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POST 00619E : COMBATING RUMOURS 13 December 2003 _______________________________________ UNICEF Regional Office for East and Southern Africa (ESARO) has produced a report two years ago with the help of Joyce Kramer, on antivaccination rumours and how to combat them. The topics has lost no relevance and this popular document is regularly updated. The problem even seems to be growing and it affects many countries, especially in their efforts to eradicate polio and eliminate tetanus. Robert Davis (mailto:[log in to unmask]) from ESARO is sharing with us the last version revised this month. Many of you will be very interested especially programme managers who will find useful ideas and strategies. The document is rather large (92 pages) and relatively heavy (372K). So we reproduce only the foreword and condensed "Lessons learned" here below. Those who are interested in the full document, it can be accesses directly from our site at : http://www.technet21.org/COMBATINGRUMOURS.doc _______________________________________ Foreword * The Genesis of Antivaccination Rumors The Expanded Programme on Immunisation (EPI), set up in 1974, has been one of the largest and best documented public health programmes in history. The present report seeks to fill a gap on the EPI bookshelf by documenting an underreported phenomenon in developing countries, namely, the rise of antivaccination campaigns mounted against vaccination. The vaccination programmes of recent decades have, to a certain extent, been the victims of their success. As morbidity and mortality have declined, so, too, has the African public's perception of the importance of some vaccine preventable diseases (measles is a notable exception). Fears of side effects and rumors of long term repercussions of vaccination, never entirely absent, have surfaced as vaccination programmes have matured and approached their goals of polio eradication and tetanus elimination. The near disappearance of some EPI target diseases, especially polio and, in some countries, tetanus, has raised the quite natural question "Why vaccinate?" This question has arisen just as political and religious forces opposed to government have a new tool, in the Internet, to provide support to their allegations against vaccination. The large and growing scientific literature on vaccine side effects has become a blunt instrument for attacking all vaccines, without due attention to the question which all parents need to answer: do the benefits of this vaccination for my child exceed the risks? There are, of course, articulate defences of vaccination against its detractors. In the international field, the best known of these is the World Health Organization (WHO) homepage, http://www.who.int/vaccines-diseases/sa ... ttox.shtml) * Why is it important to document rumors? Given the importance of vaccination, and the possible threat from antivaccination campaigns, surprisingly little has been written on the subject from developing countries. The subject has been widely reported from industrialised countries, especially the sometimes devastating campaigns against pertussis vaccination (1). A recent report by the U.S. monthly Consumer Reports, examining anti-vaccination attitudes and arguments in the US context, notes that questions about vaccine safety "can be detrimental to the general public, as those with concerns may choose not to have their children vaccinated." The report cites findings of a Colorado study that concluded that unimmunised children are 22 times more likely to contract measles and six times more likely to contract pertussis than those vaccinated. In developing countries, where case fatality rates may be higher, the effects of antivaccination campaigns carry risks even more serious than in the industrialised countries (2). * Documenting rumor campaigns The present report contains case studies from Kenya, Uganda, and Tanzania done by a consultant for the UN Childrens Fund, UNICEF. Each case study involved an in-depth study of the campaigns and included interviews with key players said to have spread rumors. The studies sought to determine the basis for their views and whether they were, or can be, brought over to the EPI position by persuasion. Interviews and focus groups included mothers, fathers, health workers and officials, religious leaders, the media, and elected officials. * Combating rumors This report also reviews responses of national and local governments, WHO, UNICEF, and other agencies and officials to see whether these responses were effective in combating or stopping the rumors. Additionally, this report seeks to determine whether there is a direct correlation between rumors and drops in vaccination rates. If so, what can we learn for future campaigns? What is working? What is not? * Developing tools to use in future campaigns Finally, this report looks at lessons learned from the experience of these three countries. From the lessons of these campaigns, can a set of tools be prepared to share with other national programmes to support future vaccination campaigns and routine immunisation? The country studies show the need for tailor made responses. With that much said, there are generic lessons learned from these studies which are of more than country specific interest LESSONS LEARNED The following table shows how rumor campaigns have developed in different ways in western countries and in the three countries studied in the present study. COMPARISON OF ANTIVACCINATION RUMORS IN WESTERN AND EAST AFRICAN COUNTRIES WESTERN COUNTRIESEAST AFRICA TARGET OF ANTIVACCINATION CAMPAIGNSROUTINE VACCINATIONSSIAs VACCINES MOST OFTEN TARGETEDPERTUSSIS AND MEASLES/MUMPS/RUBELLATETANUS TOXOID AND ORAL POLIO VACCINES CORE ARGUMENTS AGAINST VACCINATIONMEDICAL AND PHILOSOPHICAL ARGUMENTSRELIGIOUS AND POLITICAL ARGUMENTS HIV/AIDS ARGUMENTS NOT IMPORTANTIMPORTANT IN SOME COUNTRIES FAMILY PLANNING ARGUMENTS NOT AN ISSUEIMPORTANT IN SOME COUNTRIES "WESTERN PLOT" ARGUMENTSNONEXISTENTCOMMON MILITARY VACCINESIMPORTANT FOR ANTHRAXNOT IMPORTANT While every rumor campaign has its specificities, the following generic responses are often indicated. BEFORE THE SCHEDULED ACTIVITIES · Prepare packages on frequently asked questions for all health workers, especially before vaccination campaigns or introduction of new vaccines. · Involve ethnic, religious and political minorities in information activities. · Schedule EPI campaigns outside the timeframe for family planning or AIDS awareness campaigns. · Associate tetanus toxoid in the public mind with successful pregnancies. · Give TT in prenatal clinics, not family planning clinics. · Keep TV, radio and other media on board. WHEN THE STORM BREAKS · Disseminate a single set of messages through the same channels as those used by the rumormongers. Everyone from the dispensary attendant to the Minister of Health needs a copy of the key messages, with no confusion about the official line. · Do not raise the rumormongers' profile by identifying and denouncing them. Our job is informing the public about vaccines, not denouncing our opponents. · Monitor vaccinations in areas reached by rumors. Do not overreact where there is no decline in vaccinations. Quantify impacts. Do your vaccination tally sheets tell a different story from what you anticipated? Do not respond to a decline in vaccinations which does not, in the event, materialize. · Meet with your opponents as well as your friends. · Combat ignorance with knowledge, not with coercion. (1) E J Gangarosa, A M Galazka, C R Wolfe, L M Phillips, R E Gangarosa, E Miller, R T Chen, "Impact of anti-vaccine movements on pertussis control: the untold story," The Lancet 1998; 351: 356-61 (2) "Vaccines: An Issue of Trust" 01/08/01 Consumer Reports Online (http://www.consumerreports.org) ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________
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