Overview
Project AViD took a critical anthropological approach to exploring what actions can be taken to optimise vaccine acceptance during a disease outbreak. Whilst some countries already face logistical challenges to vaccine deployment and administration, these system weaknesses are exacerbated during times of disease outbreaks. In addition to access challenges, some populations have underlying distrust in national and international bodies that provide vaccines, which can also amplify in times of emergencies, as seen in the Ebola and Zika outbreaks. Rumours and misinformation are also commonly spread in times of outbreaks, especially when the diseases are unfamiliar, or there is an absence of information available.
Clarissa Simas, former Research Fellow at the VCP, was the lead for the Brazil case study.
Background
On March 29th 2015, Brazil first notified the World Health Organization (WHO) of an unknown illness characterised by skin rash, which was rapidly spreading in the northeast of the country. In 4 months, nearly 7000 mild cases were reported with no causalities among them and symptoms were mild and appeared not too problematic. However, in October 2015, researchers from the northeaster state of Pernambuco, in Brazil notify an unusual increase in the number of cases of microcephaly among new-borns, which led authorities to declare, a month later, a state of national public health emergency as cases of microcephaly continued to increase. Scientific evidence confirmed that the cause of microcephaly outbreak in northeast Brazil was Zika virus infection during pregnancy. WHO deemed the Zika outbreak as Public Health Emergency of International Concern, the fourth declared since 2009, prompting international response and mobilisation.
For the period of uncertainty (and beyond) of what was causing the microcephaly outbreak, alternative hypothesis spread via rumours. These were communicated not only in person but also in social media, where they were amplified – recent data published by Facebook Brazil identified that rumours were among three out of the ten most shared content about Zika on the platform. One of the main rumours circulating at the time was that an expired batch of vaccines administered by the government was responsible for microcephaly. Despite scientific evidence of link between Zika during pregnancy and microcephaly, recent qualitative interviews point to a lingering suspicion of a link between vaccines and microcephaly. Therefore, there is the need for research addressing the social context in which the Zika epidemic took place and how it mediates confidence in a Zika vaccine.
Methodology
Maternal immunisation is key to protecting maternal and newborn health. We interviewed pregnant women in Brazil to identify barriers to and enablers of maternal immunization in the country. In-depth interviews and focus groups were conducted in Brazil with 60 pregnant women from São Paulo and Rio de Janeiro at different stages of their pregnancies. Participants were encouraged to discuss views on safety, efficacy and importance of maternal vaccines, access to vaccines, interactions with healthcare professionals, and sources of information on vaccine-related matters.
Findings
There was generally a positive regard for maternal immunisation among the interviewed women, many of whom associated vaccination with protection of their unborn child. The interviewees cited several reasons for adherence to immunisation guidelines, including recommendations from healthcare professionals, targeted communication campaigns, and active use of a vaccination card or booklet. There were no reported barriers for maternal vaccines. However, some women using private healthcare services reported not having been asked about vaccines at check-ups, which could adversely affect vaccination rates. The study also identified important vaccine confidence builders. Many of the interviewees critically reflected upon information received, placing themselves as the decision makers over their health choices.
The most prominent barrier to Zika vaccination was a rumour that the vaccines caused microcephaly. This was the most commonly cited reason for choosing not to vaccinate among the interviewees. To the best of our knowledge, this has not been previously reported in the literature and requires further investigation into the extent of this issue and how it can be mitigated.
