1) The document discusses a presentation given by Dr Aminah Bee Mohd Kassim on educating and challenging the community about vaccination. 2) It provides a brief history of vaccination and its impact in reducing diseases like smallpox and polio globally. However, vaccination rates have faced challenges from issues like conspiracy theories and alternative medicine practices. 3) In Malaysia, the National Immunization Promotion Campaign 2016-2020 aims to address vaccine refusal in the community through education, clarifying rumors, and garnering community support. It involves an immunization info kit, media campaign, and empowering advocates. 4) When challenging the community, effective communication is key. Advocates must listen respect

1. Vaccination: Educating and
Challenging the Community
Dr Aminah Bee Mohd Kassim
Public Health Physician
Family Health Development Division
8th National Public Health Conference, Hotel Equatorial Malacca
3-4th August 2016

2. Content
• Vaccination - A little bit of history
– Impact of immunisation
• Immunisation programme
– Evolution and some reasons for refusing
– We are being challenged
– National Immunisation Promotion Campaign 2016
– 2020
• Challenging the community
– what we need to do

3. 1718
Variolation in Turkey
5/14/1796
Jenner's Breakthrough

4. TOT Vaksin | Putrajaya | www.suhazeli.com
What is
Vaccine?
A vaccine is a biological preparation that improves immunity to a particular disease.
A vaccine typically contains an agent that resembles a disease-causing microorganism,
and is often made from weakened or killed forms of the microbe, its toxins or one of
Killed or Inactivated
virus/bacteria
Recombinant vaccineRecombinant vaccine
Polysaccharide or toxoid
vaccine

5. Impact of Immunisation
Programme Globally
Polio Free (2000)
• The world has yet to
eradicate polio
• 2 countries still reporting
polio – Pakistan and
Afghanistan
Eradication of Smallpox
• 1980 – cease
immunisation

6. Impact of Immunisation Programme
Spread is controlled
i. Hepatitis B
ii. Diphtheria
iii. Measles
iv. Pertussis
v. Rubella
Difteria

7. • “Vaccines can only improve health and
prevent deaths if they are used, and
immunization programmes must be able to
achieve and sustain high vaccine uptake rates.
Vaccine hesitancy is an increasingly important
issue for country immunization programmes”
Dr Philippe Duclos, Senior Health Adviser for WHO’s Immunization, Vaccines and Biological
Department

9. Stage 3 : loss of confidence in small pox
vaccination in the US
1870 - Vaccine use decreased & smallpox outbreaks occurred
1850s – ‘irregular’ physicians led challenges to vaccination
Smallpox cases declined between 1802-1840

10. NUMBER OF
PERTUSSIS
CASES
JAPAN stopped DPT 1975
NUMBER OF
PERTUSSIS
DEATHS
Stage 3 : loss of confidence in Pertussis vaccine
in Japan

11. 0
20
40
60
80
100
120
0
20
40
60
80
100
120
140
%coverage
No.ofcases
Poliomyelitis case Immunisation Coverage
1977 - Last major outbreak of wild
poliovirus (121 cases)
3 imported
cases
in 1992
Poliomyelitis in Malaysia , 1974 - 2015
11
For polio, even at 80%
coverage we can see the
impact – reduced number of
cases.

12. Bilangan Kes Measles di Malaysia; 1980 – 2015
0
20
40
60
80
100
120
0
100
200
300
400
500
600
700
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
IR per 1mil. pop MCV1 Coverage MCV2 Coverage
2014 2015 2016
(Jun)
Measles
cases
235 1402 873

13. Some of the reasons for refusing

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15. TOT Vaksin | Putrajaya | www.suhazeli.com
BCG
Hep B
DTaP-Hib-IPV
MMR

16. Conspiracy Theories
16
TOT Vaksin | Putrajaya | Zulkifli Ismail

17. TOT Vaksin | Putrajaya | www.suhazeli.com

18. TOT Vaksin | Putrajaya | Zulkifli Ismail

19. Vaccines are Harmful
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20. TOT Vaksin | Putrajaya | www.suhazeli.com

21. Naturopathy Practices and
‘Makanan Sunnah’
Habbatus Sauda, Honey, Dates,
Promaganate Drinks,
Extended Breastfeeding, Virgin Coconut
Oil etc.

22. Natural, Alternative Protection
22
TOT Vaksin | Putrajaya | Zulkifli Ismail

23. Anti-Vaxxers On The ‘Net
23
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24. 24
My child, my
choice!
TOT Vaksin | Putrajaya | Zulkifli Ismail

25. We are being Challenged!
• Definition of challenged –
to question whether something
is true, accurate, or legal
• People are now questioning if immunisation
works? Is it safe? is it still relevant? Are there
alternatives?
• Angry? Upset? Threatened?

26. What do we get out of being
challenged?
Being challenged-that’s when we grow the most.
1
• We are asked to reconsider our views, to explore
where they came from, to understand where we are
now
2
• We need to learn how to communicate better, to make
ourselves understood in ways that we don't currently
know – out of our comfort zone
3
• We get to know viewpoints that are not ours, to really
understand them, and perhaps even to adopt them

27. Immunisation Coverage, 2004 - 2015
27
65
70
75
80
85
90
95
100
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
BCG DPT (3) POLIO (3) Hep B (3) Measles Hib (3)
So how do we fare
actually?

