Vaccine skepticism and worries about side effects among ethnic minorities is well known and well researched, but a deeper insight into its context and driving forces is needed

 

(First published in Danish at Raeson.dk 25^th August 2021 - https://www.raeson.dk/2021/professor-morten-sodemann-vaccineskepsis-blandt-minoriteter-er-velkendt-og-velundersoegt-men-der-er-brug-for-en-dybere-indsigt-i-dens-kontekst/)

You cannot fix a problem you do not understand. There is a need for much better knowledge about the skepticism of minorities and about how this skepticism is nurtured, reinforced, and spread. And we need to acknowledge that we, the majorities of the high-income countries, ourselves have a share in the blame for skepticism about medicines and vaccines. If we are not prepared to realize that, then we will never create the basis for inclusion and equality in health.

In an interview on 18 August in the Danish newspaper Politiken, it was mentioned that vaccine skepticism in ethnic minority communities could have other causes than those we are used to hearing in Denmark, and an example of vaccine skepticism was mentioned based on the CIA using a vaccination campaign in Pakistan to capture and kill Osama Bin Laden. Many believed that the example was precisely an expression of misinformation, but it is in fact correct and well documented that the Americans, to identify where Osama Bin Laden was in a suburb of Islamabad, first carried out a false study of children's antibodies against hepatitis (hepatitis) through blood tests in order to compare the children's DNA with Bin Laden's DNA. Next, a fake polio vaccination campaign was organized in the area where it was now known that Bin Laden's children lived, and through that, his housing complex was found. This led to skepticism towards foreign health campaigns in Pakistan and in a number of countries on the African continent.

One has also seen a correlation between the frequency of drone flights and adherence to vaccination campaigns: As US drone flights over Pakistan slowed, vaccination adherence increased again. In many countries, vaccination workers have been hunted wildly after the process in Nigeria, DR Congo, and Pakistan, just as vaccine skepticism has been widespread on social media in South Africa even before COVID-19. The problem has been hailed as one of the world's 10 biggest health problems by the World Health Organization (WHO). At a recent public meeting in suburban area of Odense, Vollsmose with a high proportion of ethnic minorities, it was pointed out that many refugees come from countries where you cannot trust either the authorities, the government or the press, while social media is perceived as "our own media", because it is the media that politicians close each time there are demonstrations. Social media therefore becomes the least unreliable source of information.

A recurring problem in Africa

The political undertones of the vaccination debate are not new - celebrities, religious leaders, presidents, and political leaders have for centuries helped to keep the skeptical flame burning . For example, Ghandi believed that vaccines were a "fatal misconception not even found among the savages." Certain denominations, such as the American Apostolic Churches, have been active opponents of vaccines in several African countries, and the churches have had direct responsibility for measles epidemics in a number of African countries. In Nigeria, religious leaders in three states decided in 2003 to boycott a global polio eradication program with vaccination. The rumor was that the vaccines infected Africans with Western diseases like HIV and cancer and that they were meant to make girls infertile. Childhood vaccinations were accused in Cameroon of making girls in certain ethnic minority groups sterile. Due to political touch anxiety, the misinformation could spread and was the direct cause was the direct cause of a fivefold increase in the number of polio cases in Nigeria in 3 years.

India (like several other countries) has a dark history when it comes to forced sterilization among the poor and less privileged, and the link between vaccination and sterilization in countries with ethnic conflicts is obvious (see, among others, Deepa Dhanraj's documentary, ‘Something like a war’). There are over 36 documented links between infertility and vaccination, mass treatments of children, condom campaigns with defect condoms, poisoned milk powder or drug trials – the first dating back to 1920 and up to today. For example one of the current vaccine manufacturers had to pay large compensations in Nigeria after a failed, unethical medical trial with medical treatment of meningitis, where the participants were not told that they were involved in a trial.

In Mozambique, a cholera vaccination program ran into problems because a previous government program to desinfect water wells with chlorine was blamed for making girls infertile, and it led to all sorts of misinformation about other vaccination campaigns being brought into the rumor mill - because parts of the population in advance was anger at the government.

During the Ebola epidemic, more than 250,000 blood samples were taken, which, often without acceptance, were exported to the major vaccine companies in the high-income countries, which further contributed to skepticism about the rich countries' real intentions when "offering help" in health programs such as vaccinations and testing.

Effort requires insight

Most people in low-income countries would like to be vaccinated, but due to the many political links that have always existed between vaccines and politics, the majority of respondents in a CDC survey - 15,000 people in 15 African countries - would like evidence that the vaccines are safe and that there are no hidden agendas with the vaccines. The study also showed that there was a lack of respect among health authorities around the world for this understandable skepticism (and their own role in it), and that one had neglected, globally, to explain why vaccines may make sense both for oneself and for society at the same time. Authorities should refrain from basing campaigns on prejudices and preconceptions and instead become more aware of the needs of specific target groups and then organize a wide range of tailored information and vaccination campaigns.

Public health research has identified rumors and misinformation as significant barriers to vaccination, but they have primarily been perceived as communication errors that need to be corrected by providing more accurate information about vaccines. But rumors are more than just stories that are not true. The widespread rumor of sterility after vaccination is a way of formulating understandings about reproductive organs, collective survival, feelings of social exclusion and can be an expression of powerlessness towards the global power structures.

Vaccine skepticism among minorities is well known and well researched, but a deeper insight is needed into its context, group thinking, historical conditions, political and socio-cultural contexts, political disgrace, and media coverage.

You cannot fix a problem you do not understand. There is a need for much better knowledge about the skepticism of minorities and about how this skepticism is nurtured, reinforced, and spread. And we need to acknowledge that we, the majorities of the high-income countries, ourselves have a share in the blame for skepticism about medicines and vaccines. If we are not prepared to realize that, then we will never create the basis for inclusion and equality in health. The good bad news is that today we are as skeptical of science as humans were in the Middle Ages.

The example of the CIA's unscrupulous use of false, well-documented vaccination campaigns shows that truths and lies are opportunistically woven into each other. When Western powers can invent one vaccine, they can invent anything with their vaccines. Correct news turns into fake news in a particular social context. There are organized Russian network trolls that drive vaccine skepticism, for example towards the Pfizer vaccine, to promote the Sputnik vaccine. There is no quick fix - just hard work.

The concerns that refugees may have about the side effects of medical treatment and vaccines are often quite basic and are based on experience and knowledge from the home country. A targeted effort based on dialogue is needed to create the knowledge that enables the individual to decide about e.g., vaccination or treatment of diabetes. It is a sound investment that will ensure a stronger inclusion of ethnic minorities in prevention and treatment.

The vaccine skepticism of ethnic minorities is not just a vaccine skepticism but a skepticism towards the authorities who most often want to hurt them and who therefore fail their part of the welfare contract. Because as several expressed it at a recent public meeting in the district Vollsmose in Odense: ‘Why are you so preoccupied with vaccinating us now - where was your care for us before COVID-19?