vaccination challenging the community

Vaccination: Educating and Challenging the Community

Dr Aminah Bee Mohd KassimPublic Health Physician

Family Health Development Division

8th National Public Health Conference, Hotel Equatorial Malacca3-4th August 2016

Content

Vaccination - A little bit of history Impact of immunisation

Immunisation programme Evolution and some reasons for refusing We are being challenged National Immunisation Promotion Campaign 2016

2020 Challenging the community

what we need to do

1718Variolation in Turkey

5/14/1796Jenner's Breakthrough

TOT Vaksin | Putrajaya | www.suhazeli.com

What is Vaccine?

A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of

Killed or Inactivated virus/bacteria

Recombinant vaccine Recombinant vaccine

Polysaccharide or toxoid vaccine

Impact of ImmunisationProgramme Globally

Polio Free (2000) The world has yet to

eradicate polio 2 countries still reporting

polio Pakistan and Afghanistan

Eradication of Smallpox 1980 cease

immunisation

Impact of Immunisation Programme

Spread is controlled

i. Hepatitis Bii. Diphtheriaiii. Measlesiv. Pertussisv. Rubella

Difteria

Vaccines can only improve health and prevent deaths if they are used, and immunization programmes must be able to achieve and sustain high vaccine uptake rates. Vaccine hesitancy is an increasingly important issue for country immunization programmes

Dr Philippe Duclos, Senior Health Adviser for WHOs Immunization, Vaccines and Biological Department

Stage 3 : loss of confidence in small pox vaccination in the US

1870 - Vaccine use decreased & smallpox outbreaks occurred

1850s irregular physicians led challenges to vaccination

Smallpox cases declined between 1802-1840

NUMBER OF PERTUSSIS CASES

JAPAN stopped DPT 1975 NUMBER OF PERTUSSIS DEATHS

Stage 3 : loss of confidence in Pertussis vaccine in Japan

0

20

40

60

80

100

120

0

20

40

60

80

100

120

140

% c

over

age

No. o

f cas

es

Poliomyelitis case Immunisation Coverage

1977 - Last major outbreak of wild poliovirus (121 cases)

3 imported cases

in 1992

Poliomyelitis in Malaysia , 1974 - 2015

11

For polio, even at 80% coverage we can see the impact reduced number of cases.

Chart2

281974

251975

391976

1211977

181978

41979

567.2

169.4

565.8

261.1

264.2

466.7

162.2

067.6

067.1

075.5

089.5

090.5

392.7

089.2

089.6

089.9

092.3

091.4

093.4

093.2

095.4

096.7

094.9

094.3

095.2

094.3

096.2

098.7

096.3

098.4

098

099.5

099.7

096.9

095

Poliomyelitis case

Immunisation Coverage

No. of cases

% coverage

Chart1

281974

251975

391976

1211977

181978

41979

567.2

169.4

565.8

261.1

264.2

466.7

162.2

067.6

067.1

075.5

089.5

090.5

392.7

089.2

089.6

089.9

092.3

091.4

093.4

093.2

095.4

096.7

094.9

094.3

095.2

094.3

096.2

098.7

096.3

098.4

098

Poliomyelitis case

Immunisation Coverage

Year

No. of cases

% coverage

Sheet1

Reported Doses Administered (%)

