UNIC Canberra Interview
Dr Satish Gupta, Chief Health Programme, UNICEF, Papua New Guinea
The State of the World’s Children 2023: For Every Child, Vaccination reveals that the perception of the importance of vaccines for children declined by more than one-third in Papua New Guinea (PNG). Is this a global trend, or is it of particular concern in PNG?
In PNG, confidence in vaccines is significantly lower compared to other countries. Surveys conducted in 2022 show that only 52% of people in PNG believe vaccines are safe, and 54% think they are effective. This is a sharp decline from 2015, when 85% felt vaccines were safe and 89% believed they were effective. However, this decline is not unique to PNG; it mirrors a global trend observed in 52 other countries studied during the COVID-19 pandemic.
The report identified several factors that suggest the threat of vaccine hesitancy may be growing. Could you explain what these factors are?
Several barriers contribute to vaccine hesitancy in PNG. The country’s diverse linguistic landscape and low literacy rates make traditional messaging and communication methods inadequate for raising awareness about vaccines. Additionally, caregivers often have low vaccine literacy, limited knowledge about vaccine efficacy, and fear of side effects. Healthcare providers themselves may lack sufficient knowledge about vaccines and effective communication skills.
Does misinformation play a large part in PNG, and can you give some examples of misinformation?
Misinformation has significantly impacted routine immunisation coverage in PNG. Scepticism about COVID-19 vaccines has led some people to fear that routine immunisations are covertly administering COVID-19 vaccines. Some religious groups refuse vaccination unless their leaders approve. Sorcery-related beliefs and the misconception that a single vaccine dose protects against all illnesses also hinder vaccine acceptance.
What is the actual backslide in childhood immunisation in PNG since the pandemic?
In 2021, approximately 25,000 children under one year old (8%) missed their routine vaccinations due to COVID-19 pandemic control measures, such as limited travel and the repurposing of health workers for pandemic response activities. Additionally, since 2015, 50% of PNG’s annual cohort of children has remained unimmunised, creating significant immunity gaps among vulnerable children.
What are your short- and long-term concerns?
Short-term concerns include the spread of misinformation and a drop in vaccine coverage, which could lead to outbreaks of vaccine preventable diseases and health security issues. Long-term concerns focus on the growth and development, including the nutritional status, of unvaccinated children.
Could the lack of confidence in routine immunisation become another victim of the pandemic and lead to the next waves of deaths through measles, diphtheria, or other preventable diseases? Is this already happening in PNG?
The pandemic-induced vaccine hesitancy has indeed affected confidence in routine immunisations in PNG. Communities stopped bringing children to immunisation sessions out of fear that they would be given COVID-19 vaccines instead. However, extensive efforts in 2022-2023 to enhance community awareness and demand for routine immunisations have led to a recovery in community acceptance. This is evidenced by the 71% vaccination coverage for Measles-Rubella and Polio supplementary immunisation activities for children under five in 2023.
The report urges all governments to undertake four key actions. What are they, and do you think they can address the challenges outlined above?
The report suggests four main actions for governments:
Vaccinate every child, everywhere. This means identifying kids who haven’t received any routine vaccines (zero-dose) or who are under-vaccinated, and addressing the barriers that prevent them from getting their shots. It also involves catch-up programs to vaccinate those who missed their routine immunisations:
Strengthen demand for and confidence in vaccination. This involves working with civil society organisations, faith-based groups, caregivers, and healthcare providers to tackle fears and misconceptions about vaccines. A well-rounded communication strategy tailored to PNG’s unique context is crucial here.
Commit to and invest in immunisation and health. Governments need to show strong leadership, ensure accountability, and prioritise funding for primary healthcare, including vaccines. This means putting money into vaccine programs and the operational costs needed to run them effectively.
Build resilient health systems and make them shockproof for the future. This involves training and retaining health workers through career development and incentives, improving data quality and monitoring, securing a steady supply of vaccines, and embracing innovative solutions like digital tools for remote training and electronic reporting.
These actions, if effectively implemented, can significantly address the challenges of vaccine hesitancy and low immunisation coverage in PNG.