Misinformation is not only a problem when it comes to COVID-19 but other public health programs have also had to overcome steep challenges posed by it. The Measles Rubella vaccine campaign by the public health department of the Brihanmumbai Municipal Corporation in Mumbai was mired with misinformation and hesitancy toward vaccination.
The World Health Organization has stated that one-third of deaths related to measles worldwide come from India.
India launched one of the world's largest vaccination campaigns against measles and rubella on 5 February 2017 and more that 12.5 million children were re-vaccinated successfully. The measles vaccine was already a part of the country's Universal Immunization Program. The rubella vaccine is a recent addition. India is a signatory to eliminate measles and rubella by 2023.
The Global South Continuum held a round table discussion on National Measles Immunization Day with three doctors who were involved with the Mumbai campaign and a behavioral psychologist to understand the hesitancy. Dr. Rajusingh Rathore, Senior Medical Officer forExpanded Programme of Immunisation; and Dr. Sheela Jagtap, Assistant Health Officer, Public Health Department, from the Municipal Corporation of Greater Mumbai along with Dr Amin Kaba, Pediatrician, Prince Aly Khan Hospital who was earlier involved with the MR campaign and Anurag Vaish a behavioral pyschological consultant were in conversation with Govindraj Ethiraj, founder of BOOM and IndiaSpend about Mumbai's campaign.
Mumbai's Campaign
Mumbai's 2018 campaign aimed to cover public and private sector settings like schools and health facilities to reach out to children in the age group of nine months to less than 15 years.
Dr Rathore discussed that although smooth, the Mumbai campaign was not bereft of its own problems of hesitancy and misinformation. Mumbai's campaign also was quickly planned and executed without having enough communication dissemination and awareness about the necessity of this vaccine.
Battling Misconceptions And Misinformation
All the three doctors agreed that they faced severe resistance from two sections of the society which they had not anticipated. These two sections were the elite schools and upper middle class and the minority community in the lower socio-economic strata of society. A trust deficit towards the public health system also was highlighted.
Elite schools had their reservations with the whole campaign and the administration faced issues in convincing them to participate.
"Among the elite community, they believed that they already vaccinated their children with well-known pediatricians and why the need for this additional dose?", said Dr. Rathore as he discussed the nature of the problem.
Dr Jagtap also highlighted the reluctance of the elite schools to participate. "Acceptability from public schools was good, there wasn't much of resistance but of course the private and elite schools there was a lot of resistance."
For schools, the doctors mentioned that they had to seek the help of private practitioners, pediatricians, NGO's, and the Indian Medical Association. These doctors helped in convincing the parents and school authorities.
The Muslim community had their reservations as there was misinformation that vaccines lead to infertility and could wipe off their community. Dr Rathore overcame this by immersing himself with the community and explaining to them the benefits of the vaccine.
Distrust Of The Public Health System
Dr.Jagtap discussed the lack of trust in the public health system in detail.
"The elite community had a lack of faith or confidence in the vaccine provided by the Municipal Corporation, since it is a free vaccine, so whatever comes free people don't realize the value of it. We assured them that whatever the vaccine the corporation is providing, it is the best quality and maintained in cold chain that is the proper temperature right from the manufacturer till it reaches the beneficiary."
She further mentioned that the BMC had about 300+ cold chain points where the vaccine was stored and monitored through an Electronic Vaccine Intelligent Network where a real time monitoring of the vaccine was done. They also shared that whatever vaccinewas provided by the government for this campaign was the same quality vaccine provided in the private sector.
The reasons for vaccine hesitancy were lack of confidence in the public health system, complacency as the people did not feel the need for such a vaccine and convenience but the public health officials were delivering these services.
Dr. Kaba spoke about the role of the media and the misreporting which further created more distrust in the public health system. "When you see the headline, it gives you palpitation, your blood pressure shoots up, 5 children collapse after taking vaccine, I am not giving it to my child but if you read, in the very next line it was reported 5 children admitted to the hospital after vaccination, they went home in 1 hour, that wasn't written in the report. That comes in fine print."
As this was an injection based vaccination and not a drop like Pulse Polio, many people from the upper classes of society did not trust the public health system as they felt it lacked cleanliness and hygiene, Dr Kaba further stated.
Vaish felt that the community at large lacked a health seeking behaviour and did not feel the need for a new vaccine. The three doctors resonated with this sentiment stating that there was not enough budget for advertising.
Future Steps
Dr Rathore emphasized that communication, micro-planning so that all the facets are taken into consideration and proper training are the areas that should be focused for any future vaccination project.
Dr. Jagtap also stated that sub-departments within the public health department were unaware about the project's scale and that is something she wishes could change.
Also Read: Measles-Rubella Vaccination: Is It Safe? All You Need To Know