Department of Global Health Lecture Series Heidi Larson February 9, 2009 'Why Do People Believe What They Do? The impact of rumors on global health.'

1. Why do people believe what they do? The impact of rumors on global health Heidi J Larson, PhD Associate Research Professor , Dept. International Development, Clark University Research Associate , Harvard Center for Population and Development

2. The Vaccination Monster (London, 1808)

3. Anti-Compulsory Vaccination League -1878

4. 200 years later

6. Diseases Prevented by Routine Immunization in the USA: A Dramatic Increase Modified from Pickering 1985 (7) 1995 (10) 2007 (16) DTP(DTaP) Polio MMR Hib HepB Varicella Pneumococcal Influenza Meningococcal Tdap Hepatitis A Rotavirus HPV DTP(DTaP) Polio MMR Hib HepB Varicella DTP Polio MMR

7. GLOBAL ENVIRONMENT - P Davies, S Chapman, Department of Public Health and Community Medicine, University of Sydney; J Leask, National Centre for Immunisation Research and Surveillance; March 21, 2002

9. An “honest response”* to Incomplete Science unintended, negative consequences Impact of Thimerosal on Hepatitis B vaccine uptake Issuance of resumption of birth dose AAP/USPHS Candid Precautionary Statement * CDC/MMWR

12. Nigeria: wild poliovirus dot map, onset Jan – 11 th Jul, 2003/04 * 2003 2004 In 2004, the number of WPV cases is more than 3 times as compared to 2003 * Onset of most recent case on 11/07/2004 W1 (415) W3 (76) W1 (58) W3 (67) WHO/NIE/EPI

13. Katsina, NIDs 2, 2004: Reasons for Rejection No. of LGAs involved=13 PEI endorsement by Nig. Medical Association, Muslim Medical Doctors Association, Pharmacists, Midwives Boards etc. important

14. Kaduna, NIDs 2, 2004: Reasons for Rejection Religious Leaders key to diffusing rejections and promoting compliance

15. Sources of Information : Caretakers SIAs, April 2004 (Percent)

17. Spread of wild polio virus 2004-2005 In HQ as of 21 June 2005 6 polio endemic countries 14 countries with imported virus 6 countries 're-established' polio 1,256 cases ’04, 555 cases ‘05

19. Mbarara district, UGANDA DTP3 reported coverage, 1989-2000 NID dates changed, coinciding with malaria peak season Fears created by the deaths from malaria right after children received OPV in 1997, led to association of child deaths with NID season, and routine vaccination. Temporal association became a causal association in the minds of many

21. INCIDENCE TIME Disease Vaccination Coverage Outbreak I II IV Prevaccine Increasing coverage Resumption of confidence Adverse events III Loss of confidence

22. INCIDENCE TIME Disease Vaccination Coverage Outbreak I II IV Prevaccine Increasing coverage Resumption of confidence Rumours / media event III Loss of confidence

24. INCIDENCE TIME Disease Vaccination Coverage Outbreak I II IV Prevaccine Increasing Coverage Resumption of confidence III Loss of confidence Increased need of evidence-based information / education Adapted from J.Bonhoeffer et al.