On Saturday, an unvaccinated 15 year old boy died in kerala’s Malappuram district due to diphtheria. Malappuram has attracted attention in recent times for its Muslim community with a strong reluctance to adopt immunization.

According to Medical officer Dr.Ummer Farook, this year, two clinically confirmed cases of diphtheria have been recorded.

The boy who died was a student of an Arabic college. 98 other students in the same institution have failed to take the vaccine because of the community’s resistance. But after a student fell it, others were willing to get vaccinated.

A hospital in the Malappuram district

Dismal stats

Diphtheria has been brought under control by the Indian government thanks to the introduction of the DPT vaccine in the immunization program of 1985. But a relapse of the disease has been observed in Kerala for a few years now. In 2008, for instance, at least 12 cases of the disease were reported in Malappuram.

Between 2008 and 2015, 20 to 35 children have died of diseases which were preventable with vaccination. 15 kids died of tetanus while five lives were snubbed out by diphtheria and 13 succumbed to measles. One child left the world with brain infection.All the kids, except the last one were under the age of 6.

In 2015 alone, five diphtheria cases were reported in the Malappuram district, two of which resulted in death. A survey conducted by the health department in the district in the same year puts the number of unvaccinated children in the 7 to 15 years age group at 1.72 lakh.

A chart provided by the DMO, Malappuram shows data of vaccine preventable diseases and death in the period of 2008 to 2015. The data relies on entries that were made in government hospitals and medical colleges. Since a higher number of people usually approach private hospitals, the actual figures are probably worse.

According to 2015 statistics, out of the 342,657 children under the age of five in Malappuram, 23, 912 are kept out of all immunization efforts-the highest rate in the entire state.

Also official data indicates that more than one in every three children within the age group of 5 to 10(36 percent) who grow in the district never had any immunization at all. A situation that leaves them vulnerable to a host of diseases including diphtheria, tetanus, hepatitis-B, meningitis, measles and also poliomyelitis. However, it is not the lack of access to medicine that brings about this situation. These children were denied immunization by their parents or relatives.

Propaganda by religious or quasi-religious bodies is said to be a key factor behind this unsavoury situation.

The rise of the anti-immunization wave

The mistrust among the people towards vaccination is a phenomenon which emerged all too fast-threatening to bring back deadly diseases which were long considered eradicated. The role of clerics and fringe elements in this development is getting more noted in the mainstream media.

Inspired by the fundamentalists in countries such as Africa and Afghanistan, certain bodies try and convince the lesser informed among the Muslim population in the region that vaccines are instruments tactically used by the west to reduce the size of their community. Another misinformation that’s circulated is that vaccines are derived from animal tissue and pork based gelatin. This makes the product forbidden-for Islam allows consumption of halal meat products,where the animal is bled to death as Allah’s name is invoked.

Even open campaigns against immunization drives have been held. Anti-vaccination campaigns have been organized by clubs and local groups across the district-something that has affected the health department’s polio vaccination programme many times over. Notices and pamphlets bearing messages against immunization programs are distributed, especially in rural regions.

The fall in the number of children who are immunized in the district is evident in the graph below:

No one demonstrates the extent of such propaganda better than K.Abubaker Koya when he says they were told by the local cleric that unnecessary vaccinations will affect the fertility of children when they grow up. This made them scared to administer the vaccines. Koya, a native of the region has four kids.

Another father from the region whose son was afflicted with yellow-fever says how the mosque committees saying that the injections/oral drops are anti-Islam has become common like the purdah.

District authorities make a special mention of two powerful local groups with a strong opposing stand against immunisation. One group is made of a large number of families with allegiance to the Sunni faction that’s led by Kanthapuram AP Aboobackar Musaliar. The other constitutes the families of the Jama’at-e-Islami followers.

In an interview he gave to the newspaper, The Hindu in 2015, Shaikh Mohammaed Karakunni, the leader of jama’at e-Islami said that the question of immunising children or not was one of personal choice. He claimed that his organization has never officially endorsed a boycott of immunisation efforts.

The Kanthapuram Sunni group also made a similar claim. And while it’s true that no religious groups or leaders have given their official stamp to opposing immunisation, none of them has actually exhorted their community to vaccinate children either.

But, not all anti-immunization activists may use the baton of religion.

For instance, anti-vaccine activists made a collectorate march following the death of children due to diphtheria in Malappuram. The video of a speech that was made by an activist at the march is given here.

The activists demanded that compulsory vaccination drive be ended and also a CBI probe to be initiated to verify the health department’s claim that the recent cases of diphtheria were due to the absence of immunization.

The public speech which was made by a leading naturopath in front of the Malappuram Collectorate made a good study in oratory. He also added that gynecologists create vaccine from children’s body parts and that doctors are effectively murderers.

He also promises to make anyone a doctor by taking a week-long course, the fee being Rs.7000.

Advert for the 7 day course, with caption, “You can become a doctor too”

Yet another claim made by the activists is that germs are non-existent. So, what’s the need of administering vaccination? The health department, they claim, is just helping the vaccine manufacturers sell more products.

