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Did the Call for Boycott by the Catholic Bishops Affect the Polio Vaccination Coverage in Kenya in 2015? a Cross-Sectional Study

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Did the Call for Boycott by the Catholic Bishops Affect the Polio Vaccination Coverage in Kenya in 2015? a Cross-Sectional Study Open Access Research Did the call for boycott by the Catholic bishops affect the polio vaccination coverage in Kenya in 2015? A cross-sectional study Ian Njeru 1,& , Yusuf Ajack 1, Charles Muitherero 2, Dickens Onyango 1, Johnny Musyoka 1, Iheoma Onuekusi 2, Jackson Kioko 1, Nicholas Muraguri 1, Robert Davis 3 1Ministry of Health, Nairobi, Kenya, 2World Health Organization, Nairobi, Kenya, 3American Red Cross, Nairobi, Kenya &Corresponding author: Ian Njeru, Ministry of Health, Nairobi, Kenya Key words: Polio vaccine, vaccination, vaccine safety, boycott, Catholic bishops Received: 30/01/2016 - Accepted: 07/04/2016 - Published: 07/06/2016 Abstract Introduction: Polio eradication is now feasible after removal of Nigeria from the list of endemic countries and global reduction of cases of wild polio virus in 2015 by more than 80%. However, all countries must remain focused to achieve eradication. In August 2015, the Catholic bishops in Kenya called for boycott of a polio vaccination campaign citing safety concerns with the polio vaccine. We conducted a survey to establish if the coverage was affected by the boycott. Methods: A cross sectional survey was conducted in all the 32 counties that participated in the campaign. A total of 90,157 children and 37,732 parents/guardians were sampled to determine the vaccination coverage and reasons for missed vaccination. Results: The national vaccination coverage was 93% compared to 94% in the November 2014 campaign. The proportion of parents/guardians that belonged to Catholic Church was 31% compared to 7% of the children who were missed. Reasons for missed vaccination included house not being visited (44%), children not being at home at time of visit (38%), refusal by parents (12%), children being asleep (1%), and various other reasons (5%). Compared to the November 2014 campaign, the proportion of children who were not vaccinated due to parent’s refusal significantly increased from 6% to 12% in August 2015. Conclusion: The call for boycott did not affect the campaign significantly. However, if the call for boycott is repeated in future it could have some significant negative implication to polio eradication. It is therefore important to ensure that any vaccine safety issues are addressed accordingly. Pan African Medical Journal. 2016; 24:120 doi:10.11604/pamj.2016.24.120.8986 This article is available online at: http://www.panafrican-med-journal.com/content/article/24/120/full/ © Ian Njeru et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction objected to polio vaccination thereby derailing eradication efforts. In both Afghanistan and Pakistan, the Taliban issued edicts banning polio vaccination since they suspected that the vaccine contained a The World Health Organization (WHO) launched the Global Polio contraceptive [22]. In Nigeria three states boycotted a polio Eradication Initiative (GPEI) in 1988 with the goal of eradicating campaign conducted in August 2003. This was caused by a boycott polio by the year 2000 [1]. Subsequently, a plan of action for global order from the Supreme Council for Sharia on the suspicion that the polio eradication was developed and approved in 1989 by the World vaccine contained contraceptives and Human Immuno-deficiency Health Assembly and adopted by the African region [2]. This plan Virus (HIV) [21, 23, 24]. The boycott resulted in a resurgence of proposed four approaches to polio eradication: maintaining high cases and wild polio virus outbreaks occurred in many African routine immunization coverage, National Immunization Days (NIDs), countries which had previously been disease free [21]. Although Supplementary Immunization Activities (SIA) and surveillance for polio campaigns in Kenya have previously been successful, religious Acute Flaccid Paralysis (AFP). In 1996, the “Kick Polio out of Africa” resistance to mass vaccinations is beginning to take root. It all was launched in Africa and targeted to vaccinate 50 million children started in 2014 when the Catholic bishops complained that tetanus within the year [3,4]. Before the discovery of vaccines in 1955, polio vaccine administered to women of reproductive age during a used to paralyze or kill half a million people every year [5]. By 1988, campaign was laced with contraceptives in the form of Human polio was endemic in 125 countries paralyzing 350,000 children Chorionic Gonadotrophin (HCG) [25]. This claim was supported by annually [6]. Although the goal to eradicate polio by the year 2000 the Kenya Catholic Doctors Association, a pro-vaccination group, was not met as planned, the global polio eradication initiative has which alleged that six samples of the tetanus vaccine tested positive made tremendous progress. Firstly, the transmission of wild polio for HCG [26, 27]. The government denied the claims and responded virus has been interrupted in all countries except two; Pakistan and by appointing an independent committee to test the vaccine and the Afghanistan [6]. Secondly, the number of polio cases declined to dispute fizzled out subsequently [28]. In January 2015, the Ministry only 359 in 2014 which represents greater than 99% reduction since of Health and the World Health Organization (WHO) conducted a 1988. Compared to 2014, the cases in 2015 declined further by polio risk analysis that identified 32(68%) counties to be at approximately 80% [7]. Thirdly, neither type 2 nor type 3 virus has moderate to high risk of polio in Kenya. Two preventive vaccination been detected recently [8]. Kenya has not been left behind in the campaigns were therefore planned for April and May 2015 targeting war against polio and has made good progress in controlling the 32 and 11 counties, respectively. However, the Catholic bishops disease. The last indigenous polio case was detected in 1984. objected to the campaigns and demanded that the vaccines be However, four outbreaks occurred in 2006, 2009, 2011 and 2013 as tested first [29]. The campaigns were therefore postponed to a result of importation from neighboring countries resulting in 2, 19, August and September 2015 in order to allow for more time for 1 and 14 wild polio cases respectively [7, 9]. The latest outbreak consultation with the Catholic bishops. The government engaged that occurred in 2013 was successfully controlled but the country the bishops and formed a committee to address the issues raised. remains at risk due to close proximity to other vulnerable countries, The government also consulted other stakeholders who presence of refugee camps in the country and areas with sub recommended that the campaigns should go on as planned since all optimal population immunity. In an effort to finally eradicate polio the issues raised had been addressed. However, the Catholic globally by 2018, the GPEI in consultation with national health bishops were not fully satisfied with the process and hence called on authorities developed the “Polio Eradication and Endgame Strategic all their faithful to boycott the August 2015 polio campaign [30]. Plan 2013-2018” [10]. The plan has four objectives: detection and The population of the Catholic faithful in Kenya is 23% and interruption of wild virus, strengthening routine immunization and therefore comprises a sizeable proportion of the population [31]. withdrawal of oral polio vaccine, containment and certification and Boycotting the vaccination campaign has serious implications for the finally legacy planning. Under the first objective, outbreak response polio eradication agenda in Kenya and may reverse the gains made continues through the period of the strategy and this is in the last few decades. We therefore conducted a survey implemented through immunization campaigns. The second immediately after the August 2015 campaign in order to find out if objective has introduced certain milestones in which all countries the call for boycott by the Catholic bishops did affect the polio were expected to introduce at least one dose of inactivated polio vaccination coverage. The survey also aimed at determining the vaccine (IPV) into their routine immunization schedule by end of reasons for non vaccination. This paper presents the results of this 2015. If the strategic plan is implemented well as planned, then survey. polio eradication will become a reality. However, political and social barriers, including religious resistance to vaccination are threats to the success of the endgame strategy [11]. Methods Generally, most religious groups have issued statements supportive of immunization. However, there has been some opposition to Study design vaccination by religious groups due to various reasons. Some churches believe in healing everything through prayer rather than This was a cross-sectional study that was conducted for 2 days the administration of health products whose contents they are following the polio campaign that was conducted in 32 counties suspicious of [12]. According to a review by Grabenstein, causes of from 1st to 5th August 2015. The findings of this study was religious opposition can be categorized into
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