All things no matter its material basis have ideas, practices and beliefs surrounding it,

legitimized culturally and socially (Kleinman). These ideas, beliefs, and practices around
something are influenced by the world we live in, and also changes as the world around us
changes (Kleinman). This is the case with vaccines. No matter what a vaccine is materially; a
weakened or killed form of a microbe intended to provide immunity, how it is understood is
shaped largely by culture, which we use as a resource to understand the world around us
(Wardlow). Thus, the social construction of reality around vaccines and how it is perceived by an
individual, ultimately affects ones decision to vaccinate or not (if they have a choice). As
follows, when trying to increase the amount of vaccination rates in an area, addressing the
underlying determinants around vaccine refusals is of paramount importance in global health
interventions, just as much as supplying the actual vaccine.
Ukraine, a country that was once a part of the former Soviet Union, has had the lowest
vaccination rates in Europe for several years. In the BBC broadcast titled, Why does Ukraine
have Europes lowest vaccination rate?, David Stern narrates that this is due to a myriad of
reasons including; the death of a 16 year old boy after a measles injection, beliefs that the
vaccine is of poor quality, several doctors encouraging not to vaccinate due to perceived risks,
and a shortage of the vaccine itself. Stern reports that only 70-75% of the population is
immunized from Polio, whereas 80-85% coverage is needed to stop the spread of the disease;
leaving the country vulnerable to an outbreak at any time. An update on the current situation is
given in another article from Newsweek, titled Millions of Ukrainian Children at Risk from
New Epidemics. In this report, Maxim Tucker writes that the aforementioned low vaccination
coverage and risk to Polio-like outbreaks, is now further exacerbated by the ongoing war. This
conflict in Ukraine; has resulted in poor living conditions, a collapsing health care system,
restriction of access to civilians in the midst of the conflict zone, and shortages of vaccines;
leading to conditions for an imminent outbreak. As of present, efforts are being made to supply
vaccines, to support the health care system, and to supply other medical equipment, yet there has
been no mention of efforts being made to address the misconceptions around vaccinating.
BBC video attributes beliefs of certain doctors and the public to thinking vaccines are harmful
and risky rather beneficial, due to ONE reason; the death of Anton who the media wrongly
blamed vaccines as the cause of death. The media fails to mention the other myriad of reasons,
and culture and health related behaviours are not caused by a single reason but many underlying
determinants. Health officials say this is due to internet disinformation about risks and harms,
and a doctor who is pro vaccination say vaccines are good quality, implying this is what
Ukranians need to hear to improve vaccination rates. It is implied vaccination refusals can be
solved by just communicating the risks and benefits more effectively rather than addressing
underlying determinants like political economy, and government corruption, which the video
briefly hints to with the distribution system and shortages. To increase vaccination rates just
communicating the risks and benefits will not change opinion, but need to address the underlying

determinants people use to understand the world around them, reference Wardlow. Also reference
Maria about underlying issues.
In the BBC video about Ukraines low vaccination rates (have epidemiological number), it is
observed that parents concerned about their childrens health, choose not to vaccinate because
they believe the vaccinations available to them are of poor quality, and can harm or kill her
children (Stern, BBC).

is mentioned that even the pediatrician, also decided not to vaccinate her children, because she
believes that the risk of the vaccine is far greater than the complications from the disease. Stern
explains that this started after the death of a 16 year old boy, after people wrongly accused
vaccines as the cause of the death, and vaccination numbers plunged drastically. After this many
doctors convinced patients not to vaccinate their children. Health officials say the fears are
baseless driven partly by internet disinformation. Another doctor is shown saying that the
vaccines in Ukraine is high quality. The video does mention that for people who want to
vaccinate, vaccines are hard to come by, but the government does not have enough money to buy
vaccines, and the distribution system is plagued with problems. Doritz says that Polio is the first
disease that when it arrives parents will say What did I do? I thought the disease did not exist.
Health officials say if immunization rates do not increase it is not a question of if but when.
The BBC video attributes that the death of the 16 year old boy, and people wrongly blaming
vaccines as the cause, is what caused vaccination rates to plunge. This is inaccurate for the video
tp
Health-related behaviours are often influenced by a myriad of factors. In the BBC broadcast
Stern narrates that Ukraine has the lowest immunization rates in Europe and the former Soviet
Union, the problem started when people wrongly blamed a measles injection for the death of a
16-year old boy. After this vaccination numbers dropped, to just half the child population, and
many doctors advised parents to not vaccinate their children. The newscast only attributes one
reason as to why vaccination rates are low, and does not explore the other lurking factors as to
why this occurs. Health related behaviours are often influenced by a myriad of factors and not
just one D. The broadcast also failed to explore why parents would believe vaccines are harmful
enough, to be considered the cause of death. Stern also narrates that parents believe that vaccines
are poor quality and fails to explore why that is, and also says that doctors also believe that
vaccines are risky and harmful, and encourage patients to not vaccinate their children. The video
also fails to explore why doctors and parents believe vaccines are poor quality, and fails to
explore the reasons why. He also attributes the boy dyeing as the reason for why parents and
doctors started to not vaccinate. When it is clear that these two populations are stratified by their
jobs, and probably have different reasons as to why they believe so.

Both news sources talk about a fear of an epidemic; however it is not specified if the fear
is an international one or one that is also shared by the public. Is this more of an international
fear of the epidemic or public fear? Fear, although not the best motivator would increase
vaccination rates if people knew the consequences of the disease. There is more fear of the risks,
then the actual disease itself, thus people choose not to vaccinate.