Interview with IVI scientist: Dr. Alfred Pach
‘Our ultimate concern is people'

Dr. Alfred Pach, a medical research anthropologist, was one of the first researchers to join the Diseases of the Most Impoverished (DOMI) program, a Bill & Melinda Gates Foundation-funded research program launched in 2000 to accelerate development and introduction of new vaccines against cholera, shigellosis and typhoid fever. For DOMI, Dr. Pach has been conducting research on the attitudes, beliefs and practices of populations in Asian countries regarding these diseases, and on their potential interest in demand for vaccines against these diseases. Before working for the IVI, Dr. Pach  was with the National Opinion Research Center at the University of Chicago, and has consulted with the National Institute on Drug Abuse, Family Health International, Save the Children/US and UNAIDS.—Ed.


Q: Would you explain your work as a medical anthropologist at the IVI and relations to IVI’s vaccine research?

A:  I am a cultural anthropologist with a degree in public health. From this perspective, our interests are to examine broadly-conceived, socio-cultural aspects of health, illness, healing and prevention. We try to understand the influence of individual beliefs and practices, as well as health systems and political-economic conditions, on perceptions of diseases and especially on the use of vaccines. Some of the questions we ask are:

  • How do people perceive their risk for various diseases? 
  • How severe do they think they are? 
  • How much demand is there for a vaccine against a particular disease?
  • Do they have any fears of adverse effects of vaccines, and, if so, what kinds of concerns?
  • why do people participate or not participate in the DOMI vaccination projects?

Responses to these questions vary substantially across communities and countries, since different cultures have different practices and histories of traditional and allopathic medicine.

Vaccines are the cheapest and most effective way to prevent diseases, yet if people do not want a vaccine, for whatever reason, it won’t benefit those in need. We can provide good medical explanations of why people need to get vaccinated, but they still might not accept a vaccine for any number of reasons. This is a crucial issue to consider for policy makers who are considering whether or not to introduce a vaccine, which is a major focus of DOMI.


Q: In your studies, what are the common perceptions about vaccines?

A: As I mentioned, most people appreciate the benefits of a specific vaccine and want to prevent a dreaded disease. On occasion less positive responses may involve uncertainty and misperceptions about the effects of a vaccine. As in every community, some individuals for any number of reasons start rumors about the vaccine, and then people begin to question the vaccine. Also, people have histories of vaccine programs from the past in which they might not have had good experiences. Lingering uncertainties from programs may carry through to affect participation in other programs. However, there are generally positive sentiments about vaccines from experiences with the Expanded Program on Immunization and due to DOMI’s community involvement in their media campaigns, recruitment and follow-up.

Q: News reports have said that in some developing countries, people refused to have their children vaccinated because they believe the vaccine would damage their health.

A: Yes. We have seen some of these fears expressed in some communities. You know a vaccine program involves not only an intensive preventive intervention, but also occurs in relation to a community’s body politic through various community representatives, and so it may inadvertently intersect with tensions already in a community. It is our job to identify those issues and suggest means to deal with them. 

In another case, cholera is seen in many countries as a disease of the poor or the ‘underclass’ and, therefore, those not identifying with these groups may resist participation in a vaccination campaign. 

Q: Are there many socio-behavorial studies regarding vaccines?


A: Not really. The IVI is somewhat unique in the world in supporting this level of socio-behavioral research. There have been a few studies on recipient attitudes and participation in the Expanded Program on Immunization, on problems with particular vaccines (i.e. MMR) and there have been studies regarding a future AIDS vaccine, but they have not been as extensive as the work we are doing in DOMI. So this area has great potential to grow. Appreciating the importance of social research in vaccine development and introduction is pivotal because vaccines are not only about the science of vaccinology, but about the people who use them.

So we are looking to the vaccine recipients to tell us what is meaningful to them about these diseases and vaccines. Hopefully this will lead to a more informed two-way communication. We have to understand the thoughts and experiences of those who use and need vaccines, so that programs can serve them more effectively. Clearly since there is not much of this kind of research going on in the world, there needs to be more of it and hopefully a better understanding of vaccine use at all levels. That is one of our goals.