YearBCGDTP1DTP3MCVPol3HepB3Hib3MMRDPT-Hib

198066.667.2

198165.569.4

198295.272.865.8

198394.372.161.1

198495.161.864.2

198594.968.166.7

198696.471.362.234.662.2

198790.375.668.667.967.6

198899.573.867.871.367.1

198999.491.584.160.975.5

199098.794.7907089.586

199198.292.691.679.890.587.9

199210093.292.882.992.787.9

1993101.289.989.779.789.285

1994102.992.794.581.189.685.6

1995102.190.382.289.987.1

1996100.391.592.784.792.387.4

1997100.991.99384.391.487.5

1998100.392.894.186.193.491.1coverage DPT-Hib not included

1999101.99293.186.693.290.7Coverage of MMR not included

200099.994.595.388.495.493.3

200199.395.396.892.296.795

20029973.585.775.594.993.1

200399.2102.898.793.994.390.9

200410095.594.271.495.293.871

200598.395.995.389.994.391.584.7

200698.993100.571.196.296.383.3

200798.793.397.187.398.796.395.787.3

200896.3

200998.4

2010100.8

201194.1

2012

Sheet1

BCG

DTP1

DTP3

MCV

Pol3

Hib3

Year

% coverage

Polio

BCG

DTP1

DTP3

MCV

Pol3

Year

% coverage

Sheet3

Poliomyelitis caseImmunisation Coverage

197428

197525

197639

1977121

197818

19794

1980567.2

1981169.4

1982565.8

19832.0061.1

19842.0064.2

19854.0066.7

19861.0062.2

19870.0067.6

19880.0067.1

19890.0075.5

19900.0089.5

19910.0090.5

19923.0092.7

19930.0089.2

19940.0089.6

19950.0089.9

19960.0092.3

19970.0091.4

19980.0093.4

19990.0093.2

20000.0095.4

20010.0096.7

20020.0094.9

20030.0094.3

20040.0095.2

20050.0094.3

20060.0096.2

20070.0098.7

20080.0096.3

20090.0098.4

20100.0098

20110.0099.5

20120.0099.7

20130.0096.9

20140.0095

Bilangan Kes Measles di Malaysia; 1980 2015

0

20

40

60

80

100

120

0

100

200

300

400

500

600

700

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

IR per 1mil. pop MCV1 Coverage MCV2 Coverage

2014 2015 2016 (Jun)

Measles cases

235 1402 873

Some of the reasons for refusing


BCGHep BDTaP-Hib-IPVMMR

Conspiracy Theories

16TOT Vaksin | Putrajaya | Zulkifli Ismail

TOT Vaksin | Putrajaya | Zulkifli Ismail

Vaccines are Harmful


Naturopathy Practices and Makanan Sunnah

Habbatus Sauda, Honey, Dates, Promaganate Drinks,

Extended Breastfeeding, Virgin Coconut Oil etc.

Natural, Alternative Protection


Anti-Vaxxers On The Net


24

My child, my choice!


We are being Challenged!

Definition of challenged to question whether something is true, accurate, or legal

People are now questioning if immunisation works? Is it safe? is it still relevant? Are there alternatives?

Angry? Upset? Threatened?

http://www.macmillandictionary.com/dictionary/british/question_1http://www.macmillandictionary.com/dictionary/british/true_1http://www.macmillandictionary.com/dictionary/british/accuratehttp://www.macmillandictionary.com/dictionary/british/legal

What do we get out of being challenged?

Being challenged-thats when we grow the most.

1 We are asked to reconsider our views, to explore

where they came from, to understand where we are now

2 We need to learn how to communicate better, to make

ourselves understood in ways that we don't currently know out of our comfort zone

3 We get to know viewpoints that are not ours, to really

understand them, and perhaps even to adopt them

Immunisation Coverage, 2004 - 2015

27

65

70

75

80

85

90

95

100

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

BCG DPT (3) POLIO (3) Hep B (3) Measles Hib (3)

So how do we fare actually?

Normal Curve

Challenge today

Real challenge is ensuring we develop a better understanding of public concerns about vaccines Demand rigorous evidence of safety, efficacy,

technical issues regarding vaccines

Evidence regarding publics attitudes towards developing effective communication strategies

Build and sustain trust with the public

Identify the main cause for increase in the numbercases of children not immunised

Too busy

Forget

Transport

Under-mine

severity

Refuse vaccinati

on

Fee Act for Immigrants

Defaulters

MOH surveillance showed an increasing number ofparents who refuse vaccinations for their children

Doubts on efficacy Concerns on side effects and safety

Ingredients not permissible by religion

Is there still a need?

Alternative medicine options

637

918

1541

0

200

400

600

800

1000

1200

1400

1600

2013 2014 2015

No children not immunised

1% of those attending health clinic

?% of children attending private facilities

National Immunisation Promotion Campaign 2016 - 2020An initiative spearheaded by the Ministry of Health to address the

issue of vaccine refusal in the community and to strengthen the National Immunisation Program in

Malaysia.

To clarify common rumors and allegationson vaccine safety

focusing on vaccines with decreasing uptake rates.

To garner community support for the NIP and reject anti-vaccine movement

a) Transmission of VPDsb) Controversies regarding alternatives to vaccination c) Exploring opinions of pro-vaccination groups.

To promote and strengthen parents' knowledge, beliefs and actions

to continue to accept recommended vaccines in the NIP schedule.

