The Drum Beat 180 - Addressing Public Trust in Immunisation
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Vaccines are among the most closely regulated of health interventions yet in some countries have become the subject of intense public debate. This issue, developed with UNICEF as a partner in GAVI, focuses on issues and resources for addressing public trust in immunisation.
GAVI Advocacy and Communication Task Force
"The mission of the Advocacy and Communication Task Force (ACTF) is to facilitate the achievement of GAVI Milestones by strengthening advocacy and communication support for immunization at global, regional, and country levels."
During 2003, partners in the Global Alliance for Vaccines & Immunizations (GAVI) Advocacy & Communication Task Force (ACTF) are working to develop strategies, tools and activities to:
- Promote the value of vaccines and build public trust in immunisation;
- Establish mechanisms to ensure that timely, accurate information about immunisation is available to the public and the media.
- Develop programme guidelines for building alliances around immunisation and for responding to questions about immunisation.
Strategies will focus on global advocacy as well as country-based initiatives.
Contact immunization@unicef.org
VACCINE SAFETY COMMUNICATION BASICS
as identified by UNICEF
Key Issues
1. Immunisation saves the lives of about 3 million children every year. Very rarely, adverse reactions occur. While most of these are mild, any reaction is a cause for great concern, and must be swiftly and effectively investigated and appropriate action taken.
2. Rumours and misinformation about vaccines and immunisation sometimes occur because suspected or real adverse reactions to vaccines are handled inappropriately. Erroneous information in media responses to vaccine safety issues can lead to further propagation and sensationalisation of misinformation. As a result, rumours about vaccines may spread, possibly leading to diminished immunisation rates and increases in childhood illness and death.
3. Communicators responsible for managing vaccine safety issues need to:
- Respond appropriately with accurate information:
- Build partnerships with the media to promote responsible public health reporting:
- Understand the source of any misinformation and/or resistance to immunisation.
- Work through appropriate channels and spokespeople to promote accurate information and cooperation.
Key Resources
4. State of the World's Vaccines & Immunization
WHO, UNICEF and the World Bank, Dec 2002.
Highlights the immense strides made in global immunisation since the mid-1990s and charts progress in the development and introduction of new life-saving vaccines that have the potential to save millions of lives every year.
Click here for the PDF version of this.
5. Combatting Antivaccination Rumours: Lessons Learned from Case Studies in East Africa
UNICEF 2001.
Examines the origin and impact of rumours on immunisation programmes in Uganda, Kenya and Tanzania. Includes analysis and recommendations.
6. Building Trust in Immunization: Partnering with Religious Leaders and Groups
UNICEF May 2004.
Emphasises proactive strategies for working with religious groups while also outlining key steps in responding to resistance to immunisation.
7. Communicating About Adverse Events
Dr CJ Clements, Dec 2002.
Examines general principles for communication surrounding adverse events related to immunisations. Uses case studies and reactions of DTP, OPV and IPV, Hib, MMR, and HepB vaccines as a strategy for communication.
8. Advocacy for Immunization: How to generate and maintain support for vaccination programs [PDF]
9. Partnership Building with the Media: Rumours and how to handle them. [Power Point]
WHO: Vaccines & Biologicals.
Uses the rumour that HIV/AIDS is linked to OPV to illustrate how a communicator might respond effectively.
10. Roleplay: Rumours About The Vaccine
A 20 minute exercise that looks at how to respond to rumours circulating about measles vaccine on local radio.
11. Immunization Safety Update Vaccines & Immunization Vol 1 No 1 2002. [PDF]
Immunization Safety WHO/UNICEFM
Focuses on cooperation between WHO & UNICEF to ensure quality vaccines and safe immunisation for the world's children.
12. GAVI Immunization Advocacy Resource Kit
A collection of immunisation advocacy materials from the GAVI partners, including documents authored by WHO, UNICEF, and the CVP at PATH. Nearly all Kit materials are available for download from the CVP PATH Library.
ADVERSE EVENTS FOLLOWING IMMUNISATION
13. Immunization Safety at WHO
Site covers the safety of all aspects of immunisation, including vaccine quality, vaccine storage and handling, vaccine administration and the disposal of sharps. Includes information for parents, health care providers, the media, and others who are interested or concerned by the safety of vaccines.
14. Management of Adverse Events [PDF]
Immunization Safety Update Vaccines & Immunization Vol 1 No 1 2002.
Claims that adverse events following immunisation (AEFI) are rare and mostly mild. WHO and UNICEF assist developing countries in establishing proper AEFI monitoring systems.
15. Vaccine Safety Issues of Interest
Centers for Disease Control & Prevention
Includes fact sheets and links on a range of issues and the latest research.