28. Normal Curve

29. Challenge today
• Real challenge is ensuring we develop a better
understanding of public concerns about vaccines
– Demand rigorous evidence of safety, efficacy,
technical issues regarding vaccines
• Evidence regarding public’s attitudes towards
developing effective communication strategies
• Build and sustain trust with the public

30. Identify the main cause for increase in the number
cases of children not immunised
Too
busy
Forget
Transport
Under-
mine
severity
Refuse
vaccinati
on
Fee Act – for
Immigrants
Defaulters

31. MOH surveillance showed an increasing number of
parents who refuse vaccinations for their children
Doubts on efficacy Concerns on side
effects and safety
Ingredients not
permissible by religion
Is there still a need?
Alternative medicine
options
637
918
1541
0
200
400
600
800
1000
1200
1400
1600
2013 2014 2015
No children not immunised
• 1% of those
attending
health clinic
• ?% of children
attending
private
facilities

32. National Immunisation Promotion Campaign 2016 - 2020
An initiative spearheaded by the
Ministry of Health to address the
issue of vaccine refusal in the
community and to strengthen the
National Immunisation Program in
Malaysia.
To clarify common
rumors and
allegations
on vaccine safety
focusing on vaccines with
decreasing uptake rates.
To garner community
support for the NIP
and reject anti-
vaccine movement
a) Transmission of VPDs
b) Controversies regarding
alternatives to vaccination
c) Exploring opinions of pro-
vaccination groups.
To promote and
strengthen parents'
knowledge, beliefs
and actions
to continue to accept
recommended vaccines in the
NIP schedule.
1 2 3
NIP = National Immunisation Program; VPD = Vaccine Preventable Diseases
OBJECTIVES
EDUCATE AND
CHALLENGE
THE
COMMUNITY

33. Immunisation Info Kit for advocators
The
Immunisation
Info Kit consists
of information:
• For public
• For healthcare
professionals

34. Comprehensive media campaign
APR - MAY ONWARDS
Presscoverageand
write-ups
TVFeatureOnlineandsocial
media
May – August 2016
• Public engagement
through social media
influencers
• Continuation of press-
coverage and write-ups,
TV feature and online
strategies.

35. Campaign aims to empower the community’
Students in institutes
of higher education
Clients in the maternal
and child health clinic
and maternity wards
Young professionals
Expecting or new
young parents
Pro-vaccine messages to reach all

36. Share the concept of
Community Rights vs. Individual Rights

37. So...when we challenge the individual
/community what do we need to do?

38. People have changed-Our New Reality
38
Earn
Trust
Not
Dismissive
Updated
VigilantShow We Care
Differentiate
Hesitancy
From Anti-
Vax
Proactive
Earnest
TOT Vaksin | Putrajaya | Zulkifli Ismail

39. To challenge the community
Communication Skills
Knowledge

40. Challenge – need effective communication
• Respectfully LISTEN to
parental concerns
• Do not interrupt
– The other person will
loose confidence in
their ability to be heard
and will want the
conversation to be over.

41. Challenge – need effective communication
• Be careful with body
language
• Speaking plainly and
clearly
• Maintain tone of
conversation even as its
importance or intensity
escalates. - Do not raise
you voice or gesturing
wildly.

42. • Try to understand the other persons perspective fully.
• Ask yourself “Am I challenging out of care, or out of
the desire to be right? “
• Is this a situation where challenging this person can
have a good and worthwhile outcome?
• Do not LABEL – e.g. Antivax
– problem lies in 'what happened' and not 'who did it'
Challenge – need effective communication

43. • When parents acknowledge
ownership of their situation, they
will be able to effectively resolve it.
– Parents need to be aware if they
don’t vaccinate their children, they
are putting their children and their
contacts at risk
– Unvaccinated children have to stay
home during outbreaks
• Only through reflecting on their
own actions will they be likely to
create different and more effective
ways of acting in the future.
Challenge – need effective communication

44. • Our response requires knowledge, tact
and time
– Health professionals providing immunisations are
required to be well informed across a range of
different vaccines
– NEED TO READ - vaccine preventable disease and
its complications, immunity and immunisation,
different vaccine types, the mode of action, the
risks and benefits
When we challenge the community

45. • Don’t worry about every possible question
– Be ready to provide good websites and handouts for
patients/parents
– Be aware of major vaccine-critical group and individuals and
become familiar with their websites
– Be ready to answer common questions-has not changed much over
past 200 years
– It is acceptable to say you will look into it and get back to patient
with more info
When we challenge the community

46. Websites to get info on immunisation
www.immunise4life.my
www.ifl.my
Initiated by: Organised by: In collaboration
with:
www.myhealth.gov.my
www.infosihat.gov.my
http://fh.moh.gov.my
Malaysia’s 1st Comprehensive Public Immunisation
Engagement Programme
• Government
• Professional
Bodies
• Industry

47. We Should All Be Advocates!
47

48. Conclusion
• Educating and challenging the community on
issues of vaccination and immunisation is very
challenging and never ending
• We will have to continue to constantly
– Update our knowledge
– Develop our communication skills

49. THANK YOU FOR YOUR ATTENTION
aminahee@moh.gov.my
03-88834003