Public health is concerned with protecting and improving the health of people and their communities by promoting healthy lifestyles, researching disease and injury prevention, detecting, preventing and responding to infectious diseases.
Immunisation as a public health intervention offers a critical opportunity to elevate mother and newborn health on the broader health and development agenda and catalyze progress towards sustainable development. It protects mothers, the developing fetus, and young infants during vulnerable time in their lives.Maternal immunisation not only boosts the mother’s immunity against dangerous pathogens, but a mother’s antibodies can be passed to her unborn baby in-utero through the placenta or through breast milk thereby protecting her and the baby from life-threatening illnesses. For new-born babies, these maternal antibodies provide essential protection during a “window of vulnerability” when infants are too young to get their own immunizations.
There is progress in development and accessibility to life saving vaccines. However, some communities in developed and developing countries still harbour suspicions about such interventions. This mistrust affects proper and timely uptake of new vaccines. Low-and-middle-income countries (LMICs) face challenges of misinformation and negative narratives around safety of vaccines and new medicines. Narratives like Africans are ‘guinea pigs’ for the western world have led to avoidance of life saving interventions.
Community engagements improve health literacy through collaborative processes between stakeholders and communities to identify the needs and pursue corrective strategies. They facilitate equal participation where everyone shares information, perspectives, clarification of viewpoints and developing solutions. Communities are empowered to develop local solutions to achieve common goals and to overcome barriers.
Researchers at Makerere University Centre for Health and Population research (MUCHAP) conducted such engagements in Eastern Uganda to discuss issues around immunization programs, vaccine safety and introduction of new vaccines for pregnant women. Emphasis was on joint problem identification and analysis to craft a preferred state. Sessions were participatory and empowering for members, deepened understanding through listening, and common goals and action points were developed. Participants understood vaccine preventable illnesses as both infectious and non-communicable diseases with some not having any known vaccine.
Some of their sentiments on maternal and neonatal immunization, and introduction of new vaccines were legitimate while others were inaccurate: ‘new vaccines should be brought to market when it has no side effects’;‘it is important to save lives of pregnant women if the older vaccines have weakened, new vaccines are good for pregnant women because many get affected with several medical problems, new vaccines will fight against the increasing diseases which are harmful to the health of pregnant women like candida’; ‘it may reduce the number of pregnant women who undergo caesarean section during times of delivery’. Such views point to vaccine acceptability.
Negative opinions related to immunization of pregnant women included: ‘during the introduction of Hepatitis B vaccine, some people were told that the vaccine may prevent them from giving birth’;‘new vaccines may lead to delivery of deformed babies’, and ‘they want to deter young potential mothers from producing children to control population size and their children will not be pregnant in future through the introduction of new vaccines’.
The two major causes of infant deaths that disproportionately impact those living in LMICs are Group B streptococcus (GBS) and respiratory syncytial disease (RSV). No licensed vaccines currently exist against GBS, but work is underway to develop a vaccine that can begiven to pregnant women so that newborns are protected even before birth. On the other hand, the treatments available for RSV are limited but several vaccines are in development.
As we wait for the vaccines in pipeline, it is important to listen to communities through engagements. This will (a) correct the misinformation and negative narratives, (b) mitigate the spread of negative stories by some groups out of ignorance (c) improve health literacy, and (e) access organic information from those impacted by such interventions. If the negative narratives are not explained to clear false impressions, we risk avoidable vaccine preventable morbidities and mortalities now and in future.
By Dan Kajungu Msc. PhD
Lead Research Scientist and Director, MUCHAP
Vaccines and Medicines safety Researcher
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