POST 00619E : COMBATING RUMOURS 13 December 2003
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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
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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)
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