RESPONDING TO RUMOURS & MISINFORMATION
Polio Vaccine
16. Simian Virus 40 & Human Cancer
The US National Cancer Institute, Sept 23 2002.
Clinical investigations show no link between polio vaccine and cancer.
More information at WHO
17. EPI Vaccines in HIV-infected Individuals
WHO: Vaccines & Biologicals
"To date, there has been no reported increase of adverse reactions in HIV-infected persons to the live oral Polio and measles vaccines, nor to DPT and hepatitis B vaccines, which contain no live organisms...."
Tetanus Toxoid (TT) Vaccine
18. Tetanus Toxoid Controversy, The Philippines
WHO: Vaccines & Biologicals
Analysis shows how rumours that the tetanus toxoid vaccine (TT) was laced with a contraceptive hormone spread and influenced immunisation programmes in several countries.
19. Combatting Antivaccination Rumours: Lessons Learned from Case Studies in East Africa.
UNICEF 2001
Includes analysis of the origin, impact and response to rumours of a so-called contraceptive component in TT in Tanzania.
Pertussis
20. Anti-Immunisation Scare: The Inconvenient Facts [PDF]
by Dr. Steve Basser, 1999.
"Over the last few years immunisation rates in Australia have fallen. As a result there have been outbreaks of the infectious diseases immunisation is designed to combat. Earlier this year there was a significant outbreak of pertussis (whooping cough) with at least 3 children dying from this preventable disease...." A deconstruction of anti-vaccination arguments.
21. Impact of Anti-Vaccine Movements on Pertussis Control: the untold story [PDF]
E. J Gangarosa, A M Galazka, C R Wolfe, L M Phillips, R E Gangarosa, E Miller, R T Chen. Lancet 1998; 351: 356-61.
Reviews the impact of anti-vaccine movements against whole cell pertussis in Sweden, Japan, the UK, and The Russian Federation.
The Measles Mumps Rubella (MMR) Vaccine
22. MMR and Autism: Conclusions of the meeting of the Global Advisory Committee on Vaccine Safety held in December 2002
Review by an independent researcher of the risk of autism associated with MMR vaccine.
23. BBC In Depth Report on Measles Mumps & Rubella Vaccine
On the controversy that erupted after unfounded allegations that MMR vaccine was linked to autism. "Research clears MMR. The expert whose research shows no link between MMR and autism says he hopes his findings will put an end to the controversy over the vaccine...."
24. Misleading the Public About Autism & Vaccines
Letter from Neal Halsey M.D. to the editor of the New York Times, Nov 11 2002, stating that their reporting in the article "The not so crack-pot autism theory" has contributed to public misunderstandings of vaccines and other health care issues. He states that the NYT and other newspapers need to conduct self-examinations into their role in misleading the public and modify procedures accordingly to help prevent future misrepresentations of scientific data.
25. A Population-Based Study of Measles, Mumps & Rubella Vaccination & Autism
Kreesten Meldgaard Madsen, M.D. et al. New England Journal of Medicine Vol 347:1477-1482, Nov 7 2002.
Affirms that there is no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autistic disorder. Provides evidence against the hypothesis that MMR vaccination causes autism.
Thimerosal
26. What is Thimerosal?
CDC National Immunization Program
No harmful effects have been reported from thimerosal at doses used in vaccines, except for minor reactions like redness and swelling at the injection site. Includes links to reports and FAQs on Thimerosal.
27. Thimerosal, Facts or Rumours?
Presentation delineating the facts about thimerosal, methyl mercury and ethyl mercury.
Dr CJ Clements
28. Statement from the Global Advisory Committee on Vaccine Safety (Thimerosal)
Nov. 2002
Hepatitis B Vaccine
29. Q & A
WHO: Vaccines & Biologicals
"Hepatitis B vaccines have been shown to be very safe when given to infants, children or adults.... More than 500 million persons have received the vaccine worldwide...."
OTHER RESOURCES
World Health Organisation (WHO) Vaccines, Immunization & Biologicals
Children's Vaccine Programme at PATH (CVP/PATH) Online Library
In particular related to anti-vaccination activities.
Click here for more...
Click here for more...
Communication Handbook for Polio Eradication and Routine Immunization.
(WHO, UNICEF, USAID (Basics ii and CHANGE projects).
Click here for the PDF version of this.
Centers for Disease Control & Prevention National Immunization Program
Parents of Kids with Infectious Diseases (PKIDS) - links to immunisation issues
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This issue was drafted with UNICEF as a partner in the GAVI Advocacy and Communication Task Force. Additional questions regarding these or other issues may be addressed to vaccines@who.int or immunization@unicef.org
We invite you to send us articles, programmes, web sites, publications, etc. from different perspectives on this same subject. Please contact dheimann@comminit.com
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