Part Two: Debunking lies, misinformation about WHO, vaccines for Tetanus, HPV and Malaria

They further allege that the United Kingdom and the United States of America (UK and USA) eradicated malaria without recourse to vaccines or initiatives, such as the use of sterile mosquitoes that is currently under research. 

In the first part of my article, I debunked the lies and misinformation that WHO is an organisation led by non-elected bureaucrats. I also debunked the lies and misinformation that the amendments to the International Health Regulations (IHR) and the proposed Pandemic Agreement would usurp the sovereignty of countries, especially those in Africa.

In this second part I want to debunk the lies and misinformation about the tetanus, HPV, and malaria vaccines. 

The Tetanus Vaccine: This vaccine, also known as tetanus toxoid (TT), is used to prevent tetanus. During childhood, five doses are recommended, with a sixth dose given during adolescence.

After three doses, almost everyone is initially protected, but additional doses administered every ten years are recommended to maintain protection. The tetanus vaccine is part of the recommended series of childhood and adult immunizations.

It protects against a bacterial infection called lockjaw which has no cure and 10%-20% of the people who have it die. In 2018, about 25 000 new-borns died from tetanus, a 97% reduction since 1988, largely due to scaled-up immunization with the tetanus vaccine.

Thanks to the tetanus vaccine, lockjaw has become very rare. However even if rare, you still need to be vaccinated against it.

The Human Papilloma Virus (HPV) vaccine This vaccine is recommended at ages 11–12 years. The HPV vaccines can be given starting at age 9 years. All preteens need HPV vaccination, so they are protected from HPV infections that can cause cancer later in life.

Teens and young adults through age 26 years who didn’t start or finish the HPV vaccine series also need HPV vaccination. The first dose is routinely recommended at ages 11–12 years old, although it can be started at age 9 years. Only two doses are needed if the first dose was given before 15th birthday.

HPV vaccine has the potential to prevent more than 90% of HPV related cancers. Since HPV vaccination was first recommended in 2006, in the US, infections with HPV types that cause most HPV cancers and infections in the private parts have dropped by 88% among teenage girls and by 81% among young adult women. The protection provided by HPV vaccines lasts a long time.

Malaria: This is mosquito-borne disease, places a particularly high burden on children in the African Region, where nearly half a million children die from the disease each year. In 2021, the WHO approved the first vaccine for malaria and in 2023, the second malaria vaccine was approved for the prevention of malaria in children. 

Recommendations for approval of any vaccine are based the advice of the WHO Strategic Advisory Group of Experts on Immunization (SAGE) and the disease specific Policy Advisory Groups after a review of the safety and efficacy data for the vaccine. 

Malaria in Africa: Why  have we not beated it yet? 

One reason malaria is so persistent is that the malaria parasite (germ) has a very complex life cycle, which involves many different developmental stages in multiple hosts (mosquitoes and humans).

While malaria was eradicated from Europe and the United States in the 1970s through a combination of insecticide spraying, drug therapy and environmental engineering, in Africa eradication remains challenging because Africa has the most efficient malaria vectors.

Moreover,  the most lethal malaria parasite also predominantly found in Africa and is responsible for most malaria cases and deaths – 80% of which occur in children younger than five years old. The WHO acknowledged these factors when it excluded Africa from its first Global Malaria Eradication Campaign, which ran from 1955 until 1969.

Since then, there have been many advances in malaria control and these include long-lasting insecticide treated nets, malaria rapid diagnostic tests and artemisinin-based combinations for malaria treatment. Despite these developments. 

Malaria elimination is still a challenge in Africa. In fact, only three countries- Algeria, Morocco and recently Carbo Verde , have been certified malaria-free in Africa.

The reasons for the elimination targets remaining out of reach, include;  poverty, human movement, resistance of the mosquitoes to insecticides and the parasites to medicines used, increasing urban malaria and climate change. 

Anti-vaccine activism or the "anti-vax" movement
The video circulating on social media is part of organized opposition to vaccination. This anti-vax movement seems to be led by the Kenyan doctor Wahome Ngare, the chairperson of the African Sovereignty Coalition and a director of the right-wing Kenya Christian Professionals Forum (KCPF), the South African Journalist/Lawyer Shabnam Mohamed, and has now been joined by our own Hon Sarah Opendi, Woman MP Tororo.  

