On 30 November, the Belarusian Republican Centre for Hygiene, Epidemiology and Public Health announced that 3.7 million Belarusian citizens had voluntary vaccinated themselves against flu. This number proves that Belarusians still generally trust their public health institutions despite a growing anti-vaccination sentiment in the blogosphere and social networks.

At the same time, the Ministry of Health should adequately address anti-vaccination prejudices, which quickly spread via the Internet. A slight decrease in national herd immunity will inevitably lead to outbreaks of dangerous diseases. To do so, the authorities might introduce legal punishments for non-compliance with the national vaccination schedule.

Anti-Vaxxers in Belarus

At present, vaccines, rather than diseases, are the focus of numerous online and offline discussions in Belarus. The rapid penetration of the Internet has brought a powerful, yet pervasive platform for those who are against vaccinations, also called anti-vaxxers, to spread their message. Numerous pseudoscientific online sources work to undermine parents’ confidence in and ask questions about the necessity of vaccinations. In Belarus, certain “mums’ blogs” and social media groups have emerged advocating for non-vaccination and spreading unsupported rumours about vaccines’ side-effects.

Photo: BelTA

Why might Belarusian “mums” object to vaccinations? Some of them have experienced certain post-vaccination complications, while others simply do not possess the basic knowledge about the subject. A number of “mums” have overheard rumours of possible links between the BCG-vaccine (used primarily against tuberculosis) and lymphadenitis, or the MMR-vaccine (used to prevent measles, mumps, and rubella) and autism. Consequently, these “mums” use blogs, forums, and social media groups to discuss their experiences and exaggerated fears.

It is important to stress that Belarusian “mums” are not the only ones in the post-Soviet space objecting to vaccinations. A range of similar social media groups and forums have emerged in Kazakhstan, Russia, and Ukraine. Muslim preachers, especially in the Central Asian republics, advocate for non-vaccination on religious grounds and link female infertility to post-vaccination side effects.

According to Kyrgyzstan’s Ministry of Health, the growth of anti-vaccination prejudices among the Muslim population caused an outbreak of measles in 2015. It appears that anti-vaccination sentiment has spread rapidly across the Commonwealth of Independent States (Armenia, Belarus Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan).

When the law remains silent

The growth of anti-vaccination prejudices has prompted several EU’s states, including France, Germany, and Italy, to toughen their laws on compulsory vaccination. Thus, Italy has introduced fines up to 500 euro for non-compliance after a measles outbreak in spring 2017. Belarus, on the other hand, does not fine or punish for non-compliance with the national vaccination schedule.

The Belarusian vaccination schedule covers hepatitis B, polio, tuberculosis, diphtheria, tetanus, whopping cough, measles, parotitis, rubella, haemophilus infection, streptococcus pneumonia, and flu. In accordance with the Belarusian vaccination schedule, a newborn child receives its first vaccination against hepatitis B within twelve hours since the time of birth. The remaining vaccinations are predominantly conducted within the first year of life. Vaccines and vaccination procedures are free of charge.

For those parents who consciously object vaccination, a special exemption clause exists. A parent must sign an official refusal letter in the presence of medical workers. In Belarus, such a procedure takes no more than two working days. Sometimes medical workers overtly express their discontent and warn of school enrolment problems. Yet, unlike Italy, legislative sanctions do not apply to those Belarusian parents, who consciously object vaccination. Non-vaccinated children legally attend public nurseries and secondary education institutions. They may be banned from classes only in case of an epidemic.

Interesting comparisons can be drawn with Moldova and Ukraine, where non-vaccinated children cannot attend state-run nurseries and schools. In Ukraine, legislation conflicts with the Constitution, which grants a universal right to education, while national healthcare legislation prevents the unvaccinated from attending school. Several parents have already appealed to the supremacy of Ukrainian Constitution over national health care law.

In Moldova, human rights lawyers lost a similar legal dispute. The Moldovan Constitutional Court ruled out that compulsory vaccination does not violate the right to education. Those parents who consciously object vaccination can pursue individual teaching or homeschooling. Hence, a legal precedent for toughening compulsory vaccination has been already established in the CIS.

Will Belarus change its healthcare policies?

Photo: sb.by

At present, the situation with public health in Belarus is within the norm. The vaccination coverage of Belarus against major diseases is around 96–98 percent of the total population. Certain vaccine-preventable diseases, such as polio and measles, have been absent in Belarus for several decades. Diphtheria was the last major epidemic, which affected Belarus in the mid-1990s.

The diphtheria outbreak occurred as a result of organizational disruptions within public health institutions after the break-up of the Soviet Union. Yet, Inna Karaban, Belarus’s chief epidemiologist, said that a significant proportion of those affected by diphtheria refused vaccination in the 1980s.

In the 21st century, the major concern for Belarus is the growth of more resistant forms of tuberculosis, in particular, MDR-TB. High levels of smoking and alcohol consumption have contributed to MDR-TB’s development. The Ministry of Health announced a state-run “Tuberculosis” programme for 2016–2020, which focuses on MFR-TB treatment nationwide. Yet, combatting resistant forms of tuberculosis also requires mass anti-alcohol and anti-smoking campaigns.

To conclude, while the situation within Belarusian healthcare is not critical, there will be no rapid legislative measures. By November 2017, approximately 35 percent of Belarusians have voluntary vaccinated themselves against the flu. This shows a high level of trust towards national healthcare institutions.

Nevertheless, the Ministry of Health should trace the online anti-vaccination sentiment and organize public campaigns to combat prejudices. Cases of post-vaccination complications should be adequately addressed. The attitude of medical staff to hesitant parents must also improve. Medics should find the right words to explain the significance of herd immunity to the nation.