{"id":36679,"date":"2016-05-16T16:40:57","date_gmt":"2016-05-16T15:40:57","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmj\/?p=36679"},"modified":"2016-05-16T16:40:57","modified_gmt":"2016-05-16T15:40:57","slug":"heidi-larson-et-al-vaccine-crisis-in-china-act-now-to-rebuild-confidence","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2016\/05\/16\/heidi-larson-et-al-vaccine-crisis-in-china-act-now-to-rebuild-confidence\/","title":{"rendered":"Heidi Larson et al: Vaccine crisis in China\u2014act now to rebuild confidence"},"content":{"rendered":"

The recent unfolding of a five year old story<\/a> of two million doses of vaccines illegally\u00a0procured and sold across China is a confidence breaker. Worse, it is not a new\u00a0episode of abusing a public health good for personal financial gain, but the latest of a\u00a0series of public health incidents in China.<\/p>\n

Twenty nine companies have been implicated in the current saga<\/a>, 202 individuals\u00a0arrested, and 357 civil servants \u201cdismissed or demoted\u201d according to the official\u00a0government report. [1] The value of the improperly stored and distributed vaccines\u00a0(some about to expire), has been estimated at over $40 million. The former\u00a0pharmacist who choreographed the scandal, along with her daughter, were arrested\u00a0nearly a year before the story became public. However, little was done about the crisis\u00a0then.<\/p>\n

Once the story went public, WHO was quick to announce<\/a> that the public should not\u00a0worry about harm due to improperly stored or expired vaccines. [2] They acknowledged\u00a0that there was a risk that the vaccines would not provide the protection individuals\u00a0had personally paid for. These vaccines were Category 2 self-financed vaccines, but\u00a0some also protected against childhood infections mainly targeted by Category 1\u00a0vaccines in the national immunization programme. Whether category 1 or 2, public\u00a0trust around all vaccines has been broken. While the WHO statement aimed to calm\u00a0the public, it was perceived by some as a gesture to protect the government. The\u00a0public is angry, and not without reason.<\/p>\n

Chinese authorities responded by aligning agencies to track the flow of the vaccines\u00a0and rectify supply chain flaws. However, widespread public distrust over vaccine\u00a0safety still loomed large. As other vaccine incidents in history have shown, there are\u00a0often long term impacts on vaccine confidence with consequent declines in vaccine\u00a0uptake. [3] Following the Chinese hepatitis B vaccine scare in December 2013, for\u00a0instance, despite the fact that reported childhood deaths following vaccination were found to\u00a0be unrelated to the vaccine, vaccination rates of hepatitis B dropped by 30% in ten\u00a0provinces, and the national immunization programme reported a 15% decline in\u00a0overall vaccine acceptance<\/a>. [4]<\/p>\n

This recent episode should be a wake-up call for more rigorous restrictions on\u00a0entrenched bribery and corruptions that undermined public confidence for health\u00a0systems and products. [5] Already in the 1990s there were reports of public distrust\u00a0towards healthcare professionals and the health system, stemming from perceptions\u00a0of financial motives. [6] Public protests erupted as well as individual attacks on health\u00a0professionals, who were physically abused, some fatally, by distrusting and angry\u00a0citizens. In a survey conducted by the Chinese Hospital Association among 312\u00a0hospitals between late 2012 and early 2013, the number of assaults on doctors\u00a0increased from 20.6 to 27.3 per hospital between 2008 and 2012. [7]<\/p>\n

What can be done to mitigate the negative consequences of this recent incident, as\u00a0well as rebuild and protect public trust moving forward?<\/p>\n

First, prompt, clear, and honest communication with the public is needed about what is\u00a0being done to address not only this recent incident but, more importantly, the\u00a0underlying weaknesses in the system. Because these deeper issues will not have a\u00a0\u201cquick fix\u201d solution, regular updates on progress in implementing any promised\u00a0actions are critical for restoring public confidence.<\/p>\n

Second, listening to the public and identifying particular vaccine concerns will be\u00a0essential to inform appropriate responses and build trust. [8] This can be done through\u00a0systematic media surveillance to detect emerging rumours and concerns, combined\u00a0with public perception surveys and focus group discussions.<\/p>\n

