Growth in vaccine-sceptic Ugandans puzzles experts

People that are opposed to vaccination (anti-vaxxers) have become more visible during the Covid-19 pandemic and Sunday Monitor understands they appear to be winning more followers.

Health experts are now warning that if not upturned, this trend could have devastating long-term effects on other routine immunisation for children and adults, reversing gains made in the fight against killer diseases in the country.

The coverage of important vaccinations such as those against tetanus and human papillomavirus have for years remained far below the expected level. 

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The Health ministry also says routine vaccination for children like polio and measles are struggling to reach respective targets.

Anti-vaxxers, who talked to Sunday Monitor, cited the hasty development of Covid-19, reported cases of adverse effects and even death among recipients in foreign countries as well as a “hidden agenda of population control by vaccine promoters” as reasons for their opposition.

“Obviously, if vaccines can kill and cause serious and debilitating lifelong damage–which they can, and do–the vaccine administrator must provide that information to the client in unambiguous fashion, regardless of the estimated size of the risk. It’s an ethical mandate that must be fulfilled, but it never is,” Mr Moses Mugisha said.

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He argues that regardless of one’s personal beliefs regarding vaccination, the idea that the government can mandate a medical procedure without one’s consent should be cause for concern to everyone because it contravenes basic human rights principles and attacks freedom of choice on what one allows to enter his or her body.

Many Ugandans who share common views with Mr Mugisha feel threatened by the Public Health (Amendment) Bill, 2021, which the government last month tabled before Parliament.

The government—in that Bill—is planning to make it compulsory for Ugandans to get vaccinated. Short of that, it’s proposed that offenders be either fined Shs4m or jailed for six months.

Dr Immaculate Ampaire, the deputy manager of Uganda National Expanded Programme on Immunisation (UNEPI), said a lot more should be done despite the Bill—if approved—having the potential to address resistance to vaccination. 

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She said before Covid-19 the Health ministry was already grappling with anti-vaxxers.
“For some vaccines, the coverage is as expected. But for others, the coverage is below,” she said, adding, “The human papilloma vaccine (HPV) for prevention of the cancer of the cervix is lower than expected. Vaccination for tetanus among women of reproductive age is also below what is expected.”

Mixed scorecard
A 2018 report by researchers from Makerere University School of Public Health estimated the uptake in Lira District at 17 percent.

The low uptake of HPV vaccine is particularly worrying given that the cervix accounts for 80 percent of all female cancers as per the Ministry of Health. 

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Uganda introduced HPV vaccines around 2006 with the first HPV pilot vaccination implemented in 2008 in Nakasongola and Ibanda districts.

“We had tried to improve but the school closure [due to Covid-19] took us back to the drawing board. Since the schools are now open, we can learn lessons and find ways to strengthen those programmes,” Dr Ampaire said.

She explained that they have faced resistance from organised groups such as Njiri Nkalu, a religious organisation that vehemently opposed vaccines. It strongly believes in divine protection rather than man-made vaccines.

“The Public Health (Amendment) Bill, 2021 will address some of these challenges. But generally, acceptance of vaccination in Uganda is not the biggest problem. We have the political will and I think we should exploit the demand for vaccines which are available. But we also need a clear framework for accountability and sense of ownership for this country,” she said.

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Dr Jane Aceng, the Health minister, told MPs last month that the Bill has a section on vaccination and immunisation as a public health measure to protect the vulnerable.

“When we introduce new vaccines, we need to get a mass of people so we create mass immunity. It is important that whoever is supposed to be vaccinated is vaccinated,” she said.

Dr Ampaire revealed that while vaccines that are given in the first year of life seem to be on track, challenges remain.

“For the infants, the mothers bring the children because it has been inculcated in their minds to do so,” she explained.

Immunisation coverage
According to the World Health Organisation (WHO) and United Nations Children’s Fund (Unicef) report for Uganda’s immunisation coverage in 2019, the country didn’t score 100 percent coverage for any immunisation.

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For the Bacillus Calmette-Guérin vaccine, which is given for tuberculosis, the coverage was estimated at 94 percent. This represented an increase from 86 percent coverage in 2008. Diphtheria-Tetanus-Pertussis (DPT1) immunisation coverage was at 91 percent in 2019, which is higher than 89 percent of 2008.

Whereas for injectable polio vaccine, the 2019 coverage was at 88 percent—a sharp increase from 60 percent in 2016. But for the measles (MCV1) vaccine, the coverage was at 78 percent in 2019—a slight increase from 77 percent in 2008. 

Anti-vaxxers have—without providing evidence—tried to link this vaccine and MMR with autism.

Dr Alfred Driwale, the manager of UNEPI, says the yearly build-up of the number of children who are not vaccinated is a threat to the fight against killer diseases.

Dr Simon Peter Sebina Kibira, a lecturer in the Department of Community Health and Behavioral Sciences at the Makerere University School of Public Health, reckons that acceptance of vaccination has a lot to do with the deadliness of a disease.

He adds that resistance to Covid-19 vaccination is a result of comparatively lower risk the disease presents to people.

“When the disease is no longer threatening, naturally human beings will drop in terms of vaccination. If people were seeing that the disease was killing as it happened in the second wave which was driven by Delta, it would be easy to influence people to go for vaccination,” Dr Kibira said.

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He added: “When you are threatened that the disease is dangerous, you are going to do something about it. If you find that the disease is like normal flu, you ask yourself why you should go for the Covid-19 vaccine and not for the flu vaccine. People are rational and they ask themselves those questions.”

Educated shun jabs
The expert, nevertheless, encourages parents to take their children for measles, polio and the rest of the vaccinations “because…the diseases are dangerous.” Yet anti-vaxxers seem to be growing in leaps and bounds. 

According to Prof Winstons Muhwezi, a behavioral scientist and director of research at Advocates Coalition for Development and Environment (ACODE), hesitancy for vaccination is surprisingly high among the educated people.

“Generally, I think younger and more educated people like to question everything brought by the government. This is good for someone who is educated, but it can also be counterproductive,” he said.

The expert thinks the decline in Covid-19 vaccination rate could be because of the fears triggered by the rumours that there is some hidden agenda in the vaccination—especially the belief among some Pentecostal Christians that the vaccine is the onset of 666 and the accompanying theological connotation.

“Also the messaging around vaccination has been changing and this could be an issue. At one time they said there were two doses and others only required one dose to be fully vaccinated. But right now they are talking about a booster dose,” he opined, adding, “People start having questions in their mind. Are we dealing with a country where everybody is understanding the reasons for the changes or others feel they are in the dark? We need to be very clear about that.”

Issue
Anti-vaxxers, who talked to Sunday Monitor, cited the hasty development of Covid-19, reported cases of adverse effects and even death among recipients in foreign countries as well as a “hidden agenda of population control by vaccine promoters” as reasons for their opposition.