After a nine-month-long struggle, a mother delivers a baby. To prevent her precious child from infectious diseases, she vaccinates her child. But, sometimes, immunisation can have some adverse effects. In very rare cases, the outcome is fatal. Recently, similar incidents were observed in Doti and Ilam district. Following such events, several media published news addressing the cause of death. It was reported that the cause was either the negligence of a health worker or the administration of polluted vaccines. The police even arrested the health worker who had vaccinated the child in Doti, without actual evidence of negligence. If we don't tackle such incidents properly, it will undermine people's confidence in vaccination. This would result in a reduction in vaccine coverage followed by an increase in the incidence of infectious diseases. Moreover, such events will demotivate the grassroots-level health workers from performing their duties.

Adverse events following immunisation can be vaccine-related, which results from the vaccine or immunisation process, or be coincidental events that are not related to the vaccine or process. The government of Nepal is trying to reduce immunisation error by ensuring the quality of vaccines through cold chain maintenance at every stage and training health workers at various levels. However, when fatal or severe outcomes occur, such incidents are not handled in a systematic manner. This results in the loss of public trust. The government has a mechanism to investigate such incidents with support from the World Health Organisation, but most of the time we concentrate on analysing the causes of such events. We also lack proper compensation mechanisms for the mourning family. Further, the stakeholders are not concerned with the misinformation that is spread in a rampant manner, both online and in print.

One of the potent sources that discourage people from trusting vaccines is the rapidly-growing media. Media organisations must be careful that their reporting is not based on rumours and erroneous information. In the above-mentioned case, some sources published that incident as ‘Infant's death after injecting four vaccines at the same time’. The title alludes that the fatal outcome was due to erroneously administered heavy doses. However, the Nepal Government has a national immunisation schedule in which a child can take four vaccines at six weeks of age. Further, due to the heavy penetration of social media, such negative rumours spread rapidly.

Researchers in public health coined a term to define such incidents, calling it 'misinfodemics'. It is the rapid spread of misinformation about health and disease which can be detrimental to the health of a large number of people. One profound example is the refusal of the Measles vaccine throughout the world after a researcher published a false article showing the relationship between the Measles vaccine and autism. Similarly, the Ebola death toll in West Africa was fueled by online misinformation. In the context of Nepal, although the severe impact of such 'misinfodemics' has not been observed yet, it is very likely to occur due to globalisation. If the stakeholders don't give enough attention to this sensitive issue, this may create severe distrust among people.

The process of vaccine development is a robust one that assures its efficacy and safety. Although all vaccines used in the National Immunisation Program in Nepal are safe and effective if used in the correct manner, we can't assure that these are completely risk-free. That is why some reactions following immunisation are unavoidable. What we can do is minimise those events and address such incidents in a systematic manner through awareness, educating media personnel to publish such sensitive news after cross verification, and addressing victim's families through financial compensation and psychological support.

Meanwhile, the Ministry of Health and Population is planning to conduct the Measles-Rubella Campaign for children throughout the country in February and March 2020, to eliminate the two diseases from Nepal. As the target group for vaccination is huge, it is highly likely that some reactions following immunisation will occur to a few. The stakeholders should be prepared earlier so as to minimise the long-term impact of such events.

Quality control of vaccines, no doubt, should be the prime agenda. But, at the same time, counselling is paramount. Health workers should inform the family members about the role of vaccines and their possible side effects prior to immunisation. Sometimes, the queue of children is so long that it is almost impossible to counsel. Still, in such a case, group or mass counselling can be done. After vaccination, the child should compulsorily stay at the vaccine delivery site for at least 30 minutes for observation, which is not usually practised. In case any adverse reactions occur during or following the immunisation procedure, the family should be counselled compassionately. The mechanism of financial compensation should be easy and quick. The investigation report should be disseminated widely so that people can get factual information.

Media advocacy is an important avenue to prevent 'misinfodemics'. The stakeholders should educate journalists who are involved in the reporting of health-related issues. Realising the possible havoc that might occur due to misinformation, it is imperative that the editor overseeing news about healthcare and public health in every media should be an expert who can judge the validity of information in a scientific manner.

The burden of infectious disease in Nepal is still high and, to eliminate such diseases, vaccination is one of the most cost-effective primary prevention approaches practised worldwide. To eliminate and eradicate infectious diseases through successful immunisation programmes, we need the collaborative effort of various stakeholders including the active and supportive role of the media sector.

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