A dangerous re-emergence of measles in Europe has shocked EU health minsters into tackling the public’s lack of trust in childhood immunisation
with the launch of campaigns against vaccine-scepticism.Instead of celebrating the eradication of measles in 2010 as the EU had planned, the reverse has happened and Europe is now witness to a series of epidemics in the disease, largely a result of often middle-class parents’ growing fear of the real or imagined side-effects of vaccinisation.
In April, the World Health Organisation warned that measles cases in Europe have exploded as a result of insufficient numbers of children having received vaccination, with 6,500 reported in 33 EU and non-EU countries from January to March.
EU states are now home to the highest burden of measles in the developed world and the bloc is the largest exporter of measles to the United States. Between January and April, 275 cases were reported in Britain, against a total of 374 cases for the whole of 2010, according to the European Centre for Disease Prevention and Control [ECDC]. Many of the incidents were travellers to France, other parts of Europe and India.
The worst affected in the EU has been France, which saw 4,937 cases over the first three months of the year, up from 5,000 for all last year. Belgium also saw a jump from 40 cases for 2010 to 155 in the first three months of 2011. Then in May, the ECDC said it had recorded 10,000 cases of measles in 18 countries in the EU alone since January, including four deaths. The WHO blames the soaring number of cases on under-vaccination of children, particularly of those who are now between 10 and 19 years old.
In response, on Monday (6 June), EU health ministers backed plans for monitoring by Brussels of the growing health risk of vaccine-scepticism and to produce a communications strategy to battle the phenomenon and convince the public of the benefits of immunisation.
“It is important to have a discussion on how to contribute to finding a solution to the effect that there are still lot of measles cases in the EU and that it is on the increase,” Hungarian national resources minister Miklos Rethelyi, who chaired the meeting, told reporters. The head of the ECDC, Mark Sprenger, briefed the ministers on the scale of the problem. “The window of opportunity to act is rapidly closing,” he warned the ministers, calling for “an extraordinary effort” to overcome the problem.
“Vaccinations are now the victims of their own success. Today many people are more worried about assumed adverse side effects than the disease itself,” he continued. “Unaware of the risks related to the disease, many parents decide not to vaccinate their children against diseases like measles and rubella.”
Due the growth of the number of unvaccinated children over the past few years in Europe, the herd immunity – whereby chains of infection are more able to be disrupted when large numbers of a population are immune to a disease – of the general population has been lost. As a result, those too young to be vaccinated are at significantly greater risk of being infected.
According to the Vaccine Preventable Diseases program at the WHO’s European Region, some 30 percent of the French cases involved babies too young to receive vaccine. In order to reach an elimination level for the disease, at least 95 percent of the population must be immunised with two doses of the Mumps/Measles/Rubella (MMR) vaccine. However, only 17 EU Member States have reached the 95 percent coverage rate for one dose of MMR. Coverage for two doses of MMR is, according the the ECDC chief, sub-optimal in nearly all EU countries.
He said that countries will need to run specific catch-up campaigns in order to protect all the children and young adults who missed the opportunity to be vaccinated. “It is [about] getting back people’s trust in vaccination … The science-base behind these measures is clear, simple and indisputable.”
Social media a problem
“Nowadays, people don’t see the disease. It’s as if it just disappeared. So they are not familiar with how severe it can be. Twenty percent have severe consequences, many will be hospitalised and some will die,” he said. “At the same time, they hear scare stories about side effects. We need to be much more reactive to these sorts of stories in the media,”
In an odd historical twist, those in developing countries, ironically often with lower levels of education, are more familiar with the everyday nature of such diseases, he said and so are much less sceptical about getting vaccinations.
He was also quite critical of the way such information spreads rapidly via social media such as Facebook or Twitter. “I don’t want to blame social media, but we have to be aware that this is a factor and so we need to be employing social media as well, with objective information to counteract this.”
An EU official said: “The 27 [EU] ministers also wanted to send out a decisive public message, that all member states stand behind the effectiveness of vaccines because there are some middle class people who are not big fans of vaccines and this is one of the best weapons we have in fighting disease.”
Europe last year was also embarrassed by a failure to meet its goal of eliminating measles and rubella by 2010, “because of lower-than-required vaccination coverage prevailing at sub-national levels,” according to a ministers’ statement following the meeting. While much of health policy remains the province of national authorities rather than the EU, the cross-border nature of the problem has convinced health ministers that a European approach is needed and the commission is now to co-ordinate the promotion of childhood vaccination.
Specifically, the EU will develop a public relations toolbox on how to reach out to different populations “aimed at engaging with persons who are sceptical about the benefits of vaccination providing clear, factual information about the advantages of vaccination.” The communications strategy will involve “evidence-based links between vaccination and diseases.” The EU executive is also to monitor levels of public support for vaccination programmes and, working with the ECDC and the European Medicines Agency, establish how vaccination and the real levels of protection in the community can be tracked.
EU states for their part are to map the reach of vaccination services and boost their national or local strategies in response to this assessment. National capitals are not just focussed on lay members of the public however; states are to target health professionals too, in order to improve their support for immunisation programmes. Laboratory capacity will also be expanded in diagnostics and surveillance of diseases that should have been prevented by vaccines.