Regaining the public trust in immunization

On January 24, another criminal complaint related to the anti-dengue vaccine was filed with the Department of Justice (DoJ). The mother of a 39-year-old physician, Dr. Kendrick Gotoc, who was inoculated by the vaccine three times prior to his death on April 22, 2018, filed cases of obstruction of justice, reckless imprudence resulting in homicide, torture, and violation of the Consumer Act against Health Secretary Francisco Duque, former DoH chief Janette Garin, and 37 others.
This was amidst the clarification from the Department of Health (DoH) that no deaths had been linked to Dengvaxia and calls from doctors’ group Doctors for Truth and Welfare to “halt the continuous spread of unproven claims of deaths caused by the dengue vaccine by the same unqualified but noisy people who are largely responsible for the fall in vaccine confidence in the country.”
The DoH admitted that the controversy has in part caused last year’s decline in measles vaccination and outbreaks in the country. According to the Vaccine Preventable Diseases (VPD) Surveillance Report of the Department’s Epidemiology Bureau, majority of the cases of measles nationwide are of children ages 1-4 years who were not vaccinated.
In the same report, the top five reasons for non-vaccination were 1) mother was busy, 2) not eligible for vaccination, 3) child was sick, 4) fear of side effects and 5) forgot the schedule. These reasons are also common excuses of parents and/or caregivers who intentionally disregarded the immunization schedules for their child. Disregarding a child’s immunization schedule is a lame excuse of those who are not fully aware of the benefits and protection that their child can get after being vaccinated.
The reluctance or refusal to vaccinate despite the availability of vaccines is popularly called by health experts as “vaccine hesitancy” – and this threatens to reverse the progress made in tackling vaccine-preventable diseases. In its new year message for 2019, the World Health Organization (WHO) cited vaccine hesitancy as one of the world’s top 10 global health threats, alongside air pollution and climate change, noncommunicable diseases, global influenza pandemic, and dengue, among others. Given the low confidence in the system or anxieties in conflict settings, the threats of fragile and vulnerable settings and weak primary health care both affect hesitancy. A WHO Advisory Group on Vaccines identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons underlying it.
For infants, the first vaccine comes from their mother via the breastmilk. It is the first and best protection an infant can have early in life against illnesses and diseases. Moreover, all the recommended vaccines are equally essential for infants so they will be protected at the right time. It is extremely important to have the child fully immunized as soon as possible. By definition, a “Fully Immunized Child” (FIC) is an infant who has “received one dose of BCG, three doses each of OPV, DPT, and Hepatitis B vaccines, and one dose of measles vaccine before reaching one year of age.” These are most effective when given at the specified ages, or as close to those, as possible. That is the reason why following the schedule of vaccination is of utmost importance. If a child does not complete the full series of immunizations in the first two years, he/she may be vulnerable to a disease that should have been prevented. Hence, immunization remains one of the most important and cost-effective public health interventions to reduce child mortality and morbidity.
Looking into the FIC rate in the Philippines based on the annual results of the Field Health Service Information System (FHSIS) in the last 10 years prior to the Dengvaxia issue, the country has been performing satisfactorily, with the rates ranging from 67.47% (2017) as the lowest to 86.00% (2010) as the highest. Many health-care professionals (HCPs), such as doctors, in the public health sector fear that the previous year might be the lowest FIC rate in a decade. According to Health Undersecretary Enrique Domingo, “only 50% to 60% of children are getting their scheduled vaccines a year after the scare which resulted into outbreaks of preventable diseases.” Nevertheless, let us wait for the official 2018 FHSIS report from the DOH and hope for better results.
What had happened to the health care and government systems are chapters that cannot be undone. The misinformation and false claims that are continuously propagating are obviously diminishing the public’s trust and confidence in immunization. However, there are still means to regain the momentum to continue and strongly support the routine immunization of children to protect them from acquiring vaccine-preventable diseases.
Vaccine acceptance, according to the study conducted by Larson, H.J., et.al. (2018), involves multilevel of trust: 1) trust in the product (the vaccine), 2) the provider (the specific healthcare professionals that are involved in providing and administering vaccination), and 3) in the policy maker (the health system, government, and public-health researches involved in approving and recommending the vaccine). The same study also said the important factors that influence vaccine decision-making process include “trust in the safety and efficacy of vaccines, trust in the individuals that administer or give advice about vaccination, and trust in the wider health system.”
Insinuations that vaccines are unsafe spread via misinformation and anecdotal reports of alleged vaccine reactions, either by unqualified professionals, the media, the internet and/or anti-vaccination groups, and this leads parents to question the need for immunization.
Let us leave this discussion to those who have the regulatory mandate to safeguard the safety of the public, such as the Food and Drug Administration (FDA) and the DOH. They have the technical expertise and capacities to determine the safety and efficacy of vaccines.
Doctors play a central role in educating parents and/or caregivers on the safety and effectiveness of the vaccines which are recommended by regulatory authorities. They can positively influence the immunization coverage by providing the right answers to queries and addressing common misconceptions on the part of the parents and caregivers.
There had been studies that show that parents consider HCPs as the most important source of information when deciding whether their child should be given a vaccine. Thus, investing to capacitate, not only medical doctors, but also nurses, midwives, and other allied health professionals tasked to perform the Expanded Program on Immunization (EPI) is critical.
Due to the inclusion of a political agenda, trusting the policy makers would be the hardest among the rest. However, if they will strongly support the EPI in order to protect children, this will benefit not only the families of these children but the whole country as well.
 
Alvin M. Manalansan is Health Fellow of Stratbase ADR Institute.