ReviewAddressing public questioning and concerns about vaccination in South Africa: A guide for healthcare workers
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.
References (69)
- et al.
Addressing the vaccine confidence gap
Lancet
(2011) Emerging and continuing trends in vaccine opposition website content
Vaccine
(2011)- et al.
Ileal–lymphoid–nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children
Lancet
(1998) - et al.
Feeling bad about immunising our children
Vaccine
(2005) - et al.
No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study
Lancet
(1998) - et al.
Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association
Lancet
(1999) - et al.
MMR and autism: further evidence against a causal association
Vaccine
(2001) - et al.
MMR vaccination and pervasive developmental disorders: a case–control study
Lancet
(2004) - et al.
Retraction of an interpretation
Lancet
(2004) - et al.
Autism and thimerosal-containing vaccines: lack of consistent evidence for an association
Am J Prev Med
(2003)
National Immunization Technical Advisory Groups (NITAGs): guidance for their establishment and strengthening
Vaccine
The National Advisory Group on Immunization (NAGI) of the Republic of South Africa
Vaccine
The success of immunization-shovelling its own grave?
Vaccine
Vaccinology: past achievements, present roadblocks and future promises
Vaccine
Vaccine safety controversies and the future of vaccination programs
Pediatr Infect Dis J
Vaccination in the line of fire
S Afr J Epidemiol Infect
Polio vaccines and polio immunization in the pre-eradication era: WHO position paper
Wkly Epidemiol Rec
Measles vaccines: WHO position paper
Wkly Epidemiol Rec
Measles outbreaks and progress towards meeting measles pre-elimination goals: WHO African Region, 2009–2010
Wkly Epidemiol Rec
Increased transmission and outbreaks of measles, European Region, 2011
Wkly Epidemiol Rec
Is the Western Cape at risk of an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage
S Afr Med J
Vaccine safety
Reconnoitering the antivaccination web sites: news from the front
J Fam Pract
Content and design attributes of antivaccination web sites
JAMA
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2014, Clinical Microbiology and InfectionCitation Excerpt :Primary-care providers play a central role in educating patients and parents on the safety and effectiveness of the vaccines recommended by health authorities, and can positively influence the rates of immunization just by answering parents’ questions and addressing common misconceptions. A number of studies have clearly shown that parents consider healthcare workers to be the most important source of information when deciding whether their child should be given a vaccine [30,31]: it is well known that dissatisfaction with the information given by doctors is one of the most frequently reported reasons for low vaccine acceptance rates [32], whereas physician recommendation is one of the strongest predictors of immunization. Esposito et al. [33] found that the main reason leading the parents of high-risk children to have them vaccinated against influenza was their physician’s strong recommendation.