Table 5 Resilience of policy to external influences

Rumours

The Roman Catholic Church has given us issues concerning vaccines. There are certain events that occurred two to three years ago and that has given us a problem with vaccination. The aspect of getting the Jesuits on board is very important. They are the scientific wing for the Catholics. (R05, national level)

Yes, but then those health professionals have their beliefs as well. There is this group called Opus Dei. They are learned too. However, they do not want to hear about vaccination. Community attitudes to certain vaccines like TT and the idea that it is contraception and that is also a religious organization propagating this I think due to miscommunication. (R07, national level)

Anti-vaccine campaigners

Yes, we are there (anti-vaccine campaign) just that the degree is different. It is not just in vaccination but also in medicine. There are issues around traditional herbs and there are people who want us to go back to that. It all starts as a small religious learned group of a sophisticated learned class. They argue that we have lived like that before and it can be done again. They can be quite influential. (R05, national level)

The key point is addressing their concerns in timely and proper manner because a lot of it is misinformation and misdirected journalists who write materials with the commercial aim and not necessarily from professional point of view.

Part of the effort is therefore to have scientific writers who can be critical in journalism. (R10, county level)

Sociocultural influences

The other thing is belief that some of these diseases have solutions within the cultural setup and remedies are not found on conventional medicine. Therefore, people believe the diseases do not exist or are just results of bad omen. It is like when you talk about neonatal death for example. When a child dies at three days old, you hardly notice a funeral activity for the child… yet it can be neonatal tetanus which can be prevented through vaccination with tetanus vaccine. To them, the death can be related to other cultural issues such as ‘in my lineage first born children have to die and it is normal’. …What is important is understanding the vaccine and culture around people. (R19, county level)

In-deed culture has a role to play. Everything has its base in culture because your mother is more powerful even when you go to school or not. Even if you have gone to school, there is no much difference between what you do and what she believes. If you are talking about culture in relation to pregnant mothers, we can consider Traditional Birth Attendants which we are trying to play with now. (R21, county level)

We cannot rule out culture since it is part of us. Those doing anthropology and sociology study patterns of resort and how people behave; even health seeking behavior which are entrenched in culture. Therefore, you cannot ignore that. However, education can solve certain cultural beliefs. For example, someone may believe that smearing cow dung on the cut umbilical cord can fasten healing process while education tells you that is the most effective way of contracting tetanus. Some of them can be mitigated. (R14, county level)