Quite A Revolution! Kerala’s Malappuram District Officials Tap Education Route To Vaccinate Children

A year ago, Malappuram district in Kerala reported 16 cases of suspected diphtheria. Of the 16, four were later confirmed as diphtheria and doctors had to work overtime to save the lives of those affected. The outbreak took everyone by surprise since it followed within six months of the death of six people in the district to diphtheria.

Six months ago, Malappuram district officials faced strong opposition during the Measles Rubella (MR) vaccination drive. District Health Department staff had to face angry protesters, while the hand of a nurse was twisted by a group opposing vaccination.

Reports said that some of the people in Malappuram district, where Muslims make up over 70 per cent of the population, opposed the vaccination saying it was “Modi-RSS vaccine”. Probably, the people drew inspiration from protests in Pakistan and Afghanistan. It left the state government clueless to tackle the danger that was in store. Until November last year, hardly 25 per cent of the targeted children were given MR vaccines. The district’s record with other vaccination too was poor, though a report in The Hindu in 2007 said 80 per cent of the target in pulse polio was achieved.

Revamp In Strategy

Faced with the prospect of children in the district being prone to various illnesses, including polio, measles and diphtheria, the district authorities decided to revamp their strategy and take an entirely new route. The strategy is paying handsome dividends now, with over 80 per cent of the targeted children being vaccinated.

“We reviewed the situation in the district in January. At least 95 per cent of the targeted children should be vaccinated since the rest five per cent can develop natural resistance to these diseases. We called for data and looked into all aspects of changing our approach,” says Dr K Sakeena, the district medical officer of Malappuram district.

The district officials, led by Collector Amit Meena, decided to tackle the problem through a different approach. “We decided to first educate officials in the Education Department on the need for vaccination. It was important to educate them to take on those opposing vaccination on flimsy grounds,” Dr Sakeena said.

Five-Phase Campaign

“Health officials had to work in tandem with education officials in the district. Health staff reached out to school and arranged for meetings of parents-teachers’ association (PTA). At these meetings, we explained to parents, in particular, the dangers of not vaccinating their children. It really left many parents convinced,” said Dr V P Parameswaran, a pediatrician, who was involved in the campaign.

Malappuram district officials decided to conduct the campaigns in educational institutions in five phases. “First was to reach out to the officials in the education department. They had to be first convinced. Next was conducting PTA meetings. Third, teachers were separately convinced on why all students had to undergo vaccination. Fourth, we prepared students in each school to tell others the need for vaccination. One of these students would go and address the school’s morning assembly on the importance of vaccination. The fifth phase was to carry the message to the classrooms, where every student was explained on the need to get vaccinated,” said Dr Sakeena.

Political Parties Chip In With Their Might

Educational institutions meant the health staff also approached various madrassas for their campaign. It was here that political parties like the Indian Union Muslim League (IUML) played a crucial role. Malappuram is IUML’s citadel.

“Our party took the initiative to coordinate the efforts of the health department staff. We helped in supporting vaccination in mosques, madrassas and other places through general awareness campaigns. We have a major role in the turnaround,” says Saleem Kuruvambalam, the standing committee chairman of Malappuram District Panchayat and an IUML leader.

Pointing out that 87.5 per cent of the targeted children have been vaccinated so far, Kuruvambalam said the entire leadership of IUML was involved in the success of the vaccination campaign.

A doctor, who spoke on condition of anonymity, told Swarajya that the whole issue was complicated by false campaigns by a handful of people. “One of the renowned naturopathy guys in the state was the primary culprit. He suspected the effectiveness of the vaccines and that led to a chain of misleading theories and stories,” the doctor said.

Rubbish Campaigns Against Vaccination

“Some guys started circulating stories that these vaccines were developed by the Americans to create infertility in Muslim-dominated areas in India. Some even called this a conspiracy by the Centre to cause infertility. All sorts of rubbish campaigns against vaccination were run on the social media, especially WhatsApp,” the doctor said.

Dr Sakeena said the district officials took the help of data to closely look into the problems. One of the issues they found was that the health staff, particularly the accredited social health activists, were unable to respond to queries raised by these rumours floated on WhatsApp.

“We took note of these questions and trained our staff to respond to queries raised by the people. We also trained them to take on those opposed to vaccination. In particular, we targeted women to tell them not to believe in such rumours. Such measures paid results,” she said.

Agencies like the United Nations Children's Emergency Fund and World Health Organization besides the media were roped in the campaigns. Special workshops were held for some of the stake holders, including the media in the vaccination drive.

“All these efforts will help us to achieve at least 90 per cent of our vaccination target soon,” Dr Sakeena said.

Though the district health officials have gone all out to ensure maximum coverage for the vaccination campaign, there are still a few problems. “There are still people who are against vaccination, coming up with weird arguments. A couple of small pockets are still to be covered,” said the doctor, who didn’t want to be identified.

On its part, the state government had ensured quality supply of vaccines and provided all required help. “We were backed well by the state government,” Dr Sakeena said.

The Kerala government made it mandatory for children to show their vaccination certificate for admission to schools earlier this year. But the directive did not have any impact on vaccination in Malappuram. The directive is unlikely to achieve the desired results as regards to minorities like Muslims since it is not backed by law. “When there is no legal backing to the directive, how do you expect it to have any effect?” wondered a doctor.

Referring to the deaths due to diphtheria in 2016, the district medical office Dr Sakeena said that there was a 20 per cent backlog in vaccination cases and it cannot be set right now.

“But in the current context, we are trying to ensure at least 90 per cent of the children are vaccinated. We have identified eight different aspects of health like communicable diseases, non-communicable diseases, health and sanitation and such things to attain our target,” Dr Sakeena said.

In the long-term, Malappuram district officials are looking at the prospect of at least 95 per cent of its population being vaccinated. Given the current developments, it is a target that can be achieved without much of a problem.