China mass measles vaccination plan sparks outcry

[September 13, 2010]  BEIJING (AP) -- China's plans to vaccinate 100 million children and come a step closer to eradicating measles has set off a popular outcry that highlights widening public distrust of the authoritarian government after repeated health scandals.

Since the Health Ministry announced the World Health Organization-backed measles vaccination plan last week, authorities have been flooded with queries and Internet bulletin boards have been plastered with worried messages. Conspiracy theories saying the vaccines are dangerous have spread by cell phone text messages.

The public skepticism has even been covered by state-run media, which noted the lack of trust was about more than vaccines.

"Behind the public's panic over the rumors is an expression of the citizens' demands for security and a crisis in confidence," a columnist wrote in the Chongqing Daily newspaper.

"The lack of trust toward our food and health products was not formed in one day," said the Global Times newspaper. "Repairing the damage and building credibility will take a very long time. The public health departments need to take immediate action on all fronts."

In recent years, government agencies have dragged their feet or withheld information about the spread of SARS, bird flu and, last month, an outbreak of cholera. China's slow response to SARS, or severe acute respiratory syndrome, was widely blamed for causing the outbreak that swept the globe in 2003, and led to deep mistrust both internally and internationally.

Milk products contaminated with industrial chemicals are still found despite mass recalls and several criminal convictions, including executions, after tainted infant formula sickened 300,000 babies and killed at least six two years ago.

Feeding into worries about the measles vaccine were media reports in March that vaccines for encephalitis, hepatitis B and other diseases possibly killed four children and seriously sickened dozens in one province. The health ministry said an investigation showed those vaccines were improperly stored but subsequent illnesses were unrelated. Many remain unconvinced.

Meanwhile, two Chinese vaccine makers recently said they shut operations after rabies vaccines they produced were found to be substandard.

The ministry has tried to calm the public's anxieties about the 10-day measles immunization drive, which started Saturday. It has busily issued statements, refuted rumors and held briefings to emphasize the need for the vaccine as well as its safety.

The campaign, likely the world's largest, targets all children ages 8 months to 4 or 14 years, depending on locality, and is intended to include remote areas, migrant communities and other places where previous vaccination coverage has been spotty.

Yet the publicity is not likely to easily reassure a public increasingly skeptical of reassurances from a government often seen as opaque and unaccountable, especially where public health is involved.

"This time how could the public have no doubts? They are asking: 'Is there an outbreak of the disease? Are previous vaccinations not working? Are the people in the government trying to make money from this?'" newspaper commentator Wei Yingjie said in an interview.

The public push-back marks a turnaround from the mass campaigns in the communist heyday under Mao Zedong and shows how prosperity and greater access to information are creating a more assertive populace.

"This campaign would have been no problem in the Mao era, but today we know with globalization, the Internet, the information explosion, this increasingly assertive civil society, they want to participate in the public policy process," said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations in New York.

Measles is a highly contagious viral disease that can develop into blindness, pneumonia and encephalitis and lead to death, and health experts say China needs an effective vaccination program.

Despite previous vaccination drives, China recorded 52,000 measles cases last year, including 39 deaths. The infection rates mean China is far from meeting its national pledge from 2005 to eradicate measles by 2012.

Mass drives in other parts of the world have either virtually eliminated measles or significantly reduced the number of infections. The disease has been nearly nonexistent in the Americas since 2002 and cases in seven countries in southern Africa fell from 60,000 in 1996 to 117 by 2000, according to the WHO.

Dr. Lisa Cairns, head of immunization at WHO China, said many of those infected with measles in China are young children who were likely never vaccinated.

"Because the disease is not as common as it used to be, it is easy to forget how serious it is," she noted.

China's Health Ministry has repeatedly said that the measles vaccine is safe, with random samples tested from stores around the country, and has tried to assure the public that medical personnel are prepared for emergencies, including any adverse reactions.

On Friday, a senior ministry official promised that no one would be forced to take the vaccination.

"Vaccination will only proceed after parents sign an agreement," the ministry's deputy director for disease control Hao Yang said. "We heard that some places were linking vaccination with admission to kindergartens and schools. So yesterday we issued a notice that admission to school should never be used to force children to vaccination."

Health care professionals, however, have questioned the immunization drive's broad scope, given that many children have previously been inoculated and thus would be vaccinated again.

A blog posting by a prominent immunization expert, Wang Yuedan of Peking University, urged the government to focus on formerly underserved groups like the children of rural migrants now living in urban areas, instead of vaccinating some children again. By Friday, Wang withdrew his reservations and backed the campaign, saying he was convinced by the Health Ministry's explanations.

Still, Wang said in an interview that he winced at the thought of his 4-year-old daughter suffering a possible fever from the vaccine.

"I'm a man and a father first, who has emotions and who can't watch his child suffer pain blindly," he said.

[Associated Press; By GILLIAN WONG]

Associated Press researcher Xi Yue contributed to this report.

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