Impact of Adverse Events Following Immunization on Immunization Programmes

This 26-slide presentation from the United Nations Children's Fund (UNICEF) explores documented impact of real or rumoured adverse events following immunisation (AEFI) [oral polio vaccine, or OPV] on coverage, disease incidence, and national vaccine policies around the world.

As Dr. Anne Golaz explains, impact of AEFI has been reported mostly from industrialised countries; the few documented examples from Europe and Africa are found in medical journals and United Nations (UN) publications. She begins with an illustration of the way that the reporting of AEFI can have an international impact on polio eradication. In August 2003, OPV immunisation halted in Kano state, Northern Nigeria, after rumours circulated by hardline religious clerics stating that "OPV vaccine could cause sterility in girls." Soon after the boycott started, Kano became epicentre of big and fast growing outbreak of polio, which spread to whole country: 83% global cases were from Nigeria, and polio spread from Kano to 10 other countries. Dr. Golaz explores the long-term impact of the 11-month Kano boycott, including the spreading of conspiracy theories spread to other Islamic states (Pakistan and Afghanistan). She compares various past instances where fears about vaccination had local impact, noting that, when rumours that were broadcast made little impact, officials had a plan of action to counter rumours and educate people about immunisation - starting at the community level.

Similar patterns can be seen in places such as Jordan, where an AEFI outbreak occurred in 1998; the author indicates that a small cluster of events had a major national impact. Dr. Golaz stresses that context/background is very important. In the Jordan case, there were a number of negative rumours circulating about immunisation at the time and a strong anti-government feeling - leading to a strong impact by press reports that "bad vaccine given by the government to our children". One of the lessons that emerged from this experience was that the relationship with the media cannot be built up quickly during a crisis; instead, provide the media with a continuous flow of information. Additional examples are provided that illustrate the ways in which AEFI communication has impacted vaccination patterns - not just of OPV, but of vaccines such as Diphtheria, Tetanus, Pertussis (DTP) in other countries.

The next section of the presentation explores current vaccine scares, such as suggested connections between the measles, mumps, and rubella (MMR) vaccine and autism, and the potential threats to national and international immunisation programmes. Amongst the lessons learned: train health care workers to be well informed of both benefits of immunisation as well as issues of parental concern regarding vaccine safety, and engage the news media.

Dr. Golaz concludes with some overall reflections. For example, building public trust in vaccines requires paying attention to the role of the media and health care providers in giving correct information about vaccines. It is important to address issues such as lack of information, religious opposition, and distrust of central government on other issues (poverty and marginalisation of underserved population at the root of popular disgruntlement: refusal of vaccine). The author stresses that AEFI should be taken seriously: They can have a serious impact on immunisation programmes.

For more ionfromation, contact:

Anne Golaz

UNICEF Regional Office for South Asia (ROSA)
rosa@unicef.org