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SEOUL, South Korea – Deaths were rising, as were public fears.
South Korea has dramatically expanded its flu vaccination program to cover millions more, to avoid a boost to its health care system as the coronavirus spreads around the world. But as the injections began, reports of deaths started to appear.
South Korean scientists quickly determined that the deaths were unrelated to the flu shots. But they feared that if they didn’t stop the panic, the public could avoid the vaccines altogether.
So health officials have doubled down – and in doing so, have given the world a game plan for when coronavirus vaccines become widely available.
They have stepped up their efforts to communicate with the public. They disclosed data on what was found. And they quickly got the vaccination campaign back on track, at a time when scientists dealing with Covid-19 are increasingly concerned about the rise of the anti-vaccine movement.
“South Korea is doing everything right,” said Dr Noel T. Brewer, professor in the department of health behavior at the Gillings School of Global Public Health at the University of North Carolina. “The government collects data, quickly informs the public and defends its immunization program. This will ensure public confidence and help the program.
As pharmaceutical manufacturers rush to get a vaccine for the coronavirus approved, countries around the world wonder how to safely and quickly distribute hundreds of millions of doses. Already, the pandemic has created confusion and mistrust at a time when disinformation can spread rapidly, which could complicate the global effort on immunity.
While a long-proven and widely tested influenza vaccine may raise uncertainties and concerns, it could portend challenges for massive inoculations of a brand new coronavirus vaccine. The potential pitfalls have occurred on a small scale in South Korea.
The country’s ambitious flu vaccination campaign began on September 8, a month earlier than usual. Health officials have announced plans to vaccinate 30 million people, 10 million more than last year. But in their haste, problems arose.
A company hired to transport millions of doses of vaccine had never transported such large quantities of goods before. Flu shots should be kept refrigerated, between 2 and 8 degrees Celsius. On September 21, photos began circulating online showing boxes of vaccines stacked outside in a parking lot.
As a precaution, the government temporarily suspended the investigation program. On October 6, he concluded that the vaccines were still safe, but nonetheless recalled the 480,000 doses that had been left outside long enough to become potentially ineffective.
Three days later, 615,000 doses of a vaccine shipped by another company were also recalled, after white particles were found inside. The government concluded that these were harmless protein particles.
South Korea’s flu vaccination campaign resumed on October 13. But the public was still suspicious.
The following week, a family reported that a 17-year-old high school student had died after receiving a flu shot. More and more reports of deaths have sprung up, most involving patients aged 70 and over. By October 22, the number of reported deaths had reached 28 and it was increasing day by day. Singapore briefly suspended use of a South Korean vaccine after the deaths were reported.
As Dr Jung Jae-hun, professor of preventive medicine at Gachon University near Seoul, read the news, he felt an urgent need to push back.
Influenza vaccines have been tested and used safely for decades in South Korea. If the credibility of the program could be so easily undermined by unsubstantiated claims, it wondered what would happen once millions of people started taking coronavirus vaccines.
“I think this extreme situation was created because we are living in this unusual time of Covid-19 and people are too sensitive to vaccines,” Dr Jung wrote on October 22, in the first of a series of posts on Facebook criticizing the news. reports.
He warned that reporting “deaths after vaccination” when there was no scientific evidence to establish a link was counting the number of people who died after eating breakfast.
“If people don’t understand this, it could lead to the proliferation of anti-vaxxers here, like those in the West,” he said.
While the government defended vaccine safety, it also launched an investigation into the deaths, hoping to use science to counter disinformation. If, for example, all cases were linked to a particular vaccine or clinic, or if all deaths were similar, this would raise red flags. Multiple deaths from anaphylaxis, a severe allergic reaction, would also involve the vaccine.
But the government’s forensic investigations, which would eventually rule out such connections, did not progress as quickly as the panic spread.
“Elderly people die every day, from stroke, from heart attack, but the media reported these deaths as if none of them died on a normal day,” said Dr Ki Mo-ran, epidemiologist at the National Cancer Center. on the government vaccination supervision group. “As people waited for the results, anxiety increased, confidence fell and the immunization program suffered.”
To help allay some of the public’s concerns, Dr Jung published an opinion piece in the Journal of Korean Medical Science stressing that it is not unusual for some people to accidentally die of unrelated causes after having received a vaccine. He cited a study published in 2013 that showed that 23 in 100,000 Americans between the ages of 75 and 84 had died of various causes within a week of taking their shots.
A few days after the publication of Dr Jung’s essay, the South Korean government released the corresponding national figures. Last year, according to the newspaper, 1,500 South Koreans aged 65 or older died within a week of taking a flu shot. None of the deaths were related to the vaccines. As the flu typically kills 3,000 people each year in South Korea, health officials have insisted that the benefits of vaccination far outweigh the risks.
For Dr Kim Woo-joo, professor of medicine at Korea University, the government’s initial response could have been quicker and more aggressive. “It was a failure in risk communication,” he said. “What was needed was swift, transparent, science-based communication to dispel misinformation and conspiracy theories and to show that these deaths were likely just coincidences.”
But Dr Brewer, a professor at the University of North Carolina, cited South Korea as an example of how to address vaccine fear in the future. He noted that the main threat to immunization programs across the world is misinformation, often linked to an unproven security scare.
He pointed to Japan and Denmark, where misinformation has spread about vaccines against the human papillomavirus, or HPV. Vaccines help prevent cervical cancer in women, among other diseases.
The two countries did not respond to inaccurate vaccine safety reports. As a result, Dr Brewer said, the HPV vaccination rate in Denmark has fallen by 50 percent over several years, although it has recovered after the government worked to counter false claims. In Japan, it went from 70% to 7% in just one year.
In the weeks following the start of the vaccination campaign in South Korea, the government received more than 100 reports of people dying after receiving a flu shot. Authorities quickly revealed the causes, which were unrelated to the vaccinations.
Autopsies concluded that the patients often suffered from cardiovascular and other diseases, and that all died from causes unrelated to the vaccines, such as aortic dissection, acute myocardial infarction, and cerebral hemorrhage. A medical examiner found poison in the body of the 17-year-old and police suspected suicide, although his family insist he had no reason to kill himself.
“If you just say blindly, ‘oh no, these are not relationships’ you’ll create a lot of mistrust,” said Dr. Vanessa Raabe, vaccine and infectious disease expert at NYU Langone Health who praised the response from South Korea. “You have to do some science before you say they’re unrelated.”
The flu panic has subsided in South Korea, but only 19 million people have so far received their vaccine, far from the government’s target of 30 million. Dr Jung said that, like in the United States, the political polarization in South Korea has likely contributed to some of the confusion over the safety of flu shots.
“Rather than being divided, we must learn to fight together against the common enemy,” he said. “If we are to resume our pre-Covid-19 life, go out to eat and drink and travel abroad, vaccines are our best chance.”
Choe Sang-Hun reported from Seoul and Denise Grady from New York.
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