Vaccine Concerns in the Developing World

Are people in developing countries really desperate for vaccines? Do they really walk for hours to get their children vaccinated. Maybe they do. But clearly, not everyone in the developing world is a believer. In fact, as you’re about to read, some are vaccinated at gunpoint…

Philippines

In 2015, more than 80% of people in the Philippines strongly agreed with the statement that vaccines are safe. A more recent poll in 2018, found that only 20% of people in the Philippines agreed with the statement. In 2015, 82% of people were confident in the effectiveness of vaccines, but in 2018, only 22% felt that vaccines are effective [1]

What happened in the Philippines between 2015 and 2018, that so badly shook people’s faith in vaccines?

It seems the main driver was a disastrous dengue vaccine trial for Dengvaxia, which was given to more than 800,000 school-children (although numbers from different media outlets vary – from 720,000 up to 830,000), from early 2016 through to early 2018 [2].

The program was then suspended, but not before more than 3000 children were hospitalized [3] – some for dengue fever. As of September 2018, at least 150 deaths had been reported among children who received the vaccine, but authorities declared that many of those were due to pneumonia, leukemia, asthma, central nervous system infections, and therefore ‘occurred naturally’ [4].

More than 190,000 of those vaccinations were given without parental consent [5].

The public confidence in vaccines was so severely shaken by the disaster, that routine vaccination rates in children fell to 50%-60% in 2018. Seventy-seven percent of schoolgirls had received the first shot of HPV vaccine, but only 8% of schoolgirls got the second shot.

A supplemental vaccine drive, to raise measles vaccination rates, saw health workers going from door to door, and many mothers hid their babies. As little as 36% of babies in metro Manila region received the vaccine. The Department of Health Undersecretary remarked that “health workers would spend up to 30 minutes trying to convince parents to have their children vaccinated” [6].

Health secretary Francisco Duque III declared “If needed, they (health workers) must woo the parents to allow the DOH to administer vaccines on their kids” [7].

Thailand

In some provinces in Southern Thailand, vaccination rates are below 50%, as Muslim believers refuse vaccinations. Islamic leaders addressed the issue, by saying that “though some vaccines contain ingredients derived from pigs, which are forbidden for Muslims, it was more important for a good Muslim to remain in good physical health at all times”.

“Therefore, until alternative vaccines that do not contain haram ingredients are invented, Muslims may use vaccines without having to worry that they are violating the Islamic doctrine” [8].

The messages of support from religious leaders are displayed on health authority websites, in an effort to quell concerns, and promote vaccination. Despite vaccination teams visiting schools and homes, some parents signed letters declaring they would not receive vaccines – now, or in the future [9].

India

In an effort to persuade reluctant villagers to have their children vaccinated for polio, the Indian government and UNICEF also use religious leaders to increase vaccine uptake. Islamic leaders give speeches before Friday prayer services, using quotes from the Koran, to encourage their people to accept vaccines. Newspaper columns are prepared and signed off by religious leaders. They also conduct radio question-and-answer sessions to reassure hesitant parents [10].

Vaccine hesitancy in remote areas is hardly surprising. As one religious leader put it: “For decades, the government machinery has not reached out to them; there are no proper roads, no drainage systems, no employment opportunities, no basic facilities – and suddenly a team of health officials arrive there to say we care for your children and therefore we want to vaccinate them [10].

Uganda

In 2016, the Ugandan government announced a new law that would punish non-compliant parents with six months jail time. Anybody found making “public misleading statements about vaccinations could face two years in prison or a fine, under the same law”. A Ugandan baby must have an ‘immunization card’ in order to have their birth registered, and obtain a birth certificate. That immunization card must be shown in order to enrol at school [11].

One religious group in Uganda, known as Njiri Nkalu, are vehemently opposed to vaccines, believing in divine protection, rather than man-made vaccines. In 2016, health workers, along with armed police, forcefully entered their homes and vaccinated some 200 children. Many of the parents and children tried to flee into nearby sugarcane fields, but were rounded up and vaccinated for polio. One member was heard to say: “We don’t see why you bring all these guns to harass us. Our children are protected by God and we don’t need polio vaccines” [12].

At least ten members of the group were detained by police, but later released without charge [13].

The officers also forcefully entered the homes of Tabliq Muslims who had refused vaccines for their children. The District Commissioner, who accompanied the officers, said “Although the operation was a success, there are those who were tipped off and disappeared into the bushes with their children. We shall come back to get them” [12].

Nigeria

In 2003, three states in Northern Nigeria boycotted the oral polio vaccine, due to the alleged discovery of contaminants, including trace amounts of estrogen. The boycott lasted for 15 months [14].

Today, many in the African nation still remain deeply suspicious about the true motive of aggressive vaccination programs. One group is the infamous Boko Haram (which translates to ‘Western education is forbidden’), who came to the world’s attention in 2014, when it was reported they had kidnapped 276 school-girls.

It is too dangerous for vaccinators to go into Boko Haram-held territory during national immunization days, but they do manage to get those who are leaving, or fleeing the area…” At the bus stations, and the state and national border crossings, the lunchbox-toting teams (the polio vaccines are packed into lunchboxes) are there. Peering into cars, lifting the cloaks of women perched on motorbikes to find the babies strapped to their fronts and backs. Squeezing in the little vials of vaccine.

“If they say no, then we tell them they can go back,” said superintendent of immigration, Charles Tashllani, imposing order on Nigeria’s border with Niger in Katsina. Here, late in the evening, the Polio Emergency Operations committee reviews the campaign’s first day, which has seen 3,661 teams immunise 28,882 underfives. The detail is such that eight missing marker pens are on the agenda, as is the sacking of two town announcers who did not inform people about the programme” [15].

