A health camp at a government school in South Chennai this week was poorly attended. The camp had been organised by the state government to get children vaccinates against measles and rubella. “Only four kids in my class of 30 got vaccinated despite us telling the parents that it was fine,” said a primary class teacher of the school, Ankita Acharya.
Some parents refused to get their children vaccinated after hearing rumours about 10 children in Madurai who allegedly fell sick after the vaccine was given. “Many others said that they did not trust the government doctors and they would get it done at the private one,” Acharya said.
The government is in the middle of an immunisation drive with a new measles-rubella vaccine in five states – Tamil Nadu, Karnataka, Puducherry, Lakshadweep and Goa. Rumours about dangers of the vaccine have been circulating in parts of Tamil Nadu and Karnataka. The result is that the campaign has not reached as many people as it was intended for. With just a week left for the drive to end, Tamil Nadu has covered only about 35% of the target population to be vaccinated.
The government planned to vaccinate 3.5 crore children between the ages of 9 months to 15 years across five states in the drive that began on February 7 and is scheduled to end on February 28. The campaign will slowly be scaled up to the entire country by July 2018, said health officials.
Measles is a contagious respiratory disease that causes a rash and fever, and may cause death among vulnerable people like malnourished children. The health department estimates that about two lakh children are infected with measles every year, of which 48,000 die of the disease.
Rubella, also a contagious disease, does not have any major symptoms in children or adults, but if contracted by women during early pregnancy can cause babies to be born with serious congenital defects in a condition called Congenital Rubella Syndrome. India has an estimated 40,000 cases of this disease, health officials said.
“We have completed about 50% of the target,” said Dr Pradeep Haldar, deputy commissioner for immunisation with the health ministry. “We are extending the campaign for another week. There is no time limit. We have to complete the activity (of achieving the target of immunisation).”
According to health ministry officials in the states carrying out the immunisation drive, there are doubts about the measles-rubella vaccine on two counts. Some parents are not sure if their children who have already got a measles-mumps-rubella vaccine need a dose of the new measles-rubella vaccine as well. Another group of parents, as a result of all the misinformation going around, are suspicious that the vaccine will make their children sick or impotent.
Last week, a WhatsApp audio message discouraging parents from letting their children be vaccinated went viral in some Tamil Nadu and Karnataka communities. The message falsely claimed that the vaccine is intended to make children from minority communities impotent. The message allegedly referred to the Union Home Minister Kiren Rijiju controversial tweet that India’s Hindu population was falling.
“The audio message was traced to Kerala’s Malappuram district,” said Haldar. Malappuram has a history of backlash against vaccinations. In July 2016, two children reportedly died of diphtheria, a disease that can be prevented by a vaccine provided in the government programme, because their parents did not get them vaccinated. While more than 80% of Kerala is vaccinated, in Malappuram the vaccination coverage rate is on about 50%.
When parents talk of their child not needing another dose, they do not understand that the campaign is not only for individual protection but for community immunity, said Haldar. Community or herd immunity arises when a significant number of people in the population have been immunised and a virus or bacteria finds it difficult to spread in that population. In such a case, even people without immunity remain protected from the disease. “Unless and until community is protected, this disease will continue to be in community,” Haldar emphasised.
“The less we talk about these rumours, the better,” said Dr Shalini Rajneesh, principal health secretary in Karnataka.
But government officials and communities receving vaccinations are talking about the rumours in hushed tones, which is not helping either. Health officials have been taken by surprise by the extent of the impact of the anti-vaccination rumours. Said Haldar: “We did not know how people will perceive these rumours. We never thought this connotation will be taken.”
Dr Vandana Gurnani, joint secretary at the health ministry said that as a “crisis response” health officials have asked religious leaders in Muslim communities to dispel the rumours during the Friday prayers. They have also asked doctors in affected communities to make written and oral statements allaying fears about the vaccine.
The Karnataka government started a Facebook campaign even before the immunisation drive started as the parents had started protesting against the vaccine.
The day after the WhatsApp message started going around, the Karnataka government conducted a press conference. “We said that the immunisation campaign is not just for a particular community but for everyone,” said Rajneesh. “The rumours disappeared the very next day.” She said that the state has achieved about 70% of its target.
Tamil Nadu has still not been able to vaccinate as many children as it planned to. Health officials have encountered problems like popular doctor-turned-activist V Pugazhenthi speaking out against the immunisation drive on television shows, the Times of India reported. To counter such voices, immunisation expert Dr Jacob John has written statements for the Tamil Nadu health department.
“We would have liked the campaign to go faster,” said Dr J Radhakrishnan, Tamil Nadu’s health secretary. He said that the state government has released video messages on social media from the eminent doctors and from the Indian Association of Pediatrics.
Said Dr Arun Panda, additional commissioner in the Health Ministry: “We have to deal with mischief mongers. We are going to put forth facts and evidence. We can ask parents to take an informed decision. But we cannot immunise at gunpoint.”
Addressing questions directly
But are these measures enough to gain the trust of the community?
“There is no credible information from a credible source being put out,” said Dr Subhasri Balakrishnan, who runs the Rural Women’s Social Education Centre in Kanchipuram district. “Parents should be allowed to opt out or opt in based on the information that is being put out.”
Her school-going son was sent a consent form which had just one line seeking consent, and not other information. The school also sent a leaflet with some information which had factual errors. she said. The leaflet said that rubella is life-threatening, which it is not.
Balakrishnan was also concerned about the campaign being run in schools, where there are no facilities to handle adverse events due to vaccination.
Chennai’s former director of public health Dr S Elango, said that the Tamil Nadu chapter of the Indian Public Health Association had conducted an entry and exit survey about the rubella-measles vaccination drive with a pre-tested questionnaire in four districts across Tamil Nadu. He said that from their field work, the doctors had observed that several middle class parents were not coming forward to take the vaccine, but instead were raising questions about why their children need measles vaccines for the second time and how many people actually suffer and die from measles.
“These are questions that the government must address,” said Dr Elango.
The parents were also asking for insurance for their children in the case of adverse effects due to immunisation, he said. Since there is no such insurance scheme, parents were not confident about the programme.
“Health systems should counter rumours with systematic and simple clarifications, information and keep at it meticulously,” said Dr Mala Ramanathan, Professor at Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala. “This is all the more so important in the presence of an anti-vaccination lobby that is taking hold in some places.”
Balakrishnan said, “We have no kind of information on why these policies are being made. Is this the way to go forward?”