A TB case worker with APIN Public Health Initiative, Mercy Depuun noted that the uptake of vaccines in Nigeria has been generally low because of hesitancy from the public, and this was because of a lack of trust in the vaccines. There were various myths surrounding vaccines in this part of the world, including getting infected with diseases from taking the vaccine, life-threatening side effects from the vaccine, and birth control plots by the west.
However, she pointed out that BCG vaccine coverage in Nigeria is commendable. Its initial low uptake was not completely linked to hesitancy but to parents' access to health facilities for their infants' BCG vaccination. Thus, while the availability of a new TB vaccine will be welcome in Nigeria, easy access to the new vaccine will effectively combat hesitancy.
Mercy further observed that generally this would not be an issue as the government agency responsible for the expanded programme on immunisation has some mechanism to deal with it. A massive vaccination campaign has addressed this for all childhood vaccinations, including BCG. There was some house-to-house vaccination of children eligible for BCG vaccine. Also, the eventual lifting of movement restrictions imposed due to COVID-19 has increased and improved access to health facilities for parents of infants.
Among the people who administer BCG vaccines in India are frontline community health workers or ASHA (Accredited Social Health Activist) workers. We spoke with Reshma Adagale, who is an ASHA worker in Maharashtra state of India and a part of Nagpur Municipal Corporation Employees Union: "During the 6-7 years of my working as ASHA worker, I have not had to convince much, as most people know it is important for children to get BCG vaccination and they are willing to get their babies vaccinated. Very few (around 1-2%) need to be counselled about its benefits or any hesitation they may have. They may need to be informed about its public health benefits, about possible side effects, etc. Some people make flimsy excuses for not getting their child vaccinated, like 'when children get injection they keep crying for a long time; or kids get fever after vaccination and then parents have to leave their work and take the kid to the hospital (which results in loss of wages)'; or that 'we will get our child vaccinated if the family elders permit us to do so'; or 'we did not get this vaccine in the past, so why should our child get it'. These are some myths and misconceptions we come across at times. We try our best to convince them and get their kids vaccinated." However, she confirmed that she had to work hard with people to counter vaccine hesitancy against COVID-19 vaccine.
Bhagyashree, another ASHA worker in Nagpur, India, told us that in the past 5 years of her work life, she has not encountered any vaccine hesitancy against BCG. Like Reshma, she said that COVID-19 vaccine hesitancy was there. "I had to convince them on vaccine benefits, educate them on side effects, and bust myths and misconceptions like 'it will make us impotent' etc, and eventually we got our whole area vaccinated against COVID-19."
"We need to recognize the role of Auxiliary Nurse Midwives (ANMs) and ASHA workers who have been going door-to-door around the villages in raising awareness and health education about importance of these vaccines and other health interventions since years. Ultimately it is about involvement of healthcare workers and health literacy in the field. People may not know what is 'BCG,' but they are likely to understand that its shot will help protect their child from disease in future. Role of healthcare workers on the ground is phenomenal," said Jibin TC, National Working Secretary of United Nurses Association.
Looking back over BCG vaccine rollout in the last 102 years
In May 1948, Indian Government had issued a press note stating that TB was "assuming epidemic proportions," and that it had "after careful consideration" decided to introduce BCG vaccination. Government-run BCG Vaccine Laboratory was set up in Chennai, India, in 1948, which continues to produce this vaccine till to date.
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