How can a society like Sri Lanka’s that readily accepts immunisation still believe in conspiracy theories about infertility pills

On 9 July 2019, the World Health Organization (WHO) announced that Sri Lanka has eliminated measles, interrupting transmission of the indigenous virus that causes the killer childhood disease. “Sri Lanka’s achievement comes at a time when globally measles cases are increasing.

The country’s success demonstrates its commitment, and the determination of its health workforce and parents to protect children against measles,” said Dr Poonam Khetrapal Singh, WHO’s Regional Director for South and East Asia. The WHO noted that the country reported its last case of measles caused by an indigenous virus in May 2016. Sporadic cases reported in the previous three years have all been importations that were quickly detected, investigated and rapidly responded to. This public health accomplishment is thanks to efforts of the entire public health service – from medical and para-medical staff to family health workers (midwives) and public health inspectors. Earlier, the WHO certified Sri Lanka as having eliminated lymphatic filariasis in May 2016 and malaria in September 2016. Sri Lanka has also been free of polio since 1993.

Challenged by the still considerable burden of infectious diseases and the rising number of non-infectious diseases, our state health sector is continuously fighting on multiple fronts. Its successes don’t get enough recognition; instead, citizens and the media regularly highlight its various shortcomings (which need fixing).

Where measles and polio are concerned, Sri Lanka beat these formidable diseases through countrywide and persistent vaccination. Indeed, the country’s childhood immunisation programme has been praised by the WHO on many occasions.

“Vaccination coverage in the country has been consistently high – over 95% with both the first and second dose of measles and rubella vaccine provided to children under the routine immunization programme,” the WHO noted in a recent media release. The history of immunisation in Sri Lanka goes back to 1886 when the British administration introduced a Vaccination Ordinance, making it mandatory for everyone to be vaccinated against smallpox.

After independence, successive governments have sanctioned public funds to sustain and expand immunisation coverage: BCG vaccine against tuberculosis in 1949, the ‘triple’ vaccine against diphtheria, whooping cough and tetanus from 1961, and oral polio vaccine in 1963 were early milestones. In 1978, the Expanded Programme on Immunisation (EPI) streamlined these efforts, helping the island nation to achieve high levels of vaccine coverage and disease control. Recent additions include vaccines against measles (1984), rubella (1996) and Hepatitis B (2003).


EPI has been in operation for over 40 years, supported by successive governments, and achieved close to 100% coverage for most infectious diseases. It is almost entirely self-funded by the government through the consolidated fund as part of the budgetary allocation for the health sector (vaccines are given free of charge by all government hospitals).

Sri Lanka’s national immunisation programme is often cited as one of the finest not only in Asia but also in the world. Just as remarkable is the fact that there has been widespread public acceptance of immunisation at all levels of Lankan society. Thanks to effective public education and awareness activities rolled out for decades, there has been little public scepticism or resistance to vaccines.

This contrasts with the situation in some developed countries, including Britain, Japan and the United States, where anti-vaccine sentiments have gained ground in recent years. This has led to reversals in public health gains. In the US, for example, measles was deemed to have been “eliminated” in 2000 because of vaccination success. Since then, it has re-emerged, mostly due to some communities resisting vaccination.

There are many reasons why some people choose not to vaccinate even when services are available for free. An expert group of the WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence as key reasons underlying what the global agency diplomatically calls ‘vaccine hesitancy’. In the US, all 50 states make specific vaccines mandatory – but most states also allow exemptions for religious beliefs. Eighteen states allow ‘philosophical exemptions’ that offer a wide range of reasons to opt-out. Anti-vaccine activists, or anti-vaxxers, have exploited these.

The cost of such action is rising. “Vaccine hesitancy…threatens to reverse progress made in tackling vaccine-preventable diseases. Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved,” the WHO said at the beginning of 2019. Notably, the WHO’s list of top 10 global health threats for 2019 includes vaccine hesitancy alongside better known public health hazards like the pandemic flu, Ebola, antimicrobial resistance, dengue and HIV. Each year, vaccines prevent 2 to 3 million avoidable deaths globally. However, vaccine hesitancy threatens to reverse the progress made against infectious diseases, the WHO cautioned.

Anti-vaccine sentiments were also discussed at the 11th World Conference of Science Journalists (WCSJ 2019) held in Lausanne, Switzerland, from 1 to 5 July 2019. I attended this event along with 1,100 other participants from around the world. During a session on ‘Fake News in Science: How to recognise and fight it,’ we heard how the spread of disinformation related to health can literally make societies sick.

Disinformation is a centuries- old game, but the web and social media have made it much easier to manipulate public opinion.While most disinformation is peddled for political reasons, other agendas are at work too – such as climate denialism, doubting if the Apollo moon landings really took place and vaccine resistance.

Japanese medical doctor turned health journalist Dr Riko Muranaka shared her experience of being caught in the intense debate between vaccine promoters (which includes most public health professionals) and a small but vocal group of vaccine opponents in her country. In Japan’s case, sensationalist media have been responsible for amplifying anti-vaxxers’ case. TV stations and other media had been carrying reports of recently immunised children experiencing pain, walking problems, seizures and other neurological issues. Some parents posted videos of children on social media, blaming vaccines for these symptoms. A risk-averse society went into panic mode.

For speaking out on behalf of vaccines and their public health benefits, Dr Muranaka has been accused of being in the pay of vaccine-producing companies. She was also sued for libel by a researcher whose anti-vaccine claims she refuted in an article. Having lost her defense, she has appealed – and is collecting public funds to pay for legal costs.


It is indeed a relief that anti-vaccine sentiments have not gained ground in Sri Lanka, and let’s hope it stays that way. What puzzles me, however, is how vaccines are trusted in a country where other products of modern science are suspected, feared or even demonised. We take justified pride in our high adult literacy rates, yet our scientific literacy levels are very low. That is why it is so easy for far-fetched conspiracy theories to spread rapidly even among educated persons.

For example, claims of an ‘infertility plot’ to make a majority ethnic group lose its ability to reproduce have been in circulation for years. In February 2018, these fears led to some customers attacking an eatery in Ampara on suspicion of adding ‘infertility pills’ to the food it served. That sparked off several days of anti-Muslim violence first in the East and then in the Central Province. The country’s top medical specialists unequivocally declared that no such pill or substance has yet been developed, but the myth persists.

Plenty more irrational and bizarre beliefs prompt otherwise sensible people to spend large sums of money on unproven black magic. Tales of miracle waters and ‘cosmic forces’ healing those terminally ill are reported in local newspapers without scepticism.

It is customary to temporarily suspend our disbelief to enjoy films, novels and other creative art forms. But most of us don’t confuse their fiction with fact, even with highly plausible scenarios.

Yet when it comes to real life, as opposed to art, has ‘suspended disbelief ’ become a permanent, default setting for many Lankans? Is our society more gullible and paranoid now than it was a generation or two ago? If so, who or what is responsible for this decline?

As Dr Neil deGrasse Tyson, American astrophysicist, cosmologist and science communicator, summed up our challenge succinctly: “Scientific literacy is an intellectual vaccine against the claims of charlatans who would exploit ignorance.” We need a massive effort in such intellectual vaccination!