By Joyee Au Yeung
Vaccination is a global initiative, with positive externalities including herd immunity and even potential eradication of more dangerous or deadly diseases. Sometimes, however, vaccinations are not enough to protect citizens, with issues including technical problems with the vaccines themselves, and cultural or social resistances to vaccinations. The World Health Organization developed a strategic document called the Global Vaccine Safety Blueprint [1] in 2011, aiming to create indicators for vaccine safety in all countries. The Blueprint especially focuses on poorer countries and their vaccine safety.
In China, it is mainly the former. China’s vaccine market has been quickly growing over the past decade as the state administration continues to push for a higher health standard. China is also on its way to become a major world vaccine manufacturer, yet many question the reliability of the country’s vaccines. Considering China’s disastrous domestic vaccine scandal in July 2018, domestic mistrust and anger continue to build up as citizens seek important vaccines instead. On 15th July, 2018, Changchun Changsheng Biotechnology, a Chinese vaccine producer, was found to have fabricated data for their rabies vaccine. After further investigation, it was discovered that the same company violated standards for the DTP (diphtheria, tetanus, and pertussis) vaccine. The scandal continued to spiral as a different company, Wuhan Institute of Biological Products, was also found to have produced more than 400,000 doses of faulty vaccine. [2] This faulty DTP vaccine has also been distributed to clinics and administered to children, mainly in the Shandong area. Despite the Chinese Center for Disease Control’s statement that these vaccines were simply safe but ineffective, parents became paranoid and public indignation spread rapidly on the internet and across social media.
It is important to note that many vaccines are administered for newborns and children through public health organizations in China, with the DTP vaccine being one of them. To support the growing pharmaceutical industry in China, children are also encouraged to get domestically produced vaccines instead of imported vaccines, as they usually come free or with a discount. However, this system that aims to provide the most vulnerable population from illnesses proves to be self-defeating due to these faulty vaccines. It also further damaged people’s trust in the quality of “Made in China” products, and led to many complaints and concerns.
As WeChat and Weibo discussions and rants were in full swing, censorship striked and removed the most-viewed articles and discussion posts on Weibo. This act was unable to silence the crowds, and instead only intensified their anger, since they felt like authorities should have taken their concerns seriously instead of banning them from speaking. This led to a rare two-day protest in Beijing, outside of China's National Health Commission, which highlighted the severity of this incident. People wanted to speak out for this public health concern despite potential consequences surrounding open dissent. Many protesters were parents who called for stricter drug safety standards in China, and stated that they would rather purchase foreign vaccines despite the price, as they lost all faith in domestically produced pharmaceuticals. It is ironic and concerning how these vaccines made to protect public health may actually bring harm, and may be a reflection of how China may be choosing progress over quality for growth.
However, social and cultural resistances may also hinder the spread of vaccination in the community. An obvious example is the outbreak of measles in the United States and Thailand.
Despite the fact that measles was eliminated from the United States in 2000, the U.S. experienced 17 outbreaks in 2018. [3] These cases mainly occurred due to two reasons: these outbreaks are due to unvaccinated people in Orthodox Jewish communities and imported cases from other countries. I will primary focus on discussing the vaccinated population in the U.S.
The measles outbreak is the most serious in two states: Washington State and New York, which allows parents to opt out from vaccinating their kids if it violates their own religious or personal beliefs. As the anti-vaccine movement grows, more and more parents are rejecting vaccines on the basis that they are “more dangerous” than advertised by the government. Vaccination and public health are regulated by state, meaning no federal legislation can change this situation, and our best bet may just be public information campaigns.
In Thailand, the Muslim population in the country’s southern provinces have low vaccination rates due to cultural and religious restraints. This has led to a measles outbreak in the provinces, where 14 deaths and more than 1,500 cases have been reported between September to November. [4] Gelatin, a pork product, may be used in vaccine production, which led to Muslim community’s avoidance of vaccines. Thailand’s health officials have recently clarified that measles vaccines in Thailand are imported and does not contain porcine gelatin [5] in an effort to encourage measles vaccination rates. Going forward, government officials also promised to take religious considerations seriously and protect the health for all communities.
Reflecting upon the disastrous outbreak of measles in Thailand, there are measures that the government should take to avoid these results, including considering population’s needs and demands, as well as clearer specifications concerning vaccine content. For the Muslim community, I believe it should be the government’s duty to understand and handle their needs, including reassurance that vaccines abide by their cultural and religious customs. Vaccines are only able to spread within and protect a community when the community understand that vaccinations are in accordance with their own norms and values.
In conclusion, the only way that vaccinations can truly reach and protect the community is through the government’s stricter and more transparent health standards, as well as considering the needs of the community these vaccines serve.
Joyee Au Yeung is a sophomore at the University of Pennsylvania, where she is pursuing a double major in Economics and History.
[1] The Global Vaccine Safety Initiative (GVSI). (2018, February 08). Retrieved from https://www.who.int/vaccine_safety/initiative/en/
[2] Westcott, B., & Wang, S. (2018, July 25). Chinese state pushes back against widespread outrage over vaccine crisis. Retrieved October 30, 2018, from https://www.cnn.com/2018/07/25/asia/china-vaccine-censorship-intl/index.html
[3] Measles (Rubeola). (2019, January 10). Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html
[4] Vejpongsa, T. (2018, November 06). Muslim concern about vaccine fuels Thai measles outbreak. Retrieved November 07, 2018, from https://abcnews.go.com/Health/wireStory/muslim-concern-vaccine-fuels-thai-measles-outbreak-58992675
[5] Vejpongsa, T. (2018, November 06). Muslim concern about vaccine fuels Thai measles outbreak. Retrieved November 07, 2018, from https://abcnews.go.com/Health/wireStory/muslim-concern-vaccine-fuels-thai-measles-outbreak-58992675
Image Source: https://www.radionz.co.nz/news/world/362475/china-police-probe-vaccine-maker-after-scandal-sparks-fury