A magazine run by the same physician ‘reveals’ the ‘real’ reasons of diphtheria. There are quite a few-including the smell of asbestos, talcum powder, tooth paste, paint, food cooked ion kerosene stove and so on.

Anti-anti-vaccination measures

Sakeena Pulpadan, the District panchayat vice president inaugurating the Pulse Polio immunization drive in Feb 2016

Efforts to curb the rising opposition to immunization have been afoot for a while. For instance, in 2012 the then District collector, MC Mohandas asked the police to take strict action against individuals or groups who campaign against the vaccination drives of the district health department. In that regard,the health department even formed a rapid response team to deal with the anti-vaccination campaigns.

In recent times, various pro-vaccine initiatives have come afore, like Amruthakiranam which was launched by the Kerala Government Medical Officers Association(KGMOA).

It is assumed that following the recent death of a 15 year old from diphtheria, such efforts would be strengthened.

A Kerala doctor’s powerful open letter to anti-vaccination backers

As malappuram is rattled by the death of its young ones due to preventable diseases, an open letter by a Kerala doctor to anti-vaccination proponents is gaining significance.

Dr.Nelson Jospeh practices general medicine at Lake Shore Hospital in Ernakulam, Kerala. His writing appeared in Malayalam in the site azhimukham.com.

The gist of the doctor’s writing is related in English below.

Dr. Nelson Jospeh practically opens his letter by citing a notice put out by the group, ‘Janakiyarogya Samyuktha Samithi.’ The doctor mentions the main points of the notice:

1.Doctors are the ‘agents’ of medical/pharma companies

2. There exists no case of diphtheria in Malappuram(a district in Kerala)

3.Every citizen has the right to accept or reject a particular medical treatment

4.The news that vaccination is necessary for gaining school admission is fake. The Health Department must therefore withdraw the related circular.

After listing out these key points, Dr.Nelson Joseph goes on to give his response against each of these, and other points in the notice.

1.Doctors are the drug lobby’s minions

India declared allegiance to the Polio Eradication programmes of the World Health Assembly in 1988. The pulse polio immunisation was thus begun with the intention to making available oral polio vaccine to kids under 5 years old, every year. In addition, national immunisation day is also held in high risk areas. Also, to find if even a miniscule possibility of polio exists, children suspected of the disease are given lab tests- in the program titled, Acute Flaccid surveillance Program.

Now, the assumption that doctors are minions of the medicine lobby holds no water-something that can be seen from the statistics below:

Dr.Jospeh points to the fact that whereas there used to be 1,50,000 patients in 1985, the scenario has vastly changed since then. In the light of these stats,he asks whether anyone would help bring down their own business?

2.No diphtheria case in Malappuram

The anti-vaccination notice put out by the ‘Janakeeyarogya Samyukta Samiti’ apparently got their facts wrong about there being no diphtheria case in Malappuram. To make his case, Dr. Joseph invites attention to a social media post:

The post mentions the travails of a diphtheria patient whose throat ache just wouldn’t go away, even after consulting various doctors.

3.Citizens have the right to reject treatment

Two significant points are mentioned in this regard:

a)You have the right to decide that you do not want a treatment. However, in this case you are denying your child the protection from medical issues that may arise in the future-like polio or diphtheria.

b)Denying protection to your child is something that may affect the society at large. If the number of children who haven’t taken preventive vaccination is high, it could lead to the loss of herd immunity.

In situations such as these, the state can take appropriate decisions. For instance, to eradicate small pox, vaccination was made mandatory. The doctor attributes the success of that program to the lack of opposition to it.

4. The news that vaccination is required to gain school admission is fake; the circular stating the same must be withdrawn

Though it’s stated that such a circular doesn’t exist, it’s maintained at the same time that it has to be withdrawn. How can something that doesn’t exist be withdrawn, asks the doc.

5.”Our child wasn’t vaccinated. But still, s/he is fine”

The doctor points out the fact that this is because of the herd immunity.He says that in Malappuram, when the number of children who didn’t get vaccinated fell below a certain point, the diseases resurfaced.

6.If polio has been eradicated from India, why continue with the vaccination program?

As per WHO, even if one child in the world has polio, that could be a cause enough for the disease to spread. If polio is not controlled in places where the disease is endemic, it could bring about as many as 2,00,000 new cases each year, within just 10 years all around the world. Currently, the nations that are endemic to polio are Pakistan and Afghanistan-both of which are India’s neighbours.

This puts the necessity of strong immunization measures in India in perspective.

The doctor concludes his piece by addressing those who find immunization irreligious, those who claim any immunization other than what nature has bestowed is heretic.

While maintaining that he does not have anything against religion, the doctor points out that those who make the Hajj pilgrimage must have taken vaccinations against yellow fever, meningocele meningitis, polio and influenza- as decreed by the Saudi Arabia government, one that largely follows Islamic rules.

Image credits: mathrubhumi, azhimukham.com,The Hindu
Some images may be indicative

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