Journal of Postgraduate Medicine
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Year : 2018  |  Volume : 64  |  Issue : 4  |  Page : 202-203  

Measles-Rubella vaccination campaign: A trust deficit?

A Sreedevi 
 Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India

Correspondence Address:
Dr. A Sreedevi
Department of Community Medicine, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala

How to cite this article:
Sreedevi A. Measles-Rubella vaccination campaign: A trust deficit?.J Postgrad Med 2018;64:202-203

How to cite this URL:
Sreedevi A. Measles-Rubella vaccination campaign: A trust deficit?. J Postgrad Med [serial online] 2018 [cited 2023 Oct 2 ];64:202-203
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The measles and rubella (MR) campaign is an ambitious public health initiative of the Govt. of India to eliminate measles by 2020 and control rubella/congenital rubella syndrome (CRS). It targets children in a wide age group between 9 months and 15 years.[1] This campaign is a second opportunity for those children who were left out due to either vaccine failure or failure to vaccinate. High population immunity will then be sustained by follow-up campaigns and incorporation into routine immunization schedule at 9 months and 18–24 months.[1]

The MR vaccine has a robust safety and effectiveness profile. Under field conditions, seroconversion is 85% at 9 months and 95% at 12 months or more for measles, and 95% at 9–12 months and more than 99% when given beyond 12 months for rubella.[1] Adverse reactions are generally mild and transient.[1]

For the MR campaign to be effective, it is important that no child be left behind. The current campaign is implemented through fixed sites sessions in schools and outreach centers.[1] Therefore, the teachers are relied on to convey the importance of vaccination.

The first phase of the MR vaccination campaign was launched in the states of Tamil Nadu, Karnataka, Goa and; in Puducherry and Lakshwadeep. According to estimates, Tamil Nadu recorded the lowest coverage at 54%.[2] The present study conducted in Kancheepuram, Tamil Nadu[3] looks into a hitherto less explored area vis-a-vis the role of social capital in vaccine acceptance through a case-control study. The study emphasizes the role of social capital and trust on vaccine acceptance. It also emphasizes that wherever teachers have strongly recommended the vaccine the vaccine uptake has been good and coverage levels sustained.[1],[3] The authors show how close knit homogenous groups are less amenable to advice on vaccination[3] and the influence of social media appears malicious and strong.

Though conceptually simple, implementation has run into issues with coverage more often than not being suboptimal and after repeated extensions the last run being an inch by inch progression toward the desired 95%. Vaccine hesitancy appears to be a global phenomenon and an increase in vaccine preventable disease has been observed in many developed and developing countries.[4] Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services[4] and it is critical to understand this period of indecision. In India, resistance to vaccination was due to ignorance in the past, though currently, the campaign on social media such as WhatsApp—fuels a mix of conspiracy theories, safety concerns, and questions the need for the MR campaign.[5] Studies show that the messages are inconsistent and negative.

There is a gap between the perception of risk and difficulties by parents and available scientific evidence on vaccination. This is especially so as successes of prevention are less visible due to decreasing prevalence of disease and parents question vaccinating healthy children.[6] There are also concerns that discussing vaccine hesitancy will give the antivaccine lobby greater legitimacy. The extensive work carried out for polio in India has shown that there is no basis for this. The polio eradication lessons from Uttar Pradesh emphasize the pivotal role played by social mobilization network in creating a demand for pulse polio immunization, in strengthening routine immunization.[7]

Though social and behavioral communication campaign has been included in the guidelines of MR campaign, however, its implementation in its entirety is lacking.[1] Moreover, communication is a two-way process and last minute communication planning compromises the quality of the communication.[6]

A systematic review determined that the interventions; which directly targeted unvaccinated or under-vaccinated populations, increased vaccination knowledge, improved convenience and access to vaccination, targeted specific populations (e.g., Health Care Workers), mandated vaccinations or sanction against non-vaccination and engaged religious or other influential leaders to promote vaccination, demonstrated an increase of vaccination uptake by more than a fourth (>25%).[8] Multicomponent interventions and or interventions that focused on dialog-based approaches also performed better.[8]

Methodical and proactive communication with formative research[6] can help address issues in a systematic manner and also address misinformation. It would also be important to reach the ring of influence around families that refuse vaccination. Influencing the bonding, bridging, and linking capital will help to reach, persuade, and negotiate with the influencers around the resistant individual. The communication for development process should help to deal with such bonding, bridging, and linking capital,[3] which may at times be outside the country, for example, NRI husbands in the middle east and within such as religious leaders, grandparents, etc.

Vaccine hesitancy is complex and context specific and is influenced by factors such as complacency, convenience, and confidence.[4] It is also important to anticipate operational challenges in urban areas[1] and includes residents association of urban high rises in the micro plans. Bringing into the public domain, the rigorous process undertaken before introducing a vaccine can also help increase vaccine acceptance and help address the trust deficit. Mapping the social dynamics of the resistant pockets is also the need of the hour.


1Introduction of Measles- Rubella vaccine guidelines (campaign and routine immunisation). Operational guidelines. MoHFW, Govt of India; 2017.
2MR Campaign: The state second in coverage. March 5, 2017. The Hindu.
3Palanisamy B, Gopichandran V, Kosalram K. Social capital, trust in health information, and acceptance of Measles–Rubella vaccination campaign in Tamil Nadu: A case–control study. J Postgrad Med 2018; 64:212-9.
4Noni EM, The SAGE working group on Vaccine hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine 2015;33:4161-4.
5Heidi L. Missing the signals: India's anti-vaccination social media campaign. The Vaccine Confidence Project. March 2017. [homepage of the Vaccine Confidence Project: London School of Tropical Medicine on the Internet]. Available from: [Last accessed on 2017 Dec 29].
6Sachiko O, Ligia P, Mary Q. Exploring pathways for building trust in vaccination and strengthening health system resilience. BMC Health Serv Res 2016;16(Suppl 7):639-44.
7Ellen AC, Silvio W, Jitendra A, Roma S, Rina D. Successful polio eradication in Uttar Pradesh, India: The pivotal contribution of the social mobilisation network, an NGO/UNICEF collaboration. Global Health Sci Pract 2013;1:68-83.
8Caitlin J, Rose W, Maureen O'L, Elisabeth E, Heidi JL. Strategies for addressing vaccine hesitancy – A systematic review. Vaccine 2015;34:4180-90.

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