Needles, serums, population wide implementation, and anti-vaxxers, what could go wrong?
Nation wide immunization campaigns are common practice to curb emerging epidemics in developing countries. Despite their success in reducing the burden of communicable disease, they are always met with varying degrees of fear and suspicion. Namibia is no exception.
Cases of Rubella and its most worrisome outcome, Rubella Congenital Syndrome, have been on the rise in Namibia the past few years. In response, the Ministry of Health decided to add Rubella to its routine immunizations for the first time. Since there are also a significant number of Measles outbreaks in the country, the two vaccines were combined into one.
As the Measles and Rubella vaccination campaign began, we started to notice a small but vocal group of anti-vaxxers posting to social media and urging their neighbors to refuse the vaccines.
Let’s take a look at what the anti-vaxxers say, because it offers an interesting perspective of the Namibian thought process. In the above picture I was refuting these claims at the local high school, which seemed to be the epicenter of misinformation.
“The government is trying to sterilize black people.“
Internationally, mistrust of vaccines is often tied to “Western plot” theories, which suggest that vaccines are ploys to sterilize or infect non-Western communities. These have popped up in different countries for different diseases and vaccines for over 20 years.
For example, in Cameroon in 1990, rumors and fears that public health officials were administering a range of childhood vaccines to sterilize women thwarted the country’s immunization efforts. In Tanzania in the mid 1990s, concerns about tetanus vaccine sparked sterilization rumors and halted the campaign. In 2005, measles vaccine suspicions led to decreased vaccination rates and increased infections in Nigeria.
Of course, these concerns are unfounded, and the population in those countries did not show any decline in the years after the campaign.
“The diseases aren’t dangerous.“
It has been many years since diseases like smallpox and measles ravaged these communities. People have begun to forget the disease, believing they would not kill their children.
However, if a pregnant woman gets Rubella in the first trimester, there is a 100% chance her child will develop serious congenital abnormalities that can cause blindness, deafness, facial disfigurement, mental retardation, or fetal death.
Measles is also a serious disease, explained nicely by this infographic:
“Vaccines don’t work.“
This is the weakest one. I think most anti-vaxxers will admit they work, they usually just say the risk doesn’t outweigh the benefit.
“Natural immunity is better.“
Some people believe that naturally acquired immunity—immunity from having the disease itself—is better than the immunity provided by vaccines. However, natural infections can cause severe complications and be deadly. This is true even for diseases that most people consider mild, like chickenpox. It is impossible to predict who will get serious infections that may lead to hospitalization. The risks from the vaccine are much lower than from the disease itself.
“The needles from the state hospitals are dirty.“
This was mostly a complaint from the white community, who generally get vaccinated at private doctors (who, for the record, use the same needles). There’s a sense of prejudice left over from Apartheid that the black doctors can’t practice medicine as well as the white doctors. This does not apply to all white people though, this guy got his vaccine from the state hospital!
“The vaccine is dangerous, don’t trust it.“
To alleviate this fear, the mayor and other public figures made sure people saw the pictures/videos of them being injected.
Our head doctor got his vaccine, but we had to corner him first.
“You will get the disease from the vaccine.“
There is only one recorded instance in which a vaccine caused the disease it was meant to prevent: the Oral Polio Vaccine. This happened decades ago, and the vaccine has since been modified. It has not happened again.
“I can do what I want and I don’t have to explain why I refuse.“
This one is particularly frustrating, because the refusal is not based on science or logic. As humans we feel the need to be in control, and if we lose control in one area we try to exercise it in another. This combined with a deep mistrust of authority, in part from Apartheid but also from the rampant government corruption, cause some to flout the government at every turn.
However, vaccination is not only a personal choice, but a social responsibility. Vaccines are not 100% effective, and there are those that cannot receive vaccines because they are immunocompromised (ex. cancer) or allergic to some part of the vaccine. Those people depend on herd immunity, which cannot come about if too many people refuse on principle.
The Good News About Anti-Vaxxers
They are a definite minority. In fact, we got 98% of Outjo district immunized, creating a safe herd of protected humans!
Unfortunately, even those willing to get vaccinated did not always understand why. Check out the story of these two gentlemen on a farm:
The outreach car stopped at a farm, but couldn’t find anyone there. When the nurses heard there were two men living there, they decided to return the next day. This time the men were there, and apologized for not being around. Yesterday they were working on the mountain when they saw the hospital car. They knew about the immunization campaign, and careened down the mountain to catch the car before it left. They were terrified that if the car left, they could die that night of the disease being immunized against. When the car drove away they became afraid, so they went into the wild to find aloe vera plants. They ate the plants and rubbed the juice on their face to protect themselves from the diseases until the car could come back the next day.
These men wanted to get vaccinated, but for the wrong reason. Wether the misinformation causes people to refuse the vaccine or rush to get it, we need to set the record straight.