Owing to medical misinformation and vaccine hesitancy some of the deadly diseases, which were once completely eradicated in India are making a comeback. Dr Sobuhi Iqbal and Deepika Khurana report.

Almost two years ago, the coastal city of Kannur in Southern Indian state of Kerala, the most literate state in India was in the grip of viral hoaxes and fake messages travelling on WhatsApp about how vaccines were causing more harm to their children than doing any good. As a result, parents of more than 2,40,000 children refused to give the combined measles, mumps and rubella (MMR) vaccine to their children and thus, the immunisation drive was stalled for two months.

Similarly, in Gujarat and Mumbai, the vaccination drive was stopped in hundreds of schools after the fake news of vaccines causing infertility went viral on WhatsApp and Facebook. Medical misinformation and vaccine hesitancy is a growing problem that is harming public health and putting the lives of countless children at risk. Millions of children died across the globe due to vaccine-preventable diseases.

According to the Indian Ministry of Health, in India alone, every year, half a million children die due to vaccine-preventable diseases and another 89 lakh remain at risk due to partial or no immunisation. And, what’s raising alarm bells is the fact that some deadly diseases, such as measles, diphtheria, polio and pertussis which were once completely eradicated are making a comeback.

“In Malappuram district of Kerala, diphtheria, that was eradicated has resurfaced and claimed a few lives in the region. It’s unfortunate because parents often refuse to get their children immunised owing to reasons which have absolutely no scientific relevance,” said Dr Shimna Azeez, MBBS lecturer at Government Medical College, Malappuram district of Kerala.

According to Dr Azeez, they have to keep making rigorous efforts to convince and improve immunisation coverage in the district.

“I sometimes wonder if, in Kerala; the state where almost every household has a doctor, we face this problem of convincing people who blindly believe in preachings of pseudoscientists then what would be the condition in other parts of our country,” said Dr Azeez who is a prolific writer and prominent face when it comes to breaking medical myths and misinformation in Kerala.

Until 2017, Malappuram had remained a blot on the State’s health map with an immunisation cover of 67% only. However, with aggressive push, it grew to 92% and now the community workers are aiming to achieve at least 95% mark.

“Pragmatically speaking, it’s a tough battle because parents blindly follow and believe the fake messages going viral on WhatsApp. So to educate them we often plan campaigns, counsel them – both individually and in batches, make short videos and clippings, to boost their confidence we give vaccination shots to our own children, said Dr Azeez. “I remember once when a parent challenged me to prove the safety aspect of these vaccines, I ended up injecting myself with an MR vaccine shot.” Why the reluctance? Despite the fact that vaccines have helped in decreasing deaths related to six main childhood diseases, namely, diphtheria, pertussis, tetanus, polio, measles and tuberculosis, there has been a lot of reluctance among masses when it comes to immunising their children.

The World Health Organisation defines vaccine hesitancy as “delay in acceptance or refusal of vaccines despite availability of vaccination”.

But, if experts are to be believed vaccine hesitancy is an age-old phenomenon. Agrees with Dr Gagandeep Kang, Executive Director at the Translational Health Science and Technology Institute, India. Dr Kang is referred to as India’s vaccine “God Mother” and has developed an oral vaccine against the Rotavirus that causes diarrhoea, a disease that kills almost 100,000 children in India. “Parents need to understand that vaccines are given to healthy people, while drugs are given to sick people”.

“The bar for safety for vaccines is, therefore, higher than for drugs,” said Dr Kang. Rumour mongering, religious beliefs and conspiracy theories are a few key factors that contribute to vaccine hesitancy in many parts of India and across the globe. “Vaccines cause sterility. These immunisation shots are harmful and cause cancer. Vaccines that are rejected in the US are given to our children in India. And, the worse – only God can prevent and cure problems; vaccines cannot do anything – I have heard it all in our region,” said Dr Azeez.

According to WHO estimates, as many as 10 million deaths were prevented between 2010 and 2015, and many more lives were protected from the suffering and disability associated with diseases such as pneumonia, diarrhoea, whooping cough, measles, and polio due to vaccination. But the problem of vaccine hesitancy is not just confined to India or Asian countries. Andrew Wakefield, a former British doctor and one of the loudest anti-vaccine activists published a paper in 1998 that linked MMR vaccine with autism which was later proven false as it had no scientific relevance.

But it gave rise to a group of people called anti-vaxxers. Anti-vaxxers did not believe in vaccinations and they would spread fake messages and raise doubts in the minds of parents, who resultantly would prefer to opt-out their children from vaccination drive. “Definitely, we have witnessed this issue of vaccine hesitancy plaguing rampantly in developing countries, to begin with, but it also has supporters in form of anti-vaccine activists in the developed world,” said Dr Akshay P Jadhav, a paediatrician at Rainbow Children’s Hospital, Bengaluru.

War on disinformation

Immunisation is certainly a cost-effective way to protect the children against life-threatening vaccine-preventable diseases. Millions of infants with three doses of combined DTP3 vaccine for diphtheria, pertussis and tetanus were immunised in 2017. “Improvements in global immunisation coverage is required to prevent vaccine-preventable deaths of children and the only way out is by debunking fake misinformation with reality,” said Dr Jadhav. “We need to highlight the fact that vaccines have been researched meticulously in more than 100 to 150 countries (at least) to be formally made as a compulsion in various countries including India.”

Road ahead

Speaking on the ways to address the problem of vaccine hesitancy, Dr Kang added, “Prevention is key to health and vaccines are a part of prevention. So, we need to get the facts out there and start early with explanations.”

“A quote that I value the most is: ‘Do not vaccinate all your children. Only the ones you want to keep’– it is harsh,” said Dr Kang. “But it is also the fact.”