Miriam Alía, Médecins Sans Frontières: "The mistake was not to foresee an education programme for vaccine hesitancy"

BarcelonaThe Madrid nurse Miriam Alía is the head of vaccination for Médecins Sans Frontières (MSF), seasoned in several emergency situations, such as the Ebola pandemic that swept through West Africa in 2014

What do you think has gone wrong to lower the confidence index in vaccines?

— More than going wrong, it's that we weren't prepared for the level of data exposure. When you start administering new vaccines in the population there is a phase 4 that includes super-strict pharmacovigilance measures and the fact that possible side effects have come out is a sign that it has worked, but, of course, then you have to explain well that they are not necessarily related. The lack of harmonization in the form of vaccination in each country or region is another way of creating mistrust. We have to make an effort in the way politicians talk and the way the media communicate and, of course, public health and prevention staff also have to make an effort to constantly update and be transparent, because it is normal for doubts to arise about the vaccine.

Do you think that AstraZeneca should have continued supplying it?

— While the European Medicines Agency (EMA) has been cautious and has recommended to continue vaccinating while researching, based on the risk-benefit, some countries have stopped vaccination without any scientific evidence to do so, in a very conservative decision, without stopping to assess that it could generate a negative effect on trust in vaccines in general, and in this one in particular. Of course you have to be transparent and give information but you have to be cautious and assess the risk of stopping a vaccination when there is no evidence that the effects are caused by the vaccine.

Has information been poorly communicated?

— The vaccination groups have been defined, but the pedagogical messages for health and promotion of vaccination have not been adapted to each one and this has made some groups think that they are being given a worse vaccine, when in fact there are no studies of inferiority and all vaccines that have been approved are very good and effective against severe disease. There has been good monitoring of pharmacovigilance but not good anticipation of how to do an education program to resolve doubts about a new vaccine. In MSF, when we use Ebola or cholera vaccine in places where it has not been used before, we have all this in mind from the beginning of the campaign, because it is as important as knowing how the cold chain will be maintained or having the best nurse for the administration, because if everything is prepared but people don't come, the vaccination will be a failure.

Has a beginner's mistake been made?

— It could have been done like MSF. We include in the technical groups that make the vaccination plans professionals from the social sciences, anthropologists, specialists who have carried out campaigns with new vaccines or vaccines in phase 4 with emergency authorisation, as in this case. And, of course, we should take into account the professionals who work in primary care and who know the most about vaccination, especially nurses and paediatricians.

Perhaps we have wanted to be too fast.

— I don't think so, but we have created expectations that could be dangerous. We have to be clear that the only objective of vaccination is to reduce mortality by vaccinating the most vulnerable and to protect the health system by vaccinating frontline health workers, and from there it goes down to the next less risky groups. There has been a certain marketing tendency to take the photo or to set up mass vaccination sites when in fact the bottleneck was in the supply of vaccines.

Are you not in favour of large spaces to vaccinate more?

— It is better to integrate vaccination in primary care health centers, who know the population and are the staff trusted by patients to resolve doubts and fears.