DGH Lecture Series: Heidi Larsen


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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.'

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  • DGH Lecture Series: Heidi Larsen

    1. 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. 2. The Vaccination Monster (London, 1808)
    3. 3. Anti-Compulsory Vaccination League -1878
    4. 4. 200 years later
    5. 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
    6. 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
    7. 8. So what do we need to do?? <ul><li>Scientists (and the Media!) must not to treat fear and reservation as ignorance and then try to destroy them with a blunt “rational” instrument. </li></ul><ul><li>Pattison – BMJ 2001;323:838-840 </li></ul>
    8. 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
    9. 11. WHO: World Polio Cases Rise Dramatically <ul><li>Friday, 14 January 2005, 21:00 CST </li></ul><ul><li>GENEVA - The number of worldwide polio cases last year rose dramatically after a vaccine boycott in Nigeria spawned a resurgence of the disease across Africa, the World Health Organization said Wednesday. </li></ul><ul><li>The number of cases worldwide in 2004 reached 1,185, compared with 784 in 2003, the United Nations health agency said. </li></ul>
    10. 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
    11. 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
    12. 14. Kaduna, NIDs 2, 2004: Reasons for Rejection Religious Leaders key to diffusing rejections and promoting compliance
    13. 15. Sources of Information : Caretakers SIAs, April 2004 (Percent)
    14. 16. Nigeria: Kano state: from local to international impact Endemic countries Wild virus type 1 Wild virus type 3 Importations <ul><li>Polio spread from Kano, to 10 countries: </li></ul><ul><li>Ivory Coast </li></ul><ul><li>Ghana </li></ul><ul><li>Togo </li></ul><ul><li>Benin </li></ul><ul><li>Burkina Faso </li></ul><ul><li>Cameroon </li></ul><ul><li>Central African Republic </li></ul><ul><li>Chad </li></ul><ul><li>Sudan </li></ul><ul><li>Botswana </li></ul>Polio cases as of June 15, 2004 Soon after boycott started, Kano became epicenter of big and fast growing outbreak of polio, spread to whole country: 83% global cases from Nigeria then to neighboring countries, including 10 that previously had been free of polio Importations
    15. 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
    16. 18. <ul><li>NEARLY FIVE YEARS LATER </li></ul><ul><li>Total cases globally: </li></ul><ul><li>1648 </li></ul><ul><li>Wild Poliovirus Weekly Update </li></ul><ul><li>4 February 2009 </li></ul>1648 TODAY 1185 (after boycott) 784 2009 2004 2003
    17. 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
    18. 20. <ul><li>A new study by Harvard estimates that the South African government would have prevented the premature deaths of 365,000 people earlier this decade if it had provided antiretroviral drugs to AIDS patients.. </li></ul><ul><li>The policies that resulted in the 365,000 deaths grew out of President Thabo Mbeki’s denial of the well-established scientific consensus about the viral cause of AIDS and the essential role of antiretroviral drugs in treating it. </li></ul>
    19. 21. INCIDENCE TIME Disease Vaccination Coverage Outbreak I II IV Prevaccine Increasing coverage Resumption of confidence Adverse events III Loss of confidence
    20. 22. INCIDENCE TIME Disease Vaccination Coverage Outbreak I II IV Prevaccine Increasing coverage Resumption of confidence Rumours / media event III Loss of confidence
    21. 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.