These antivaxx activists want to increase vaccine hesitancy by disseminating misinformation or disinformation. We know that myths, conspiracy theories, misinformation and disinformation spread by this anti-vaccination movement to increase vaccine hesitancy. However, we can’t stand on the fence and watch.

Indeed, we urgently need public debates around the medical, ethical, and legal issues posed by the antivaxx activists. We need serious debate within mainstream medical and scientific circles about the benefits of vaccination. 

What should we do?
The Uganda Ministry of health and relevant stakeholders need to deal with this antivaxx movement head on and here are some thoughts.

Legal interventions and incentives: Legal interventions could help combat the effects of anti‐vaccination activists, particularly the misinformation contained in some of the messaging. However, it is a fine line to walk between protecting civil liberties and enforcing laws meant to protect public health.

Although there is controversy surrounding the constitutionality of vaccine mandates, they may be  useful in public health emergencies, such as pandemics. Finally, in addition to enforcement and legal interventions, the governments, schools, and private businesses can provide incentives for vaccination. 

Misinformation harm reduction: This approach could be used by the government, nonprofits, and other influential bodies to impose advertising boycotts against media platforms that refuse to curtail the spread of misinformation. Pro‐vaccination media networks should be supported to spread factual scientific information for long‐term benefit. 

Utilizing healthcare workers more effectively: The fight against anti‐vaxx misinformation must utilize its frontline soldiers, namely healthcare workers (HCWs). Primary health care doctors, nurses and other health workers should be facilitated to  impart information and to promote vaccines. This is especially the case for newer vaccines.

Re‐engaging the vaccine‐hesitant and anti‐vax individuals: Finally, we need to engage the anti‐vax audience. Psychologists, public health experts, political and community leaders should engage the anti‐vax audience in discussion.

A technique known as “motivational interviewing” has been used by psychologists to elicit behavior change.  

This technique has been used to encourage childhood vaccination. This technique seeks to use directed and open‐ended questions to motivate the interviewee to name their own inspirations and biases, as opposed to dictating to them.

This technique does not prosecute individuals for their beliefs and, in fact, may help keep vaccine‐hesitant individuals engaged in discussion for longer, thereby decreasing their likelihood to close off the conversation or shut down  or fight back later. 

Summing up
In closing, vaccines have had a massive impact on African lives, cutting infant deaths in half over the past 50 years. The HPV vaccine offers an opportunity to combat cervical cancer, the most pervasive cancer for women on the continent.

The pap smear that Dr Wahome Ngare  refers to in his statement to the President involves collecting cells from your cervix, the lower, narrow end of your uterus that is  at the top of your vagina. It helps to detect cervical cancer early and gives you a greater chance at a cure.

It can also detect changes in your cells that suggest cancer may develop in the future, but it does not prevent the cancer like the HPV vaccine does. The Malaria vaccine adds to our interventions to eliminate malaria amidst growing insecticide and drug resistance. 

Finally, the infertility misinformation about the Tetanus Vaccine is framed around the testimonials of Dr. Wahome Ngare and Dr. Stephen K. Karanja about the 2013 vaccination campaign against neonatal tetanus in Kenyan women of childbearing age.  In 2017, Dr. Karanja and others published their claims that the tetanus vaccination campaign was a sham in an Open Access Library Journal, which features in a database of predatory journals, meaning journals that will publish anything as long as its authors pay them.

The fact-checking website Snopes debunked this entire story. This story of clandestine sterilizing vaccines being used in developing countries is not new.

As health workers, and policy makers, we need to proactively communicate the health, economic and social benefits of vaccines and immunization programs to individuals and society. We should endeavor to communicate this to the public and policy makers, for the benefit of endemic, epidemic, and pandemic diseases.

Dr Ambrose Talisuna is a Senior Epidemiologist and Malariologist. He is a recipient of the President’s Medal for his efforts to fight Malaria in Uganda.