Third, health authorities should monitor and publicly share the effects (or lack thereof)\u00a0of the illegal vaccines on individuals who received them. The public should be\u00a0encouraged to report suspected use of illegal vaccines and suspected adverse effects,\u00a0and any evidence of harm should be reported in an honest and transparent manner.\u00a0Fourth, vaccination points at hospitals and local centers for disease control and\u00a0prevention will need to provide transparent information about the sources of their\u00a0vaccines. Such transparency is important for dismissing skepticism, particularly\u00a0among parents of young children.<\/p>\n

Fifth, health authorities need to prepare for short-term and long-lasting negative\u00a0impacts on vaccination. The uptake of Measles, Mumps and Rubella vaccination in\u00a0the UK, for instance, declined drastically after the publication of Wakefield\u2019s\u00a0now-retracted Lancet<\/em> publication, which suggested links between the vaccine and\u00a0autism, prompting public panic. The decline in vaccine acceptance continued for\u00a0years, and only reached its lowest point five years following Wakefield\u2019s publication<\/a>. [9] Health authorities need to closely monitor the vaccine uptake trends of vaccines and\u00a0impacts on disease dynamics.<\/p>\n

Last but not least, health agencies with other government agencies should consistently\u00a0and strictly enforce health laws, regulations, policies, and standard operating\u00a0procedures regarding the production, supply, and use of all vaccines to prevent similar\u00a0vaccine incidents in future.<\/p>\n

The public deserves it.<\/p>\n

Heidi J. Larson\u00a0<\/strong>is director of The Vaccine Confidence Project and Senior Lecturer, Department of Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, and Associate Clinical Professor, Department of Global Health at the University of Washington, Seattle.<\/em><\/p>\n

Ruoran Li<\/strong> is a doctoral student in the Department of Epidemiology, Harvard T.H. Chan School of Public Health.<\/em><\/p>\n

Xiong-Fei Pan<\/strong> is a PhD student in Epidemiology at Sichuan University, and is also affiliated with the Chinese Evidence-based Medicine Center at West China Hospital.<\/em><\/p>\n

References:
\n<\/strong>
\n1. The State Council, The People\u2019s Republic of China<\/a>. Premier stresses vaccine\u00a0quality. 14 April 2016.<\/p>\n

2. WHO responds to the vaccine incident in China<\/a>.<\/p>\n

3. Larson HJ, Heymann DL. Public health response to influenza A(H1N1) as an\u00a0opportunity to build public trust. JAMA<\/em>. 2010;303 (3):271-2<\/p>\n

4. Chinese Center for Disease Control and Prevention. The vaccination rate of\u00a0Hepatitis B vaccine has fallen by 30% in 10 provinces<\/a>.<\/p>\n

5. Yang Z, Fan D. How to solve the crisis behind Bribegate for Chinese doctors.\u00a0Lancet<\/em>. 2012; 379(9812): e13-5<\/p>\n

6. Blumenthal D, Hsiao W. Lessons from the East\u2014China’s rapidly evolving healthcare system. N Engl J Med<\/em>. 2015; 372(14):1281-5<\/p>\n

7. Wang L, Wang C, Cao Y, Zhao Y, Chen Y, Zheng L. Analysis of and thoughts on\u00a0trends and harms of hospital violence. Chinese Hospitals. 2014; 18(3): 4-6<\/p>\n

8. Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine\u00a0confidence gap. Lancet<\/em>, 2011; 378(9790): 526-35<\/p>\n

9. NHS Immunisation Statistics, England 2011-12. Health and Social Care Information<\/a>
\nCentre. November 2012.<\/p>\n

Competing Interests:<\/strong> Heidi\u00a0Larson serves on the Merck Vaccines Global Strategy Advisory Board and is a\u00a0consultant to GSK on vaccine confidence. XP and RL have no conflicts.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

The recent unfolding of a five year old story of two million doses of vaccines illegally\u00a0procured and sold across China is a confidence breaker. Worse, it is not a new\u00a0episode of abusing a public health good for personal financial gain, but the latest of a\u00a0series of public health incidents in China. Twenty nine companies have […]<\/p>\n

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