April 26, 2016
4 min read
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Health workers identify motivators for OPV refusal in Pakistan

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Health workers reported that parents in regions of Pakistan where polio is still endemic refuse oral polio vaccines for their children due to misconceptions related to vaccination efforts, according to recent research in Vaccine.

“Refusal of the oral polio vaccine (OPV) by the general public exemplifies the difficulties faced in multiple endemic areas, including Pakistan and Nigeria,” Tahir Mehmood Khan, PhD, of the school of pharmacy at Monash University in Malaysia, and colleagues wrote. “In Pakistan, fanatics have succeeded in a propaganda campaign against the polio vaccination by spreading false messages such as that the polio vaccination will make children sterile, contains pig blood, and is not good for children.”

Khan and colleagues explored the challenges health workers faced while attempting vaccination campaigns in Pakistan by conducting focus groups with those who participated in OPV campaigns in polio “red zones.” During these sessions, the researchers explored health workers’ opinions related to factors that influence parental OPV hesitancy and refusal. Workers who conducted OPV campaign efforts in the Pakistani cities of Bannu, Kohat, Hangoo and Peshawar were approached by researchers for study participation. Four focus group discussions were held with 42 health workers from January 2015 to March 2015. Discussions centered on three topics: challenges faced by workers, parental barriers to vaccination and aftereffects of OPV.

The researchers found that the most common reasons given for parental refusal included the belief that OPV is haram, or forbidden by Islamic law; that OPV contains pig’s blood or monkey blood, and that OPV efforts are secretly being conducted to sterilize their children. Furthermore, health workers reported that many parents had strong beliefs in conspiracies related to OPV campaigns, including that the CIA is spying on them through the guise of vaccination.

The researchers said attitudes toward vaccination began to erode after an incident involving the United States in 2011, during which the CIA attempted to obtain DNA samples from children under the pretense of hepatitis B vaccinations, as part of the hunt for Osama bin Laden.

“[The Abbottabad incident] potentially led to an erosion of public trust in immunization,” Khan and colleagues wrote. “It has fueled OPV refusal, making it very difficult to attain millennium development global public health goals and also hindering the achievement of the national milestone of adding Pakistan to the list of polio-free nations.”

Health care workers also reported harsh public attitude and bad behavior toward them as security concerns. These concerns included the threat of attacks on polio teams and the overall threat of terrorist activity in the region. Workers from the Bannu and Peshawar regions, however, did not report any behavioral concerns.

Khan and colleagues suggest improving logistics and facilities for health workers conducting OPV campaigns in Pakistan’s red zones. They also emphasized a need for improved education about the purpose and benefits of vaccines, which could be spearheaded by religious leaders in order to illicit community trust. The researchers warned that without improvements, OPV-refusal may lead to refusal of other essential vaccinations.

“It is important to fine-tune a flexible and acceptable communication strategy to implement the vaccination program in the tribal and rural areas of Khyber Pakhtoon Khawa,” they wrote. “It is the job of the stakeholders to devise methods and campaigns by taking into account the local perceptions and values and by ensuring community participation.” – by David Costill

Disclosure: The researchers report no relevant financial disclosures.
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