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Losing trust – why immunisation programmes fail

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malaria_injectionWhat do South Wales, North Nigeria and Northwest Pakistan have in common? They all have outbreaks of serious viral infections which could easily have been prevented by vaccines which are known to be effective. So why are children not being immunised? There are many reasons why the outbreak of measles in Wales and the new cases of poliomyelitis in Nigeria and Pakistan continue, but a unifying cause is a breakdown in the trust between parents and medical staff.

Loss of trust

An unproven theory about a possible link between measles-mumps-rubella (MMR) vaccine and autism led to the publication of a seriously flawed study in 1998. The paper was retracted by the prestigious journal that published it but unfortunately the damage had already been done and its publication set off a panic among many parents that still results in low immunisation rates in the UK (1). The recent death of a young man with measles in Wales has been a belated wake-up call to the danger of this infection and special weekend immunisation clinics have been urgently established in South Wales.

Encouraged by an atmosphere of fear, mothers’ groups have campaigned against MMR because of putative, but erroneous, concerns about the vaccine. Individuals and pressure groups have also tried to take some international organisations providing immunisations to the courts because of these organisations’ justifiable claims that ‘vaccines prevent child deaths’. Others have spread rumours that vaccines are contaminated by mercury and contraceptives. A shocking list of some of the many myths about vaccination has just been published by WHO.

In Pakistan, immunisation teams have come under great suspicion and attack since the widespread, albeit unfounded belief that the capture of Osama Bin Laden near Rawalpindi, was assisted by intelligence gathered during a fake door to door hepatitis B vaccine campaign run by a CIA asset. In Nigeria, a fundamentalist group called Boko Haram, which is opposed to all Western ideas, has fostered many myths about immunisation. In both countries, health workers on immunisation teams have been murdered.

The necessity of immunisation

But are immunisation teams really necessary? Yes-but they are a sign of failed health care systems. Even in the poorest and most remote communities in the world there are great examples of regular maternal, newborn, child health (MNCH) programmes in which the same mentalhealthdrugs phentermine staff members support a pregnant woman, deliver and treat her and her infant and young child whenever they are sick. Those same health workers provide immunisations. They are trusted. However the trust, based on consistent care and built up by between parents and health workers over years, can be destroyed by health care systems which fail to deliver regular staff, equipment, supplies, vaccines or salaries. While ‘top up’ immunisation programmes do often contribute to increasing immunisation coverage towards ’safe levels’, their staff are often not well known to the community and therefore not as trusted as MNCH staff. That, tragically, makes them more vulnerable.

Biblical principles

So what Scriptural principles guide the development of a better system for immunisations for all?  Firstly, ensuring that integrity is foremost in everything we do, whether it is research, communications or relationships. In John 14: 6 Jesus says ’I am the way the truth and the life‘. We need to model our lives and work on Him.  David speaks of integrity and uprightness in Psalm 25:21. Jesus noted that there was ’no deceit‘ in Nathaniel in John 1: 47.

Secondly, we need to develop compassion in our relationships. Paul describes how we need to be transformed into his likeness in 2 Corinthians 3: 18.  Ephesians 5: 1 and 2 describes how we need to live a life of ’love and service‘.  Thirdly, we are told to be courageous. The Lord told Joshua to be strong and of good courage in Joshua 1: 3-9. At the end of his life, David commended his son Solomon to be strong in 1 Kings 2: 2. The Lord encouraged Isaiah in Is 41: 10 not to be fearful or dismayed because ’I am your God‘. We need to have evidence based convictions and be courageous wherever we work but especially in difficult circumstances. And if we do not personally work in such circumstances, we need to support and pray for those brave health workers who do such vital frontline work.

There are still many biological challenges for development of vaccines and these need supporting as described in the Lancet.  However, unless health workers can restore the trust that they once had, even the most brilliant technological breakthroughs will not prevent disease, disability and death.

Restoration of trust is urgently needed.

Posted by Andrew Tomkins
CMF International Study Group

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