a large-scale outbreak.
Fear campaigns referencing side effects or even child deaths following vaccination (often from a cause entirely unrelated to the vaccine) are leaving large numbers of people forgoing vaccination. Heavy handed tactics by health officials are easily construed as forcing the vaccination on the children and do little to alleviate these fears.
Information must be distributed to allow the public to see the benefits of vaccines, rather than simply forcing it on the public. India has a wide range of success stories to draw from to improve public perception of vaccines, from reduction in numbers to outright elimination and eradication of some illnesses. Using such information could go a long way in convincing sceptics vaccines could have the same successful results again.