By Mattimi Passah
After these long gloomy months of dealing with the COVID-19 pandemic, the world is finally seeing the light at the end of the tunnel. It is a hope that a vaccine will be available to protect humans from this dreaded disease sooner than later. But for a state like Meghalaya the much bigger challenge that awaits the Government is to ensure hundred percent vaccination. The truth is that till date there is still a high incidence of people who refuse to take the different vaccinations the Government provides free of cost.
The reality about low immunization is based on a ‘Case study on Immunization Defaulters’ conducted during the month of June-July, 2018 in some identified villages under Jarain PHC, Nartiang PHC and Ummulong CHC. From the interviews conducted with families of parents who refused immunization, the following are the findings from the study.
Community perception on refusal of immunization
In analysing the findings from the field study, it can broadly be stated that there are many reasons that make the parents in the identified villages refuse to get their children and themselves vaccinated.
- a)Need of immunization in the community
Most of the respondents felt that there is a need for immunization but few felt that it is not needed while some have no response whether immunization is needed or not. One of the main reasons that make parents refuse immunization is indifference to vaccinations. When asked if they are aware of the importance of getting their children immunized and the risk of not getting them immunized, the answer is always in the positive. When asked if the ASHAs and AWWs informed them about the dates when immunization is to be administered in their respective villages, the answer is again in the affirmative. The parents and mostly the mothers respond that no one stops them from getting their children immunized but it’s sheer indifference that is the reason for not vaccinating them. The standard responses of the mothers interviewed are: ‘wym kwah hi imynsiem and wymsniaw bang hi u e’, (‘I don’t feel like giving and I don’t feel good either).’
- b)Influence of religious and traditional beliefs
In some cases, the mothers in their responses categorically stated they refused to get themselves administered the different doses of vaccination during their pregnancy and also refused to get their children immunized because of religious influence(s). Still many refuse to even take the interview. The few that were willing to talk said that they do not get their children vaccinated because they believe in the power of prayer. They said that only prayer can heal them when they fall ill. If the child is sick, they would not take them to the doctor or provide them any kind of medication. They also believe that it is not necessary to do so as only their trust in God and prayers through Jesus will heal the children.
In spite of the fact that they refused to get their children vaccinated, some would hide the truth because of their religious conviction and compulsion. They refused to divulge the truth why they refused to get their children vaccinated even if the community and the health workers confirmed the same. When reminded of the risk of not getting their children vaccinated; they instead refer to their holy scriptures and say, ‘what will happen because what was written has to be fulfilled.’ They said that what is destined to happen will happen no matter what.
- c)Fear of adverse effects
There are few examples of mothers who refuse vaccination because of their concern about the adverse effects after immunization and they have evidence to justify their claims. Some examples of severe adverse effects include swelling of the thighs of the babies which last for several weeks and sometimes extend to months and cause difficulty in walking. There are two cases where the child found it difficult to walk and they still limp when they walk even two or three years after they have been vaccinated.
Some argue that they refuse to get their children vaccinated because their children continue to have high fever days and even months after the vaccination. Some parents refuse to get their children vaccinated on flimsy grounds that they don’t want to lose sleep which could be the after-effect of immunization. Some complained that after getting their child vaccinated, the baby would fall sick which affects the productivity of the mother because she has to take care of the other siblings and sometimes even her parents. It also affects the daily routine of the members of the family particularly the mother and she would not be able to go to work the next day which will cause loss of wages. This according to our observation is one reason why in some cases the father of the child would force their wives not to get the child immunized.
- d)Fear of vaccination
There are instances where the respondents informed that they refuse to get themselves and the children immunized out of fear of vaccination. One woman said that she had never had any needle piercing her body so she does not want her child to go through that ordeal too.
- e)No difference between a child who is immunized and those who are not
Most of the respondents felt that there is no difference between children who had been immunized and those who were not while some said that there was a difference. A few refused to respond. Some mothers said they do not see any difference between the children who were administered vaccination and those who were not. In spite of getting their children administered the complete doses of vaccination yet, they still have to take their children to the doctor every time. They say the child still suffers from common diseases like colds etc. They consider getting their children vaccinated a futile exercise since the children still get sick after completing all the doses.
A section of the respondents said that they never get their child vaccinated because they themselves or their mothers have never been vaccinated. In cases where both the grandmother and the mother were present during the interview both justified that nothing had happened to them even if they have never got themselves vaccinated. ‘Look at us; we are no different from the other female members of the community, they also fall sick and we also fall sick so there is no difference,’ the grandmother quipped.
- f)Lack of confidence on immunization
There are also quite a big percentage of mothers who refused to get their child immunized because of the lack of confidence in the immunization process. There are mothers we interviewed who said that they had been vaccinated during pregnancy and also allowed their elder children to be immunized but stopped all of a sudden with the birth of the subsequent kids. For example, in a family where they have six children; the three elder siblings were administered vaccination (although not the complete dose), but the siblings born later were not vaccinated.
There is this one strange case of a young mother who when asked why she refused to get her baby immunized the response was that she was angry with the Government. She did not receive the financial support (JSY) provided to mothers for delivering the baby at the Government institution. She was sad because she did not get the grant while the other mothers (her contemporaries) in the villages received the benefits.
- g)Lack of awareness
A major cause of concern is the community’s indifference towards vaccination. They would not ensure that their children received the complete doses of the immunization. In many cases mothers are not even aware of the different doses of vaccination that need to be administered to the child to complete the process. In such cases the mother unintentionally misses certain doses despite the fact that she genuinely wishes to provide complete immunization to her child.
In view of the above findings, it will be an immense challenge for the Government to get people vaccinated if and when vaccination for COID-19 is approved. Considering the fact that the Coronavirus is very contagious, the Government will have to ensure that all and no one is left without being given the COVID-19 vaccination.
(The writer is working at the Center for the Study of Complex Malaria in India, Indian Institute of Public Health Shillong and can be reached at [email protected])