Overcoming Vaccine Hesitancy

Vaccination is considered to be one of the greatest public health achievements of the 20^thcentury. It offers cost-effective interventions that have helped to build  societies free of vaccine preventable diseases and, hence, saved the lives of millions of children around the globe. Religion is one of the strongest belief systems that has existed for centuries. It provides a strict code of conduct for its believers to function in a non-primitive or cultured manner and to maintain camaraderie among its followers. Therefore, the ultimate goal of both religion and vaccination is the greater good of humankind. When both religion and vaccines  are intermingled and influenced with negative politics, however, it may result in a negative outcome, contrary to the ultimate goal that they both aim to achieve: the greater good of humankind. Therefore, it is crucial to understand the interplay of the dynamic relationships that exist between religion, politics, and vaccination. 

A conceptual framework, if drawn to showcase the complex interaction between religion, politics and vaccination, would bring forth four different scenarios with four different outcomes. Since in most places around the world, religion and politics are intertwined, this framework considers religion and politics to be a single unit with complementary subunits. Hence, the four scenarios would be as follows:

Scenario 1 would consist of a situation where there exists potent and efficacious vaccines that would have a significant and positive impact on the lives of many, and it is placed in a very favourable socio-political and religious background. This would be an ideal situation and would pave the way for a successful immunization program. The Public health action required in this scenario would be minimal, and only supportive measures would be needed.

In scenario 2, we have a strong socio-political and religious background that supports vaccinations. But, if the vaccines are not that efficacious, then there would be no point in promoting such a public health intervention. While scenario 3, would be based on a circumstance where we have a less impactful vaccine and less favourablesocio-political and religious environment. For example, in certain situations where vaccines against rare diseases like Kyasanur forest disease which are administered to only a select few, the public health interventions required here would be minimal and would mainly focus on prevention of localized outbreaks.

In the last scenario (4) there is the presence of safe, potent, and efficacious vaccines; however, the socio-political and religious circumstances are totally against it, preventing the successful implementation of vaccination campaigns. The “vaccine hesitancy” created in this scenario is of utmost public health importance and requires a full-fledged intervention to address the misinformation. The interplay of different religious beliefs and mythology interlaced with politics are the main reasons for this vaccine hesitancy. This is the most critical scenario, which is often present across different parts of the world for which a unified emergency public health intervention involving multiple stakeholders is required.

A recent example of this vaccine hesitancy was seen in the Measles Rubella (MR) [AP1] campaign conducted in India from February 2017 till April 2019. The campaign’s goal was to vaccinate 410 million children in the age group of 9 months to 15 years with a single shot of MR vaccine. The aim of the campaign was to introduce the MR vaccine into the routine immunization schedule and thereby lead to the elimination of measles and control rubella/congenital rubella syndrome by 2020. This campaign faced a lot of anti-vaccination propaganda. Multiple video clips were propagated through social media by the anti- vaccination lobby, which became instant hits and went viral especially among select minority groups. These messages were being propagated by learned, respected, and influential people in the community such as doctors, spiritual leaders, etc. The videos portrayed that the hidden agenda behind this campaign was population reduction especially since it highlighted the importance of vaccinating female children creating even more suspicion among the general public. These messages did not sit well with a few minority groups, and they termed this vaccination campaign to be an “anti-fertility drive.” The naturopaths and religious leaders also added further “colour and flavour” to the already deteriorated situation.

Lack of proper priming of the community prior to the launch of the vaccination campaign, use of old and rudimentary information, education, and communication (IEC) methods and delay from the government health sector to address these anti-vaccination lobbies all worsened the situation even further. It created suspicion in the minds of the people making them question the genuineness of the intentions behind the campaign.

This is just one of the examples of vaccine hesitancy. If we were to look at such examples from all around the world, most of the reasons behind vaccine hesitancy would broadly fall into three major domains. The first being, the religious domain which the anti-vaccination lobbyist often portray as a “population reduction agenda” or “breech in religious practices.” The next important domain which is a lot more complicated is the political domain which has some similarities  and differences to the religious domain in most places around the world.  The basis of similarity lies in the fact that it is often due to “power politics” and it only differs based on the “parties” involved. The underlying thread of the political dimension is the fight for power and lack of trust which is portrayed differently in different scenarios such as “anti-Western sentiment,” “conspiracy theories,” etc. Third is the personal belief or philosophical domain, where the anti-vaccination lobbyists pick up on various factors and portray them in a very attractive and “believable” manner that the ill-informed public easily fall prey to their vicious plot. They often capture the minor weaknesses in the implementation of the vaccination campaigns and blow it out of proportion creating fear and panic among the general public. This is often topped off by inputs from “naturopathic healers” who put forward very “convincing ideas” which further worsen the situation. 

Hence, this brings us to the big question at hand: what do we do now? Over the years we have realized two things. One, the anti-vaccination lobby is very strong and they use social media to their benefit. Second, for any vaccination campaign to be successful it would require a positive socio-political and religious background. Over the years, each one was on their own, fighting their own battle using rudimentary IEC tactics. Now, it is the time to build a unified multi-disciplinary team consisting of religious leaders, community members, public health specialists, clinical specialists, opinion leaders, politicians, etc. who would jointly combat the anti-vaccination lobbyist promptly through various media and social platforms. However, in the long run in order to have a sustainable solution to this crisis we need to create a resilient health system based on a strong foundation of a positive socio-political and religious milieu in which the general public has ardent faith.