In these times of contagious “vaccine hesitancy” much has been written on ways to convince folks to understand the importance of immunization against COVID. A wealth of clear, appealing, easy-to-understand material is currently available in print, in videos, and online. Yet millions still have their doubts.

 

Distrust of vaccines is nothing new. Long before COVID-19, fear-raising rumors spread by avid “anti-vaxxers” triggered such waves of vaccination refusal that they precipitated resurgence of measles, whooping cough, and polio in lands where they had been all but eliminated. Now, with “infodemics” of misinformation buzzing through the social media, distrust of vaccines has spread so rampantly that it deters the prospects of preventing, through timely “herd immunity”, the likelihood of far worse levels of disaster.

The hazards of such myopic delay are huge! High vaccination coverage, as quickly as possible, is needed to curb the pandemic before dangerous new variants take over. To reach high enough vaccine coverage, it’s important that all of us currently bombarded with “fake news” about vaccines, get accurate information clearly conveyed to them on their turf and terms, so that we can rationally weigh the pros and cons of getting vaccinated.

To come to grips realistically with the pandemic, it’s important that all of us—where possible through our own observations—realize that:

1. the risks from the vaccine are very small compared to catching COVID,

2. getting vaccinated, in addition to personal protection, helps protect the whole of society,

3. only when enough people—worldwide!—get immunized can the spread of the virus be stopped and the pandemic ended.

To reach this collective goal, it’s essential that nearly everyone everywhere collaborate. The choice to get jabbed isn’t just a personal option, but contributes to the well-being of all. This doesn’t mean anyone should be vaccinated by force (an imposition that could soon prove counterproductive). Rather it means everyone should get clear, accurate information, adapted to our various ways of thinking and looking at things, so that we can all make well-considered, evidence-based decisions, for our own good and the common good.

It’s unlikely many avid anti-vaxxers will change their minds. But these inflexible naysayers are relatively few: rarely more than 2.5% of a given population. Yet the seeds of doubt they sow in the minds of the larger public has led much larger numbers—often without giving it much thought—to eschew vaccination. Surveys in the US have shown that “vaccine hesitancy” averages from 20% to 40% of the public. Among care providers in some old-age homes—despite their exceptionally high risk—nearly 60% have refused vaccination! Likewise, polls show that Republicans (political conservatives or devotees of Donald Trump) tend to be far more vaccine-scorning). People of color (Black and brown), though they die from COVID twice as often as whites, tend to be more vaccine-distrustful than are whites (which is understandable given their history of having been used as guinea-pigs in medical research and vaccine trials).

It is therefore essential that ALL OF US—including skeptics and rebels—come to realize that one of the best ways to help ward off cataclysm caused by proliferation of more aggressive mutants is for virtually everyone on earth to get vaccinated against COVID as soon as possible.

This means that ALL OF US—in all walks of life, rich and poor, urban and rural, schooled and unschooled—need the opportunity to thoughtfully consider the facts, look critically for the truth, and recognize misinformation for what it is.

This kind of sobering critical analysis—both personal and collective—calls for what some of us dub “discovery-based learning”. It can help us to think for ourselves, make our own observations, and reach rational decisions for the common good.

Methods for facilitating this sort of liberating, think-for-yourself learning process are explored in Paulo Freire’s eye-opening book, Pedagogy of the Oppressed. Further examples of “discovery-based learning” can be found in our handbook, Helping Health Workers Learn (Werner and Bower, accessible through www.healthwrights.org). A number of these learning tools were developed in intercambios educativos (educational exchanges) with village health promoters from community-based health programs in Mexico and Central America during the 1980s and ’90s.

 

 

Use of Street Theater and Participatory Role-Plays to Rethink ‘Vaccine Hesitancy’

Widespread suspicion of vaccination is nothing new to the Mexico’s Sierra Madre, where I helped to launch the community based health program. In the 1960s when the villager-run health program began, the mountain region had disturbingly poor levels of health. Maternal and child mortality were high. One in ten women died in childbirth. One in three children didn’t reach age five. Tetanus (lockjaw) was a common cause of death. Half the women, by the time they reached menopause, had lost at least one baby to neonatal tetanus. The health team managed to lower these deaths by encouraging midwives to use a sterile razor blade to cut the umbilical cord. But not until we finally succeeded in routinely vaccinating pregnant women against tetanus did deaths from neonatal tetanus fall almost to zero.

But convincing the villagers that vaccination was important wasn’t easy. In the late 1960s, when we began to immunize the children against polio, tetanus, whooping cough, diphtheria, measles, and tuberculosis—all disabling or deadly diseases in the Sierra Madre at the time—most villagers were hostile toward vaccination. A decade earlier soldiers had marched into the mountains and, with little explanation, jabbed every child they could catch. In those times Mexico still vaccinated against smallpox, as a safety precaution since smallpox had only recently been eradicated worldwide. From the vaccine children became feverish and got a nasty, painful sore on their shoulder. So, understandably, parents got upset. Before the jab their kids were healthy; afterwards they were not. So the campesinos vigorously resisted further vaccination. Then, two years before the Piaxtla program began, a curandero (traditional healer) named Mencho—who understood the life-saving potential of immunization, had obtained vaccines in the county seat and begun to immunize children. But the community angrily protested. One father even threatened to shoot Mencho if he persisted. So he stopped. Since then no one had tried to vaccinate in the back country—until we launched an immunization program in 1967.

