On June 20, a nine-year-old girl in Dak Nong Province of the Central Highlands died from diphtheria, an infection caused by the Corynebacterium diphtheria bacterium, which can be prevented by vaccination.

Several days later, 12 people in the same province were diagnosed with the disease and 355 quarantined due to the ongoing outbreak.

In Ho Chi Minh City, 16 people were also quarantined after a student was diagnosed with diphtheria that had, until a couple of years ago, been absent from Vietnam since the national vaccination program started in 1981.

In the last few years, the disease has again reared its head in many central provinces suffering low vaccination rates, according to Tran Dac Phu, a senior advisor at Public Health Emergency Operations Center under the Health Ministry.

In Dak Nong Province, where several diphtheria hotspots have been identified, vaccination rates are around 48-52 percent, while the national number is reported to be 95 percent.

Falling vaccination rates have led to an increasing number of Vietnamese infected by diseases once thought conquered. Measles outbreaks occurred in 56 provinces during 2018 and 2019, for example.

A resident in Quang Hoa Commune, Dak Glong District, Dak Nong Province
gets a diphtheria shot on June 28, 2020. Photo by VnExpress/Duc Hoa.

The spiking numbers of measles patients in 2019 (including over 10,000 confirmed cases) worried many parents as previously, 133 children in Hanoi were killed by the disease in 2014.

As much as 90 percent of reported measles patients either did not receive vaccinations, have not been fully vaccinated, or have an unknown vaccination status, according to Deputy Director of the Hanoi Department of Health Hoang Duc Hanh.

The return of diseases like diphtheria and measles pose a burden on the healthcare system and public health, ascribed to low vaccination rates.

According to Dr Duong Thi Hong, deputy director of the National Institute of Hygiene and Epidemiology, head of the Executive Board for the National Expanded Vaccination Program, vaccination rates in the first five months of 2020 are lower than in 2019, which hit 32.2 percent.

Notably, measles and DPT4 (diphtheria, pertussis, tetanus) vaccination rates among children under 18 months old were 31.2 and 28.9 percent, lower than last year’s numbers, Dr Hong emphasized.

A report from World Health Organization (WHO) and United Nations Children Fund (UNICEF) in 2019 also revealed Vietnam to be among the top 10 countries accounting for 60 percent of 20 million unvaccinated children worldwide.

Disrupted services and hesitance

There are several reasons behind the decrease in vaccination rates in Vietnam, including the Covid-19 pandemic, which has severely affected many aspects of life and disrupted immunization services around the country.

According to WHO, due to the Covid-19 pandemic around the world and in Vietnam, health workers have been reassigned to pandemic response, and in many instances, have also been discouraged to conduct routine activities involving physical interaction with healthy patients.

In Vietnam, when the nationwide social distancing campaign kicked off in April, the National Institute of Hygiene and Epidemiology requested a halt to the expanded vaccination program in all provinces for 15 days, causing many children to miss their immunizations.

On April 24, WHO and UNICEF in Vietnam released a joint statement on ensuring children are vaccinated during the Covid-19 pandemic, as they need to be protected against a wide range of dangerous and lethal diseases.

With the pandemic contained in Vietnam and vaccination services resumed, some parents are avoiding healthcare facilities, worried that the Covid-19 virus could be transmitted to their families.

"I should have taken my son to the vaccination center for a DPT shot in April or early May, but I worried about the novel coronavirus," said Hoang Thi Ngoc, a 29-year-old mother in Hanoi.

Ngoc, knowing the DPT shot is for children from 16-18 months old, is extra worried as her son is already 21 months old.

For those living in remote areas, lack of accessibility to vaccination facilities have been a huge obstacle.

According to the National Institute of Hygiene and Epidemiology, while the national vaccination rate is more than 95 percent, 5-10 percent of districts, mostly in remote areas, have rates of less than 90 percent.

"Approaching vaccination services in remote areas and among minority communities is difficult due to transportation, local lifestyle, customs and awareness, so people need to be encouraged to have their children vaccinated," Dr Hong told local media, adding vaccination in large neighborhoods like at industrial zones is more complicated.

The recent diphtheria outbreak in Dak Nong Province, where the vaccination rate remains low, is an example of challenges of immunization across mountainous, remote and ethnic minority-populated areas.

In contrast, vaccination services are available and accessible to all urbanites, but a mistrust of immunization among some parents, caused by myths and misinformation about adverse effects, has prevented them from approaching these services.

Vietnam is among several countries where parents are delaying vaccination for their children out of doubts regarding the importance and safety of vaccines, an unnamed WHO official was quoted as saying at a meeting in April 2019.

Many adults read news about accidents and deaths related to vaccination and grow wary of having their children exposed.

Patients infected with measles are treated at Saigon's Hospital for Tropical Diseases
on January 14, 2019. Photo by VnExpress/Le Phuong.

The measles outbreak in Hanoi during 2014 coincided with the deaths of more than 10 babies who had been given the Dutch-made Quinvaxem vaccine between November 2012 and May 2013, and several more when it was reintroduced in October 2013.

Though the Ministry of Health had said the drug was not to blame for the deaths, many parents were wary of taking their minors to vaccination centers, as the outbreak eventually killed 133 children.

Some residents are more extreme, ignoring the benefits of vaccination and letting nature take its course.

"I had read on the Internet that vaccinations could cause autism and weaken the immunity system, so I did not let my daughter get vaccinated," Le Thuy Vi, 34, an anti-vaccine mother, recalled what she told the doctor when her 23-month-old daughter was hospitalized due to measles last year.

Before being closed down or disappearing, some groups on Facebook used to spread misinformation about the disadvantages of vaccination. Now, many Vietnamese parents still question the real benefits of vaccine, believing they could cause epilepsy, autism, or death.

Anti-vaccination movements and the desire to "let nature take its course" have taken root globally in recent years, with many countries reporting the return of diseases such as measles and polio, thought to have been eradicated or controlled, partly due to these movements.

Dr Truong Huu Khanh from Children Hospital No.1 in HCMC said the anti-vaccine beliefs among many parents affect national vaccination rates negatively, making disease spread easily to become epidemics.

WHO also named vaccine hesitancy as one of the 10 biggest threats to global health last year.

Meanwhile, amid the recent diphtheria outbreak, a myriad of parents in Dak Nong Province have rushed their minors to vaccination sites, hoping to get the shot as soon as possible. On June 29, three more cases were confirmed in neighbor Kon Tum Province.

Local authorities have warned they could be in a grip of a diphtheria epidemic, as infection could spread from person to person through respiratory droplets or contact with infected lesions.