In January this year, the World Health Organization (WHO) listed “vaccine hesitancy” as among the top 10 threats to global health this year; it is defined as [a] “reluctance or refusal to vaccinate despite the availability of vaccines”.
According to WHO, vaccination prevents between two-three million deaths each year, a figure that will rise by another 1.5 million if vaccine coverage improves. Yet, a survey of over 1,40,000 people from 140 countries has revealed the striking difference in how people trust vaccines.
At 95%, people from South Asia trusted vaccines followed by eastern Africa at 92%. Western Europe and eastern Europe brought up the rear with just 59% and 52%, respectively. The repercussions of vaccine hesitance are now playing out globally — as on October 10, 2019, nearly 4,24,000 children have confirmed measles, as against a figure of 1,73,000 in the whole of 2018.
The Indian perspective
Vaccine hesitancy has been a concern in India. For instance, one of the main reasons for five times low uptake of oral polio vaccine in the early 2000s among poor Muslim communities in Uttar Pradesh was the fear and the misconception that the polio vaccine caused illness, infertility and was ineffective. Similarly, as recently as 2016, Muslim communities in two districts in north Kerala reported low uptake of diphtheria vaccine. One of the reasons: propaganda that the vaccine may contain microbes, chemicals and animal-derived products which is forbidden by Islamic law.
Tamil Nadu and Karnataka, which have traditionally seen high vaccine acceptance, witnessed low uptake of the measles-rubella vaccine when it was introduced in 2017. A reason was again a fear, spread through social media, of adverse effects from vaccination.
As a December 2018 study points out, vaccine hesitancy continues to be a huge challenge for India. The study found nearly a quarter of parents did not vaccinate their children out of a fear of adverse events; this was in 121 high priority districts chosen by the Health Ministry for intensified immunisation drive to increase vaccine coverage.
At the UN
Against this background, last week, on November 1, self-styled “yogi, mystic and visionary” Jaggi Vasudev tweeted a dangerous message. “The significance of vaccination against many debilitating diseases should not be played down. But at the same time, it is important it is not overdone, without taking into consideration the many side-effects or negative impacts of vaccinations.”
The dangerous sweeping statement on vaccine side-effects will give anti-vaxxers the much-needed impetus and ammunition to scare parents from vaccinating their children. Stirring fear in people by falsely blaming vaccines for unrelated diseases is the bedrock of the anti-vaccination movement across the globe, India included. Even today, the message of the discredited study (in 1998) by British physician Andrew Wakefield, who linked the measles, mumps, and rubella (MMR) vaccine with autism, is used in spreading vaccine doubts and conspiracy theories.
Besides the dangerous message, it is difficult to fathom the sudden provocation for the tweet. The tweet has a link to an article published on the Isha website on October 3, which is an excerpt of a conversation between Jaggi Vasudev and Dr. Soumya Swaminathan (Chief Scientist at WHO) that was held at the United Nations General Assembly on June 27, 2019. (The article also has a link to the taped conversation, on YouTube.)
During the conversation with Dr. Swaminathan, he is seen advocating vaccination and spelling out the gains India made by preventing children from becoming crippled through oral polio vaccination. But soon he veers off track and ends up spreading dangerous misinformation about influenza (commonly referred to as flu).
With a disclaimer that he is not a medical expert, Jaggi Vasudev says: “…From listening to parents [in California], this is what I gathered. I thought some of the things they were giving vaccines for were just absurd. If a child catches a flu, or something like this, it is all right to go through some of these illnesses when you are growing up.”
This might turn out to be the most irresponsible and dangerous piece of misinformation to have ever been said from the hallowed platform of the UN. Unfortunately, the patently wrong message went unchallenged, giving it a ring of truth. The incorrect messaging did not stop there; it is now posted on the Isha website, increasing the chances of more people being misled. The blithe comment about flu sans any evidence is in stark contrast to the seriousness with which WHO and the Atlanta-based Centers for Disease Control and Prevention (CDC) treat it.
The CDC website says, “Flu illness is more dangerous than the common cold for children” especially in those younger than five years. Children older than six months and younger than five years belong to the high-risk category, the reason why the CDC recommends “vaccination against flu each year”. WHO too recognises children below five years as a high-risk group and recommends vaccination each year.
Good defence
The reason why influenza should be taken seriously is because in the U.S. alone, since 2010, an estimated 7,000-26,000 children younger than five are hospitalised each year; many end up dying. It is already proven that vaccination offers the best defence against flu and its potentially serious consequences, reduces flu illnesses, hospitalisations and even deaths.
Despite H1N1 (swine flu) becoming a seasonal flu virus strain in India even during summer, the uptake of flu vaccine in India is poor — the reason why thousands of cases and deaths get reported each year. As on November 3 this year, there have been 28,109 H1N1 influenza cases and 1,203 deaths this year in India. The number of H1N1 influenza cases (42,592) and deaths (2,991) in India peaked in 2015.
Despite its effectiveness varying from one season to another, several studies have shown that the flu vaccination can reduce the risk of flu illness by 40-60% when there is good match between the strains used in the vaccine and the circulating virus. A study in 2017 that looked at flu seasons between 2010 and 2014 found that vaccination reduced flu-associated deaths by 65% among healthy children. The vaccine can also prevent hospitalisation, reduce the severity of illness and “prevent severe, life-threatening complications” in children.
As per WHO’s recommendation, since September 2018, the protection offered by flu vaccines has been widened with the availability of vaccines containing four strains instead of three.
prasad.ravindranath@thehindu.co.in