 

By that time, fortunately, many of the villagers had come to appreciate the community health program. When the health promotores explained the purpose of vaccination, some folks—if still a bit hesitant—cooperated. But many not yet. Thus the program’s early vaccination efforts were only partially successful. We managed to vaccinated about half the children. A lot of families remained suspicious and didn’t take their children to be vaccinated … until a tragic event led them to reconsider. It happened like this:

In the small, indigenous village of Guillapa, a few weeks after the health team’s efforts to vaccinate there, a little girl named Xochi suddenly fell ill and died of tetanus. She had not been vaccinated. When her two sisters got the shots, Xochi hid and had gone without. A few weeks afterwards, as it happened, all three sisters got their ears pierced for earrings by their grandmother, all with the same sharp thorn. Four days later, Xochi developed a fever and had trouble opening her mouth. The next day her whole body began to suddenly arch backward with the painful spasms of tetanus. After an excruciating few days, Xochi died. Her two sisters, however, were fine. Word of the little girl’s agonizing death spread through the mountains.

The Piaxtla health promoters, on revisiting the distant village, figured out the chain of causes that had led to the girl’s tragic death. They explained things to the bereaved family, who then deeply regretted not insisting that Xochi get vaccinated along with her sisters. With Xochi’s parent’s consent, the health promoters composed a brief educational skit based on this sad event. When they first presented it in Guillapa, at the end of the skit, the girls’ mother, weeping, told everyone she now realized why Xochi died and why her sisters were spared. She asked her fellow campesinos to draw their own conclusions. There was a lot of discussion and debate. In the end, most agreed that vaccination had likely made the difference. Xochi’s mother begged everyone to get their children vaccinated.

The health promoters performed this brief skit in several of the neighboring villages, followed by open-ended discussions. The skit seemed to mark a turning point in people’s viewpoint and soon led to their energetic support of the vaccination effort. In fact, people of the barrancas eventually became so motivated they began to send mules to the distant Ajoya health center to transport the ice chests with vaccines. And the school teachers, and the schoolkids themselves, diligently spread the word and helped organize vaccination process in their village.

As a result of this popular involvement, vaccine hesitance began to abate. After giving it some thought, many who’d been suspicious of the vaccination campaign began to cooperate and even help promote it. Within five years, coverage in the mountain area became exceptionally high, and the incidence of the infectious diseases of childhood conspicuously declined. Indeed, polio—which had been paralyzing hundreds of children for generations—disappeared from the remote project area of the Sierra Madre almost three years before polio was eliminated from the barrios of the coastal cities.

This kind of collective commitment as seen in the Sierra Madre can be encouraged through an educational process that invites people to think for themselves. The skit—based on a heart-breaking event in their own community—helped people clarify their own observations and make rational decisions to take action for the common good.

Possibilities for facilitating this sort of empowering, people-centered learning process are laid out by Paulo Freire’s in his revolutionary book, Pedagogy of the Oppressed. A potpourri of other “discovery-based” learning tools—developed through decades working with village health promoters in Mexico and beyond—can be found in our handbook, Helping Health Workers Learn.

The Measles Monster

Another example of using participatory drama to confront “vaccine hesitancy” took place in Nicaragua, a few months after the Sandinistas had overthrown the oppressive Samosa government. The country’s new ministry of health (MINSA)—which was familiar with our villager-run health initiative in Mexico—invited a group of us from Project Piaxtla to go to Nicaragua to facilitate a community-based workshop focusing on “health education for change”. The ministry had launched an intensive country-wide vaccination campaign. This national campaign, however, was being surreptitiously undermined by the US Central Intelligence Agency (CIA) which spread rumors that the vaccines would sterilize whoever got them. (As proof, it was pointed out that the little bottles had printed on them, “agua esterilizada”! So lots of people grew “hesitant”—or worse.) To confront this sabotage, as part of our workshop, the participating brigadistas organized a street-theater skit in the marketplace, recruiting passersby and children as actors.

 

The Measles Monster skit opens with a brigadista (speaking through a narrator with a loudspeaker) loudly announcing the vaccination campaign. But one family (their faces painted white), having heard the worrisome rumors, decides not to vaccinate their children, but instead go to the beach. At that moment the huge, fierce “Measles Monster” (a tall nun played this role) rushes in, chasing after the kids on the street to catch any who are not vaccinated.

 

The children flee the Measles Monster in terror. The monster catches a child of the vaccine-hesitant family, enveloping him in its huge claws. When the monster releases him, the boy is wearing a white mask covered with the red dots of measles. He becomes very ill and nearly dies—but at last recovers, with a new mask that’s very pale and thin.

 

 

The brigadista reappears, announcing another “day of vaccination”. The boy’s family—having learned the hard way— now eagerly take all their children to be vaccinated. At the skit’s end, the brigadista asks the crowd, “Why did this child get measles?” Everyone shouts, “Because he wasn’t vaccinated!”. Then the brigadista asks, “And now why do none of the kids in this family get measles?” And everyone shouts, “Because they’re all vaccinated!”

 

As the skit came to an end, the group of children gathered on the street got so charged up that they attacked the Measles Monster, throwing it to the ground. (The nun inside the monster costume actually suffered a few cuts and bruises—but said it was worth it.)

After the skit, more of the locals were supportive of vaccination. Even kids were eager to be jabbed.