Immunization, medicine’s most powerful tool against completely preventable life-threatening diseases, is facing its biggest challenge to date: people just don’t seem to want it.

Vaccines are fairly straightforward: A simple pinprick, a couple of minutes of soreness and, just like that, a catalog of terrifying diseases are eliminated from attacking your body. There are, of course, adverse exceptions — but they are extremely rare, making immunization mostly efficient and healthy. This was, until the two Wakefield studies, of 1998 and 2002, which linked MMR (measles, mumps, and rubella) vaccines to autism. While both studies were critically examined and disproven multiple times, the studies still command a notable, misguided fan-following called the Anti Vaccination Movement — with high profile fans including Alicia Silverstone, Kat Von D and, more recently, Jessica Biel.

In India, the movement has begun making inroads, spreading via the fastest route of misinformation: WhatsApp.

“My mother told me at one point that she wishes she hadn’t vaccinated us because of a garbage anti-vax video circulating on WhatsApp,” said R., a Mumbai resident. She added, “My mother received it last year. It linked vaccines to autism and Western propaganda, which made no sense to me. She also thought Bill Gates was just making money off HPV vaccines and that it was all a hoax.” While R., an adult, was immunized before anti-vax propaganda surfaced in India, children with new and fearful parents haven’t been so lucky.

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As a result, dozens of schools in Mumbai, under pressure from mistakenly concerned parents, have refused to carry out vaccinations due to misinformation spread on the messaging platform. Thousands of children were not vaccinated due to this, according to officials at the United Nations Children’s Fund — resulting in recent measles outbreaks in the city. Though WhatsApp has made technical tweaks and tried educational campaigns to curtail the fake news epidemic on its app, the inaccuracy parade continues.

The reasons for choosing not to vaccinate range widely in India, from the more upwardly mobile class putting their trust in WhatsApp shares, to the underprivileged classes refusing vaccines because they simply do not understand or care for something they’ve survived without. However, a possible sentiment these groups could all have in common is a lack of trust in their health care provider. Often, young mothers also fear vaccinations because of complications from incorrect injection deliveries, which could cause internal damage to a bone or a nerve.

In her essay, “Why Women Lead The Anti-Vax Movement,” Jessica Valenti writes, “The reason that the anti-vaccination movement is overwhelmingly female is not just the result of mothers being the most likely to make medical decisions — it’s also because of their understandable distrust of the medical establishment… There’s also ample anecdotal evidence that doctors can be condescending to women (and men, too). So it’s no surprise that many women don’t always think the medical establishment has their best interest at heart.” While written with a gendered lens, this is also applicable to men and women from underprivileged, rural communities in India, who are routinely not taken seriously by their doctors.

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“Rural women often need to be patiently talked into vaccinations,” said Dr. Ila Pandit, an emergency medicine officer. “However, this approach doesn’t work in urban contexts because city folk often overcompensate with WebMD for their lack of knowledge. City folks feel patronized, even though they’re just as clueless [as people from rural areas]. They need just straight-up investment of time. If you spend your time trying to convince them, they’re more likely to believe that even you buy what you’re selling. They need room to ask silly questions and have them seriously answered. It’s too time and labor intensive to be effective, with the quality of the interaction factoring in more than the validity of the information.

“And most Indian doctors just don’t entertain questions about Western anti-vax fears, no matter how sincere. [Because vaccination is] one of the gospel truths of medicine, like antibiotics or anesthesia,” she added.

Time, the only resource needed to provide better care to confused, afraid parents who might succumb to anti-vax propaganda, is precious for Indian doctors, as they continue to remain overworked, overburdened and understaffed. Dr. Pandit proposes an alternate solution, “I actually think there should be dedicated doctors or health care professionals in every department of a hospital just to explain things. Like, just live narrators. They exist in some small, private, specialized hospitals in India, and I’ve heard from a nurse who worked at one of those [that] the workflow, quality of patient care, the likelihood of complications, total healing time — everything was better.”

While the modern anti-vaccination movement remains a fringe section of society, its spread — especially via its famous proponents and social media misinformation — is having global repercussions. While the pro-vaccine side has now taken to caustic humor to make light of the eventual negative consequences of no immunization, patience and empathy remain the only way health care providers can crack stubborn, potent anti-vax propaganda.

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