Irs not only formal education but also just a kind of culture around medical practice.

In a lot of south east Asian countries there’s a real expectation that doctors have to give you medicine. If you go to the Dr with a cold, instead of being told to go home and get some rest, you’ll leave with a goodies bag with all the things: paracetamol, a branded pen, antacid, vitamins, a coffee mug, antihistamine, bubblegum tooth paste, expectorant, a mask, and yes: antibiotics.

Many patients particularly from rural backgrounds, have always experienced medicine as a blend of actual therapy and showmanship. If you get headaches then the treatment is paracetamol for the pain and cupping to remove the bad spirits.

This means real practitioners providing science based medicine really need to uphold the showmanship. Better to give a kid a vaccine they might not need in order to improve the perceived value of the healthcare they received.

I can also imagine situations where a hospital might receive 10,000 doses of a vaccine from an aid organisation but are expected to provide their own hardware.