1 2 3

NIP = National Immunisation Program; VPD = Vaccine Preventable Diseases

OBJECTIVES

EDUCATE AND CHALLENGE THE COMMUNITY

Immunisation Info Kit for advocators

TheImmunisationInfo Kit consistsof information: For public For healthcare

professionals

Comprehensive media campaign

APR - MAY ONWARDS

Pres

s cov

erag

e an

d w

rite-

ups

TV F

eatu

reO

nlin

e an

d so

cial

m

edia

May August 2016 Public engagement

through social media influencers

Continuation of press-coverage and write-ups, TV feature and online strategies.

Campaign aims to empower the community

Students in institutes of higher education

Clients in the maternal and child health clinic and maternity wards

Young professionals

Expecting or new young parents

Pro-vaccine messages to reach all

Share the concept of Community Rights vs. Individual Rights

So...when we challenge the individual /community what do we need to do?

People have changed-Our New Reality

38

Earn Trust

Not Dismissive

Updated

VigilantShow We Care

Differentiate Hesitancy

From Anti-Vax

Proactive

Earnest


To challenge the community

Communication Skills

Knowledge

Challenge need effective communication

Respectfully LISTEN to parental concerns

Do not interrupt The other person will

loose confidence in their ability to be heard and will want the conversation to be over.


Be careful with body language

Speaking plainly and clearly

Maintain tone of conversation even as its importance or intensity escalates. - Do not raise you voice or gesturing wildly.

Try to understand the other persons perspective fully.

Ask yourself Am I challenging out of care, or out of the desire to be right?

Is this a situation where challenging this person can have a good and worthwhile outcome?

Do not LABEL e.g. Antivax problem lies in 'what happened' and not 'who did it'


When parents acknowledge ownership of their situation, they will be able to effectively resolve it. Parents need to be aware if they

dont vaccinate their children, they are putting their children and their contacts at risk

Unvaccinated children have to stay home during outbreaks

Only through reflecting on their own actions will they be likely to create different and more effective ways of acting in the future.


Our response requires knowledge, tact and time Health professionals providing immunisations are

required to be well informed across a range of different vaccines

NEED TO READ - vaccine preventable disease and its complications, immunity and immunisation, different vaccine types, the mode of action, the risks and benefits

When we challenge the community

Dont worry about every possible question Be ready to provide good websites and handouts for

patients/parents Be aware of major vaccine-critical group and individuals and

become familiar with their websites Be ready to answer common questions-has not changed much over

past 200 years It is acceptable to say you will look into it and get back to patient

with more info

When we challenge the community

Websites to get info on immunisation

www.immunise4life.my

www.ifl.my

Initiated by: Organised by: In collaboration with:

www.myhealth.gov.my

www.infosihat.gov.my

http://fh.moh.gov.my

Malaysias 1st Comprehensive Public ImmunisationEngagement Programme

Government Professional

Bodies Industry

http://www.immunise4life.my/http://www.ifl.my/http://www.myhealth.gov.my/http://www.infosihat.gov.my/http://fh.moh.gov.my/

We Should All Be Advocates!

47

Conclusion

Educating and challenging the community on issues of vaccination and immunisation is very challenging and never ending

We will have to continue to constantly Update our knowledge Develop our communication skills

THANK YOU FOR YOUR ATTENTION

[email protected]

mailto:[email protected]

Vaccination: Educating and Challenging the CommunityContentSlide Number 3Slide Number 4Impact of Immunisation Programme GloballyImpact of Immunisation ProgrammeSlide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Bilangan Kes Measles di Malaysia; 1980 2015Some of the reasons for refusingSlide Number 14Gelatin TerhidrolisisConspiracy TheoriesSlide Number 17Slide Number 18Vaccines are HarmfulWakefield Autisma (1998)Naturopathy Practices and Makanan SunnahNatural, Alternative ProtectionAnti-Vaxxers On The NetSlide Number 24We are being Challenged!What do we get out of being challenged? Slide Number 27Normal CurveChallenge todaySlide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Share the concept of Community Rights vs. Individual RightsSo...when we challenge the individual /community what do we need to do? People have changed-Our New RealityTo challenge the communityChallenge need effective communicationChallenge need effective communicationChallenge need effective communicationChallenge need effective communicationSlide Number 44Slide Number 45Websites to get info on immunisationWe Should All Be Advocates!ConclusionTHANK YOU FOR YOUR ATTENTION

vaccination challenging the community

Healthcare