But it’s not just extremists who have their doubts. Media reports over the years, reveal that hundreds of parents have been threatened with jail time and prosecution [16].

Pakistan

In 2015, more than 500 parents were arrested by police in Pakistan, for not allowing their children to have the polio vaccine. They could be released on bail, only if they signed an affidavit that they would allow their children to get the vaccine.

A UNICEF team leader in Pakistan explained that “First the workers (try to) convince them, then their supervisors, then senior members of the community”. If all that coercion and intimidation fails, and the parents still resist, then the police are called to arrest them” [17].

Earlier this year, a health worker was murdered, trying to persuade a man to let his children have the oral polio vaccine [18]. This comes amidst reports of an angry mob of parents setting fire to a hospital, after school-children were vaccinated, and 75 students later fell sick. Doctors denied the illness was due to vaccines, and suggested they probably felt sick due to their parent’s anxiety about vaccines [19].

China

In January, 2019, hundreds of parents in Jinhu, China, marched in the streets, demanding an explanation for the expired vaccines given to their children. More than 100 children had suffered fevers, skin rashes, and vomiting – some for months on end – since receiving the vaccines.

“Local authorities eventually found that an entire batch of vaccines was used instead of being destroyed”. Parents claimed the same kinds of reactions had been occurring for at least 10 years, and believe expired and faulty vaccines had been used for years.

Riot police from neighbouring counties were brought in to quench the protests, and authorities banned both regular and social media from reporting on ‘inflammatory’ news about vaccines [20].

It is just one, on a growing list, of vaccine scandals and controversies in China, with many parents declaring they have lost faith in China-made vaccines [21].

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References:

[1] Larson HJ, Hartigan-Go K, de Figueiredo A, Vaccine confidence plummets in the Philippines following dengue vaccine scare: why it matters to pandemic preparedness, Human Vaccines & Immunotherapeutics, 2018.

[2] Newey S, Trust in vaccines plummet following dengue scandal in Philippines, The Telegraph, 12th October 2018, https://www.telegraph.co.uk/news/0/trust-vaccines-plummet-following-dengue-scandal-philippines/. Accessed March 2019.

[3] DOH: Over 3000 students hospitalized after dengue shot, Rappler, 13th April 2018, https://www.rappler.com/nation/200187-doh-students-hospitalized-dengvaxia. Accessed March 2019.

[4] Tomacruz S, 19 out of 154 kids died of dengue despite Dengvaxia shot, Rappler, 26th September 2018, https://www.rappler.com/nation/212904-doh-report-number-children-dead-dengue-dengvaxia-shot-september-2018. Accessed March 2019.

[5] ABS-CBN News, Failon Ngayon: Dengvaxia, Available on youtube, https://www.youtube.com/watch?v=AQObs3vk3l0 (see at 5:39), Accessed March 2019.

[6] Tomacruz S, Parents still scared of govt’s free vaccines a year after Dengvaxia scare, Rappler, 27th September 2018, https://www.rappler.com/nation/212927-child-vaccination-rate-philippines-as-of-september-2018#cxrecs_s. Accessed March 2019]

[7] Cepeda M, Duque to health workers: ‘Woo’ parents to avail of vaccination programs, Rappler, 21st Febrary 2018, https://www.rappler.com/nation/196551-duque-health-workers-woo-parents-vaccination. Accessed March 2019.

[8] Rujivanarom P, ‘Vaccine Denial’ Behind Measles Deaths in the South, The Nation, Thailand Portal, http://www.nationmultimedia.com/detail/national/30356655. Accessed February, 2019.

[9] Vejpongsa J. Muslim concern about vaccine fuels Thai measles outbreak, AP News, 6th November, 2018.

[10] Pisharoty S. Interview: Muslim clerics to address misconceptions on ongoing measles-rubella vaccine drive, The Wire, 24th April, 2017.

[11] Global Press News Service, Anti-vaccine parents in Uganda face jail time under new law, The Seattle Globalist, 23rd August 2016.

[12] Yolisizira Y. 10 arrested over polio immunization, The Monitor, 3rd June 2016. As of 29th June, this article is still available online, at: https://www.monitor.co.ug/News/National/10-arrested-polio-immunisation/-/688334/3186268/-/view/printVersion/-/11q2sgd/-/%2523.

[13] Uganda 2016 International Religious Freedom Report, https://www.state.gov/documents/organization/268952.pdf Accessed March, 2019. (Note: This document has since been moved or removed from the State Department website, despite both the 2015 and 2017 reports still being available…)

[14] ABC News. Vaccine Boycott Grows in Northern Nigeria, 24th February, 2004.

[15] McVeigh T. Nigeria battles to beat polio and Boko Haram, The Guardian, 7th May 2017.

[16] Hundreds of Nigerian parents refuse polio vaccines, The Star, 2nd August 2011, https://www.thestar.com/news/world/2011/08/02/hundreds_of_nigerian_parents_refuse_polio_vaccines.html. Accessed March 2019.

[17] Saifi S, Botelho G. Over 500 Pakistani parents arrested for children’s failure to get polio vaccine, CNN, 4th March 2015.

[18] Farmer B. Polio worker gunned down in Pakistan trying to persuade family to vaccinate children, The Telegraph, 9th April 2019.

[19] Farooq Khan O. People set hospital afire in Peshawar, Times of India, 23rd April 2019.

[20] Police and parents clash in Jiangsu after 145 children get sick from expired vaccines, Asia News, 11th January 2019, http://www.asianews.it/news-en/Police-and-parents-clash-in-Jiangsu-after-145-children-get-sick-from-expired-vaccines-45954.html. Accessed March 2019.

[21] Leng S, Huang K. As new vaccine scandal grips China, parents say they have lost faith in the system, South China Morning Post, 22nd July, 2018.

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