Elsevier

Vaccine

Volume 30, Supplement 3, 7 September 2012, Pages C72-C78
Vaccine

Review
Addressing public questioning and concerns about vaccination in South Africa: A guide for healthcare workers

https://doi.org/10.1016/j.vaccine.2012.03.037Get rights and content

Abstract

Vaccination is one of the most cost-effective and successful public health interventions in the history of mankind. Anecdotal evidence, the media, and South African-based anti-vaccination websites and blogs point to the existence of anti-vaccination lobbies in South Africa, although the part played by these lobbies in sub-optimal vaccination coverage is unknown at present. This article discusses some of the claims made by South African anti-vaccination groups, including some drawn from anti-vaccination lobbyists based in highly resourced countries. While research is underway to better understand the scope and influence of anti-vaccine groups, it is important to build capacity among healthcare workers within the Expanded Programme on Immunisation of South Africa to enable them to deal empathically and effectively with parents and caregivers who have been exposed to anti-vaccination messages and who question the need to vaccinate their children. Claims that vaccines cause adverse effects need to be supported by valid and reliable scientific evidence. However, evidence alone that vaccines are safe and effective does not always result in parents being convinced to vaccinate their children. In addition to providing important evidence of vaccine safety, this paper discusses the important role of communication – especially dialogue – in building public trust in vaccination with the ultimate goal of increasing vaccination coverage and preventing future outbreaks of vaccine-preventable diseases.

Highlights

► South African Internet-based anti-vaccination claims are reviewed. ► Claims drawn from anti-vaccination lobbyists based in highly resourced countries. ► Healthcare workers find it difficult to answer questions about these claims. ► Evidence of vaccine safety is provided for capacity building. ► Communication in building public trust in vaccination is discussed.

Introduction

Vaccination for the prevention and control of infectious diseases is one of the most cost-effective and successful public health interventions in the history of mankind [1], [2], [3]. In 1974 the World Health Organization (WHO) launched the Expanded Programme on Immunisation (EPI), with the aim of making safe and effective vaccines against six major infectious diseases (tuberculosis, polio, measles, diphtheria, pertussis, and tetanus) accessible to all children of the world. At that time the WHO was well on the way to the global eradication of smallpox, with the world being certified smallpox-free on the 8 May 1980. After this success, in 1988 the WHO set the year 2000 as the target for the global eradication of polio [4]. Unfortunately, while most countries in the world are now polio-free, this aim has not yet been fully achieved, with seven countries (Angola, Afghanistan, Chad, Democratic Republic of the Congo, India, Nigeria, and Pakistan) still being either polio-endemic or having re-established infections [5]. In 2005, through its Global Immunization Vision and Strategy framework, the WHO set the year 2010 as the target to reduce measles-related deaths globally by 90%, when compared to the year 2000 [6]. In the WHO Region of the Americas, measles elimination has already been achieved [6], while in contrast measles outbreaks during 2009–2010 in 61% (28/46) of African countries including South Africa [7] have set the WHO African Region back in attaining measles elimination in the near future. Measles outbreaks also continue to occur in countries with strong health systems, such as some in the WHO European Region [8].

Section snippets

Vaccination coverage and anti-vaccination opinion in South Africa

The EPI of South Africa (EPI-SA) has made considerable progress in the past 16 years, and currently eight of the nine provinces have at least 80% coverage of fully vaccinated one year-olds [9]. This includes a birth dose of both oral polio vaccine (OPV) and Bacille Calmette Guérin (BCG); a further dose of OPV at 6 weeks; rotavirus vaccine (RV) at 6 and 14 weeks; both hepatitis B (Hep B) and a pentavalent (diphtheria, tetanus, acellular pertussis, inactivated polio virus, and Haemophilus

Study designs to prove causation

Claims that vaccines cause adverse effects need to be supported by valid and reliable scientific evidence. Immunisation programmes in most countries address vaccine safety, including surveillance of adverse events following immunisation (AEFIs) as a major component of their programmes [1], [2].

Characterisation of AEFIs, referred to as safety assessments, should follow standard case definitions drawn up by the Brighton Collaboration, the world's largest network of vaccine safety experts [13].

Anti-vaccination claims in South Africa and evidence to refute them

A recent unpublished study on South African-based websites and Internet blogs found that South African Internet-based anti-vaccination lobbyists are very much influenced by mass media reports from around the world. Most either have links to anti-vaccination websites from highly resourced countries [15], [16], [17] such as the United States of America (USA) which has been documented to have the most anti-vaccination sites on the world-wide web [18], [19], or cite anti-vaccination claims from

Talking to parents who question vaccines

Addressing some of the difficult questions about the risks of vaccines that South African parents who have been exposed to anti-vaccination messages may ask of HCWs, has been covered in this paper. However, providing scientific evidence to questioning parents does not always result in parents being convinced to vaccinate their children [3]. Good communication and dialogue skills are needed [14], [68]. Earning trust, creating awareness, deepening understanding, gaining agreement on solutions,

Conclusion

Increasing numbers of South Africans are accessing misinformation about vaccinations on the Internet, which may have a negative impact on vaccination coverage in pockets of the country where Internet usage is widespread. Outbreaks that arise in these pockets because of vaccine refusal may spill over to other provinces where vaccination coverage is low for reasons other than vaccine refusal. The recent measles outbreak which started in Gauteng Province, the economic hub of the country with a

Conflict of interest statement

None declared.

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