Forward - Combatting Antivaccination Rumours: Lessons Learned from Case Studies in East Africa

The Genesis of Antivaccination Rumours

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 rumours 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.

Why is it important to document rumours?

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 rumour 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 rumours. 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 rumours

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 rumours. Additionally, this report seeks to determine whether there is a direct correlation between rumours 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.

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