From our womb till adulthood, the immune system – our protective guardsmen throughout life – remains the mainstay for our daily activities. Without them, infections trample on our organs and wreck hell, feasting on our cells, triggering immunological reactions. The innate immune system kicks in to provide the immediate non-specific first line of defence against pathogens. Natural killer (NK) cells, granulocytes (neutrophil, basophil, eosinophil), antigen-presenting cells (macrophage), and complement proteins assemble in unison to eradicate the mess engendered by them. Important as it is, as humans, we normally get vaccinated not long after we enter the world as blank slates, clueless about the needles and fluids injected into our deltoid muscles, where it provides what is essential to defend against pathogens that had caused pandemics worldwide, such as mumps, measles, and rubella for instance. Its roots bring us back to 1796, where Dr Edward Jenner performed the world’s first vaccination on smallpox by using cowpox. He unknowingly paved the way for future generations of doctors to be well-equipped to deal with pandemics, localised endemics, et cetera, and somehow changed the world.
Immunisation not only has changed the medical landscape, for which most people would have known by now, but it also generated different views among different populations around the globe as we step afoot in the 21st century. Undoubtedly, social determinants of health play a huge role in manifesting this divergence. If we were to compare two different people, one living in the city while the other living in a rural area, at first, we might not notice a difference while they enter this world as neonates. However, after decades of being surrounded by other people with differing worldviews, the results might seem strikingly different. Their take on vaccination might differ according to the information to which they are exposed to. Religious beliefs might also play a role in this. Take for instance, in Malaysia, the initial stance on imported vaccines was filled with fear and apprehension as citizens doubt that the vaccines were not animal-derived, which were not in line with some religious principles. Fortunately, the vaccine manufacturers addressed this issue and dispelled myths formed by the community, not to push the agenda of increasing sales, but for the better acceptance of COVID-19 vaccines.
Unequivocally, the level of educational attainment of a person will affect his or her decision on whether to get immunised. Parents who did not graduate may be more fearful than those who received a formal education, propagating misinformation towards those around them – silently affecting their decisions on being immunised. Being cognisant of the latest developments such as teleconsultation, healthcare digitalisation, and vaccination through credible sources lies paramount for the wellbeing of our fellow citizens, especially during the lockdown period where mobility is restricted. Everyone should be entitled to make an informed opinion before undergoing immunisation, particularly those who are allergic, possessing low immunity, pregnant and vulnerable. Since vaccination may not be appropriate for everyone, healthcare workers should increase efforts to inform the public of the possible risks before one receives a vaccination through television, radio, SMS, and so forth.
To understand the behavioural aspects of immunisation, we must dive deep into the underlying drivers of vaccine decision-making. Policymakers should design their strategies for vaccine take-up to target these factors, such as the perceived risk of disease, vaccine efficacy, side effects, social norms, costs in terms of time and effort, and building trust in the government and the healthcare system. Different age groups possess different risk profiles, where not everyone is confronted with similar mortality and morbidity rates in case of contracting a COVID-19 infection. This propels the hesitancy and reluctance to be vaccinated. Mandating vaccination might sound extreme, albeit ethicists profess that a COVID-19 vaccine should be made compulsory under the four following conditions stipulated by the WHO:
- there is a grave threat to public health;
- the vaccine is safe and effective;
- mandatory vaccination has a superior cost-benefit profile compared with alternatives, and
- the level of coercion is proportionate.
Mandating vaccination also has its cost, it wrongly creates a perception that COVID-19 vaccines are not safe, policies may discriminate against those who are geographically disadvantaged despite the willingness to be vaccinated.
To sum things up, immunisation has its role in providing assurance to those who are vulnerable to infection. However, we must not forget the presence of behavioural aspects which teaches us to be vigilant and informed before undergoing vaccination. We must consider its risks and positive outcomes in our society to always uphold the founding pillars of medical ethics, which are beneficence, non-maleficence, autonomy, and justice.
*No references were used in the generation of this article,
Written by:
Yu Ming Zien
AMSA Malaysia