NPR has an interesting piece on distrust of vaccines this week in developing countries. Apparently there are a growing number of anti-vaccine groups in resource-poor countries, with links to like-minded folks in more affluent nations. This development is alarming and depressing, because suspicions towards effective vaccines are more likely to have negative effects where health indicators are poor, infectious agents are prevalent and health infrastructure is fragile. The risk of negative consequences of a child not being vaccinated depends where the child happens to be; a parent's decision to forgo a child's polio or MMR vaccine is not the same in Baltimore and Lagos. Such parental decisions are less ethically controversial if the parent is working from a reasonable assessment of the risks and benefits of vaccination, rather than distrust based on hearsay, rumors or shoddy science. Researchers at the London School of Tropical Medicine are apparently studying the social determinants of vaccine distrust, and what is even more tricky, developing practical ways to combat distrust when unreasonable. If successful, this sort of applied social science could assist in the prevention of much morbidity and mortality in developing countries. As with other health interventions, it is not enough that a vaccination is efficient, even life-saving: to be integrated into practice, it has to be accepted in the hearts and minds of communities.
The piece includes a quite amazing, related story: that the CIA used a hepatitis vaccination program in Pakistan as a front in an effort to obtain DNA from bin Laden's family. The effort seems to have been double failure: failure to obtain the DNA and failure to vaccinate children sufficiently. It may well have succeeded in undermining the legitimacy of humanitarian organizations in the region, particularly those funded by the US. Is the potential exacerbation of vaccine distrust in developing countries justified by the (eventually successful) goal of assassinating the world's top terrorist? Update: the New York Times has printed an editorial on the fake vaccination ploy by a former US Ambassador for HIV/AIDS and Assistant Director-General of the WHO on HIV/AIDS, tuberculosis and malaria. And, coincidentally, a piece in on the BBC news website has appeared about the global struggle to prevent and treat hepatitis.
Labels: bioethics, distrust, vaccination