Vaccination
India is facing a rising tide of people unwilling to allow themselves, or their children to be vaccinated, and the current conflict arises amidst that.
Image for representation.

Nearly half of all vaccines delivered globally are manufactured in India. This is a considerable accolade for India’s pharmaceutical industry. Indian vaccines are saving potentially millions of lives on a global basis, however, homegrown misinformation could be limiting India’s success in delivering vaccines to its own people.

The need for high immunisation coverage levels

As is currently the case across the globe, India is facing a rising tide of people unwilling to allow themselves, or their children to be vaccinated. This presents a considerable issue, as immunisation levels fall the overall effect of a vaccination campaign is diminished.

The concept is known as herd immunity. In short, as more and more individuals among a population are vaccinated, there are less chances for a disease to be passed on among the population.

For example, with immunisation levels over that recommended for a highly contagious disease such as the measles — that being above 95 percent of the population — outbreaks are effectively contained as very few members of the population can be infected. However, with a lower immunisation coverage level, for example at fifty percent, it is quite likely that an individual with the disease will expose others who have not been vaccinated to the condition, allowing it to spread among the population.

India conducted an effective campaign to eradicate polio by utilising this concept. Grassroots campaigns across cities and villages alike allowed for the administration of the oral polio vaccine to as many children as possible, raising immunisation levels considerably. With this, India began to see a reduction in polio numbers, and eventually, its eradication as of March 27, 2014.

Without the mass vaccination of millions of individuals, this would never have occurred. The campaign was widely supported. However, had levels of support been lower, small bastions of the polio virus may have remained, potentially allowing for resurgence in the future as those who had not been vaccinated pass the virus on to others.

Herein lies the danger of the anti-vaccination movement. It is not only themselves, or their children who are put in danger of infectious disease through their lack of vaccination. It is their entire local community. For every individual that foregoes vaccination, there is yet another opportunity for infectious disease to flourish among the population.

India's potential to be a world leader in vaccinations

Currently, India is seeing its own anti-vaccination movement, creating a growing fear over the human papillomavirus (HPV) vaccine. This is due to the spreading of unsubstantiated rumours of potential side effects, spurred on by social media and the resulting echo chambers.

However, HPV is one of the most common causes of cervical cancer, which kills more women in India than in any other country. The HPV vaccine is very effective in preventing infection by strains of the virus that cause the majority of cervical cancers. By neglecting to use this vaccine, women in India continue to be placed in danger, potentially facing huge medical costs down the line or even, in the worst cases, death.

Vaccines are universally recognised as the most cost effective means of combating disease. It is far cheaper to focus on prevention of a disease — potentially eradicating it entirely, as is the case with smallpox — than it is to wait until people are already affected and deal with the symptoms. This pre-emptive approach is the only means by which a disease can be eradicated for good.

India is a shining example of this. Initially viewed as one of the more challenging countries from which to eradicate polio, years of successful campaigns involving the administration of vaccines by grassroots workers eventually rid the country of a disease that can drastically reduce the quality of life for the children affected.

It is therefore of the utmost importance that the public is educated to the benefits of vaccines in India. The best means of countering misinformation is to provide the public with the correct information regarding vaccines, their safety procedures, and the years of safety tests that back them.

India has the potential to lead the way in future vaccines. Alongside its current capacity for vaccine production, domestic research is also taking place. Indigenous research is currently underway to develop new vaccines against life-threatening diseases such as malaria, dengue, chikungunya, cholera and shigella.

Armchair science, the anti-vaccination misinformation movement

Challenges may be faced along the way. As more and more Indians switch on to social media, more may be exposed to anti-vaccine sentiments. Such an issue could cause many to turn away from medical treatments, particularly among a growing wave of support for Ayurvedic practices, a concept which could sway more individuals to turn away from vaccination.

Mistrust of the pharmaceutical community is rife, this often stems from the perception that they are profiting off the ill-health of the population. While this point of view neglects the billions of dollars a year needed to research new therapies and medicines to combat disease, it is an easy viewpoint to manipulate to turn a misinformed individual against treatments such as vaccination.

In many cases anti-vaccine sentiments are derived from outright lies. The most famous example of this is the case of the disgraced former doctor Andrew Wakefield. It is from his revoked study published in The Lancet that the commonly used claim of autism through vaccination originates.

The study was revoked, Wakefield had his medical license removed due to malpractice, yet still the study is cited by anti-vaccination groups as truth. Claims to the contrary are often met with accusations that an individual is under the sway of a theoretical “evil pharma corporation”.

Wakefield tends not to find supporters among the scientific community, as only a brief glance at his study reveals gaping holes (many of which relate to his violation of ethical procedures).

The sample size for his study was only twelve children. This alone would raise red flags to anyone familiar with standard research practices as this is a miniscule sampling size for such a bold claim. Of the twelve children, it was found that Wakefield had not randomly selected candidates, and had therefore likely specifically chosen children that had both autism and a history of vaccinations to meet his conclusions.

 

He was also found following to his publishing of the study to have financial links to lawyers who were in the process of a lawsuit against a pharmaceutical company producing vaccines.

Anti-vaccination, politics and religion

In other cases political reasons are often dragged into the anti-vaccination debate. Nowhere is this more true than in the remaining hubs of the polio virus: Afghanistan and Pakistan.

Militant groups such as the Taliban have been a major hurdle to the final push to eradicate polio in the region. A major issue here is misinformation spread against vaccination. The local Taliban in Afghanistan, for example, have issued fatwas denouncing vaccination as an American ploy to sterilize Muslim populations.

India is facing similar issues amongst its muslim population. In December, hundreds of madrassas across western Uttar Pradesh have refused access to health officials to administer the measles and rubella vaccine to children, potentially putting hundreds, even thousands of children’s lives at risk.

The fears over the MR vaccine were reportedly spread via Whatsapp, with numerous claims that the vaccine would make children impotent. Though the government is conducting awareness drives to attempt to stem the issue, numerous other locations such as Saharanpur, Bijnor and Moradabad have had similar occurrences.

It is absolutely vital that India informs the public to stem the opposition to potentially life saving vaccines. If India is to lead the way in producing currently used vaccines, as well as the creation of new vaccines, its own population must benefit from this domestic production.

This article was originally published on Health Issues India. It is reprinted here with permission.