Silent refusals and distrust of vaccines is a big challenge for vaccination teams


Peshawar: After the fake immunization campaign in a failed attempt to get Osama bin Laden’s DNA lineages prior to his assassination in 2011, the efforts of polio eradication in northwestern Pakistan, the last major reservoir of polio across the globe, seems still stagnated due to gaining mistrust over different vaccines despite huge aid and official investment spending over different campaign programs, human resource and logistics etc.

The immunization coverage rate before and after Osama bin Laden’s assassination clearly shows difference in rate of immunization coverage, but as numbers of population increase each year the number of exact refusal is hard to identify. However detail investigations fond some interesting case studies which define each of the type of vaccines refusal.

The cases like Rehan a 3 years old child from Laki-Marwat patient of diphtheria and was admitted in Khyber Teaching Hospital (KTH) for normal treatment, when details were discussed with Rehan’s parents about different vaccinations the one’s government provides for prevention of diseases, they were surprised that government was offering this kind of vaccines. Further discussion with them was quite surprising as they responded as, “Yes Yes this vaccine, this is not good for children health they are causing impotency in male children”. Rehan’s family is not the first who believe this but many of the local families have the same belief about oral and injectable vaccines.

A local sanitary worker Ejaz Khan, told ‘Truth Tracker’ the reason behind why they were refusing vaccination of their child and told that “a day when I was working on UN project in IDPs camp setting up washrooms sanitary accessories, a child who was vaccinated in front of me in the camp within 2 days after vaccination his arm stopped movement, the one in which vaccine been injected. And now since 2 years have gone but his arm is still not working and he is now disabled by that arm. So I am scared of these vaccines, I will never ever vaccinate my children’s with those vaccines.” During further discussion Truth Tracker found that his son was suffering from cold and fever for the last 6 months and he had visited many hospitals and doctors for his child’s treatment but never found any hope yet despite a lot of investment.

Trust in medicine is the key determinant for assuring health care of local citizens, but most importantly it is relevant in use of vaccines. This problem is even more prevalent in countries with low literacy and lower level of education for years due to incapability of political leaders and policy makers; where no such chain of tracing system to measure quality of medicines/vaccines in practice, low quality of remedial medicine can exacerbate the negative consequences of infections.

After the US claimed Bin Laden assassination in year 2011 by CIA, the immunization coverage of Pakistan did not improved till 2015 shows UNICEF database, due to the propagating the hate and wrong image of vaccinations with referring to the incident of Bin Laden by locals and different religious groups. But later as in Federal Administered Tribal Areas (FATA) the official stakeholders forcibly started vaccinating the children of locals the rate of immunization in FATA improved, reveals in data of Emergency Operations Center (EOC) placed in FATA secretariat under support of Bill Gate Foundation.

Further analysis of data of UNICEF shows that the progress of different kind of vaccines likes BCG, DTP, TT, OPV, Pentavalent and Measles etc as shown in graph below from year 2010 to 2016 found no such improvement taken in place.

Further the same data shows that the immunization coverage in Pakistan in year 2016 is around 80 per cent, which means that in every ten children two are still un-immunized in Pakistan. But the ground reality is that many of people are still refusing the vaccines. According to another local worker Aman Khan from Peshawar, when he was working in high court judge house two years back, told Truth Tracker that a judge official representative of government is refusing vaccine for their children. “How I can agree to vaccinate my children as the official itself telling us that this is not good for children health”, he said. Not only people like Aman who held this belief, but interesting case study shows that the behavior is more common than expected likea polio vaccination team like a professional doctor who had three children who had never been vaccinated yet.

Truth Tracker explored the data of Gallup global poll, shows that Pakistan is second by following UK when it came to hesitant behavior for getting vaccines for their children. The total survey size for Pakistan was around 709 respondents in which around 99 persons shows hesitancy for getting vaccines; and 15 persons clearly refuse the vaccines, as further the most frequent response for showing the reason for refusing/ hesitancy for vaccines are “Did not think the vaccine was effective” and further most of them saying “Did not think it was needed” at all.

The Gallup data further reveals that most of the people are “Silent Refusals” who have no reason but refusing the vaccines for their children, as during detailed interview with focal person EOC FATA secretariat, Aqeel Ahmed told Truth Tracker, that it is quite surprising for us when some people go to the extent of temporarily changing their residence when they find out that Vaccination Teams along security forces forcibly vaccinate their children, this kind of refusal called “Silent Refusals” which is dangerous for their kids health as we see a lot of kids admitted in hospitals of central areas like in Peshawar from tribal areas for the diseases which can be preventable with these vaccines.

Further investigation on World Bank data reveals that in Pakistan in every thousand babies 79 are dying before reaching age five every year, same as further data reveals that neonatal babies in every thousand 46 are dying each year. The research on data found that Pakistan is worst country in the region where more children are dying before they turn age five as below graph shows in details.

The Data of Global Health Observatory of year 2015 reveals that the most of the children are dying due to “Prematurity”, which means per thousand live birth 13 children are dying and as further around 8 children are dying due to “Acute lower respiratory infections” every year.

Since the hatred for vaccines is increasing day by day with numerous numbers of reasons, we investigated the areas where many numbers of drone strikes happened since 2004 to 2017.

According to data of The Bureau of Investigative Journalism shows that since year 2004, 429 US drone strikes occurred in different places, but mostly in tribal areas of Pakistan in which more than 4 thousand people were killed, and only in 2010 in which more than hundred drone strikes occurred in which more than thousand people were killed. Further data reveals that North Waziristan is the only place where around 3 hundred plus drone strikes were recorded, in which more than 25 hundred people have been killed.

The investigation on data of drone strikes comparing with data of immunization clearly shows that the areas having more drone strikes are having less immunization rate despite the team of vaccination with security, it has become increasingly hard to reach the all the children and as most of them are refusing to immunize their children. This means that less than half of the children belonging to North Waziristan have not been vaccinated with basic vaccines like BCG and OPV etc whereas the South Waziristan the only region where in every ten neonatal kid only one is vaccinated with basic vaccines, which is dangerous for children living in these area and they are more vulnerable than the children living in settled areas of KP. Furthermore the local of Tribal areas’ people interrogate the team of vaccination about the vaccines and drone strikes, “on the one hand they are killing our children and on the other hand they are sending you to vaccinate our children”, is this what you people want to do with us? We do not need any vaccines, but we do need you to stop this whole drama of Talibanization and operation things in FATA and leave us as we were live before here with freedom and happiness.

Way Forward

It was found that the trust is key determinant to assuring health care of local citizens, and most importantly vaccination of kids is not the priority of health care of local citizens. Dr.Shahidullah Afridi told Truth Tracker, that the people who are not vaccinating their kids against diseases are the society enemies, as this is standard for all that they must insure children heath care and will be responsible of it. If they are not vaccinating their kids it will affected their own kids which obviously no one wants, the trust on vaccines can be possible with awareness of right image of vaccines and benefits.

Further he added that the different religious representatives and leading peoples of different groups should be added in the campaign to gain local citizens’ confidence on the importance of vaccines. If they share some case studies with them to show the impact of refused vaccines, as we see a lot of patients in hospital affected of different diseases due to refusal of vaccines, then they might agree to buy expensive vaccines for their children to protect them from disease their kids have. To avoid such health issues, children aged less than 5 years or equal should be vaccinated during complete course of 15 months for different vaccines and also with oral vaccinations like polio”, he concluded.


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