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Don't dismiss ‘anti-vax’
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Comment
Don’t dismiss ‘anti-vax’ To win over opponents of vaccination, we must understand the often complex roots of their mistrust, says Furaha Asani
JOSIE FORD
M
EASLES is making a shocking return to the US. At the heart of this return is a growing reluctance by some groups in society, fanned by social media, to have their children vaccinated, citing mistrust of government, big pharma and scientists in pushing inoculation. It is easy to dismiss “antivaxxers” as just misinformed and misguided. But vaccine mistrust isn’t monolithic. To fully and respectfully engage with people, the reasoning behind different communities’ doubts must be unpacked with nuance. An instructive perspective comes from elsewhere in the world. While the World Health Organization reports that vaccine uptake is increasing globally,
60 per cent of children who didn’t receive routine immunisations in 2017 came from just 10 countries in Asia and Africa. A deep-rooted mistrust of Western health interventions is one cause. Take the malaria vaccine RTS,S, which GlaxoSmithKline rolled out as part of a pilot study in Malawi earlier this year, with Ghana and Kenya set to follow. RTS,S is up to 40 per cent effective at preventing malaria in young children. Not great, but this is the first proven vaccine against a disease that kills 1200 people a day worldwide, most of them children in Africa. Yet the trial has provoked a backlash, with concerns ranging from Africans being used as guinea pigs in an unethical trial to it being a plot to sterilise local populations.
Social anthropologist Ayodele Samuel Jegede of Ibadan University in Nigeria studied the roots of a polio vaccine boycott in northern Nigeria in the early 2000s. He showed how it was influenced by the Trovan case, in which the drugs company Pfizer was accused of unethically trialling an antibiotic against meningococcal meningitis in the region in the 1990s. Pfizer denies the claims, and settled a case brought by the Kano state government out of court for $75 million in 2009. The theme that vaccines are a ploy for sterilisation has been seen in Cameroon, Tanzania, Pakistan, Afghanistan and India. It has its roots in fear of eugenics. With eugenicist programmes
conducted as recently as the 20th century in the US, this fear hits close to home – perhaps one reason why African Americans register lower uptake of certain vaccines. Jegede’s study describes how vaccine boycotts can be avoided through engagement with community leaders, local public awareness campaigns and locally based ethics committees to help ensure that interventions take into account cultural norms and sensibilities. A meta-study of 14 vaccination interventions in developing countries conducted in 2011 by Angela Oyo-Ita at the University of Calabar Teaching Hospital in Nigeria and her colleagues supports the idea that such initiatives can boost uptake. In the US, the College of Physicians of Philadelphia also emphasises the importance of communication and respect for diverse social and cultural perspectives in building trust around vaccines. Appropriate action needs to be taken to maximise vaccine take up. But that involves engaging with the roots of mistrust – and understanding that the practice of science itself may carry some blame. Collectively and pejoratively labelling those opposing vaccination as “antivaxxers” won’t solve anything. ❚
Furaha Asani is at the University of Leicester, UK. Follow her on Twitter @DrFuraha_Asani 22 June 2019 | New Scientist | 23
Letters There are more ways to profit from going green p26
Aperture Can you spot the common potoo in this image? p28
Culture A podcast about women’s sexual health is set to change lives p30
Culture columnist Chelsea Whyte feels the fear as horror stalks TV screens p32
Comment
Don’t dismiss ‘anti-vax’ To win over opponents of vaccination, we must understand the often complex roots of their mistrust, says Furaha Asani
JOSIE FORD
M
EASLES is making a shocking return to the US. At the heart of this return is a growing reluctance by some groups in society, fanned by social media, to have their children vaccinated, citing mistrust of government, big pharma and scientists in pushing inoculation. It is easy to dismiss “antivaxxers” as just misinformed and misguided. But vaccine mistrust isn’t monolithic. To fully and respectfully engage with people, the reasoning behind different communities’ doubts must be unpacked with nuance. An instructive perspective comes from elsewhere in the world. While the World Health Organization reports that vaccine uptake is increasing globally,
60 per cent of children who didn’t receive routine immunisations in 2017 came from just 10 countries in Asia and Africa. A deep-rooted mistrust of Western health interventions is one cause. Take the malaria vaccine RTS,S, which GlaxoSmithKline rolled out as part of a pilot study in Malawi earlier this year, with Ghana and Kenya set to follow. RTS,S is up to 40 per cent effective at preventing malaria in young children. Not great, but this is the first proven vaccine against a disease that kills 1200 people a day worldwide, most of them children in Africa. Yet the trial has provoked a backlash, with concerns ranging from Africans being used as guinea pigs in an unethical trial to it being a plot to sterilise local populations.
Social anthropologist Ayodele Samuel Jegede of Ibadan University in Nigeria studied the roots of a polio vaccine boycott in northern Nigeria in the early 2000s. He showed how it was influenced by the Trovan case, in which the drugs company Pfizer was accused of unethically trialling an antibiotic against meningococcal meningitis in the region in the 1990s. Pfizer denies the claims, and settled a case brought by the Kano state government out of court for $75 million in 2009. The theme that vaccines are a ploy for sterilisation has been seen in Cameroon, Tanzania, Pakistan, Afghanistan and India. It has its roots in fear of eugenics. With eugenicist programmes
conducted as recently as the 20th century in the US, this fear hits close to home – perhaps one reason why African Americans register lower uptake of certain vaccines. Jegede’s study describes how vaccine boycotts can be avoided through engagement with community leaders, local public awareness campaigns and locally based ethics committees to help ensure that interventions take into account cultural norms and sensibilities. A meta-study of 14 vaccination interventions in developing countries conducted in 2011 by Angela Oyo-Ita at the University of Calabar Teaching Hospital in Nigeria and her colleagues supports the idea that such initiatives can boost uptake. In the US, the College of Physicians of Philadelphia also emphasises the importance of communication and respect for diverse social and cultural perspectives in building trust around vaccines. Appropriate action needs to be taken to maximise vaccine take up. But that involves engaging with the roots of mistrust – and understanding that the practice of science itself may carry some blame. Collectively and pejoratively labelling those opposing vaccination as “antivaxxers” won’t solve anything. ❚
Furaha Asani is at the University of Leicester, UK. Follow her on Twitter @DrFuraha_Asani 22 June 2019 | New Scientist | 23