Trust is based on a mix of emotion and facts. The two are inextricably linked in life and work but even more so in public health. There is no one-metric-fits-all here and the sharpest schisms have predictably occurred in immunization and vaccination programmes. Resources are not the only problem.
Last week a video surfaced in Malappuram in northern Kerala, showing an Islamic leader preaching to a group of women that immunization was the work of the devil and comparing it to Adam being tempted by the snake to eat the apple. The comments were later denied but the damage was done as doubt was created and allowed to linger. Read here.
The leader in Kerala is neither illiterate nor alone and he speaks to one of the rudest wake-up calls that the world of public health has faced in the last decade – one that has questioned some very basic assumptions like literacy, education and socio-economic levels. The London School of Hygiene and Tropical Medicine (LSHTM) says that some of the most educated mothers of the world are also questioning and refusing vaccines. “These debates are not based on not having enough information, they are about alternative notions of immune systems, naturopathy, or other “evidence”- sometimes inaccurate…” collected via the internet says the LSHTM.
These mothers are not anti-science either. They want more science thus highlighting the critical role of telling an accurate story that assumes nothing and is accountable to all for everything. Communication has now become a determinant of public health along with epidemiology, economics and law.
“Watching the video of the Islamic leader denouncing vaccination fills me with hope and gratefulness. I am thankful to be living in the digital age where we can use our mobile devices to hold our leaders accountable for their words and actions,” Dr. Franklin Apfel, MD and Managing Director of the UK-based World Health Communications Associates told The News Minute. “The women attending that meeting in Kerala deserve to hear accurate, reliable and culturally sensitive information that can truly help them protect their children and themselves,” said Apfel who was the head of World Health Organisation’s (WHO) European office of media and communications in Copenhagen.
Translated for that setting, it means accurate scientific information routed through the reliable and culturally sensitive ‘voice’ of the Grand Imam of the Holy Mosque of Mecca who has said that protection against diseases is obligatory and permissible under Sharia law. Read here.
Good health is the absence of disease and vaccinations are fine examples to underline that basic public health quest. “Vaccines are not like medicines – in the best case nothing happens. The child is not crippled, killed or brain damaged,” says Mark Chataway, a health communication and policy consultant with Hyderus, a Wales UK-based company that works globally with all public health stakeholders. “In global terms that ‘nothing happens’ has meant the end of polio, millions of children avoiding life-long disability and millions more saved from death. In terms of one family, one can see this clearly,” he added.
Religious scaremongers have company and competition in the world of public health. Some lawyers are known to make money from vexatious lawsuits while others think promoting national production is a higher good than protecting children from harm. “Usually these people cannot be won over by argument or treated as rational actors. Many are crooked and lazy and they just need to be marginalized,” said Chataway, who has worked on vaccine issues with international organisations, research-based companies and governments for over two decades.
If polio is an example of how societies came together with science to make the world almost polio free, Ebola has dealt a deadly blow to trust and faith in doctors and health workers, built over ages. Speaking at the last session of the WHO’s annual assembly in Geneva last May, German Chancellor Angela Merkel was very critical of the global response to the deadly diseases. The German Chancellor taking time out to travel to Geneva to highlight the gravity of the situation was widely applauded. Several journal articles have since highlighted the failure of the international response to Ebola. The so-called “safe” burials were comfortable images on a television screen but the ground reality was very different. Read our story here.
“In the Ebola affected context, routine immunization plummeted due to a strained health system as well as fears of injections, creating new anxieties about widespread measles outbreaks,” the LSHTM said. The importance of telling a coherent and accurate story backed by science and sense, via a trusted voice could have saved lives where fear was the overriding emotion.
Meddling with immunization is dangerous. Should parents be invited to decide whether or not their children can be vaccinated? The jury is out on this but some studies (in the United States) say even positive and rational messages reduce the likelihood that parents will get their child vaccinated. “We know that the way to protect children is to use policy nudges, make parents really explain their objections and hold parents accountable for their unimmunized children in school and playgrounds,” says Chataway.
Never has the need to remain scientifically sound been greater than now when the next public health ‘crisis’ is just a click away on social media. Rarely has the need for doctors, health workers and the public health community been greater to come together on facts. The media’s role cannot be over-emphasised. It needs to address the women in Kerala who may be swayed by the cleric as well as those who have access to best practices.
Disease, like fear, does not discriminate.