Vaccination Concerns Across Europe

In Ireland in 1950 there were 15,000 cases of Measles, 5,000 cases of Pertussis, 5,000 cases of Rubella, 587 cases of Meningococcal Septicaemia, 500 cases of Polio, and 500 cases of Diphtheria.  In 2017, there were 38 cases of Measles, 264 cases of Pertussis, 77 cases of Meningococcal Septicaemia, and no cases of Polio, Rubella, or Diphtheria.  This dramatic reduction in childhood infectious diseases is due to the effectiveness of the vaccination programme.  Vaccines have played a major role in reducing morbidity and mortality among Irish children.  The number of Measles notifications in 2017 was 25 cases.  No other medical intervention could produce such beneficial results. When the Measles vaccine was introduced in Ireland in 1985, the number of measles cases decreased from 10,000 to 201 cases.  On the other side of the world, Australia has almost eliminated Measles with only 6 cases reported since 2014.

However a different picture has emerged across Europe in recent years. The number of Measles cases has quadrupled.  Despite the major societal and individual benefits of vaccination, there are many detractors. Beppe Grillo, a Five Star Movement founder in Italy, recently stated that there is a link between vaccines and autism.  He added that the pharmaceutical industry has pushed them for profit.  The impact of this new confusion and misinformation has had an immediate effect on vaccination rates.  Italian data reveals that the annual number of Measles cases in Italy rose from 843 in 2016 to 5,006 in the last 12 months1.  Italy now has the third highest per capita rate of Measles behind Romania and Greece.  Italian commentators state it is part of the anti-establishment drift.  It is thought that the distrust in vaccines is in part due to the fact that these infections have become so rare as to seem unreal.  Across Europe there have been 41,000 Measles cases in children and adults so far in 2018.  In England and Wales there have been 760 Measles cases.

Some vaccine objectors resent the perceived arrogance of scientists and the presumption that they understand the immune system. Anti- vaccinationists tend to have a mistrust of government and manufacturers.  On a wider level there is an inability to understand the concepts of risk and probability in relation to disease and its prevention by vaccination.  It is not appreciated that one case of Measles can infect 20 unvaccinated individuals.  Foreign travel and migration compound the problem of disease spread.  In 2014, there were 114,900 Measles deaths globally.  Most of the deaths were secondary to measles pneumonia with smaller numbers due to encephalitis.  Measles requires 95% vaccination coverage to reach the elimination goal.  Immunity is a game of numbers, the way to succeed is to vaccinate as many of the population as possible so that the disease disappears.  Making vaccination a prerequisite for school entry has been adopted by some countries but most states prefer a voluntary process.

The since rejected and retracted paper in the Lancet, which wrongly proposed a link between vaccines and autism, continues to have traction to this present day.  The study, which was published in 1998, had a very damaging effect. It generated a worldwide scare about the MMR vaccine.  Over the next 12 years the possible links between MMR and autism were extensively studied.  No link was found. In particular a study involving the vaccination records of half a million Danish children found that the risk of autism was the same in immunized children and non-immunised children. Despite many studies disproving the link, the association with autism continues to be raised even in the present day.  The editor of the Lancet Richard Horton subsequently stated that the contents of the paper were utterly false and that the Journal had been deceived. The paper was retracted by the Lancet in 2010. The mass media were criticized for their role in the controversy, the so-called ‘science by press conference’.  It was felt that journalists provided the paper’s findings with more credibility than it deserved.  When emotional anecdotes are substituted for data, there are serious risks that the public will be misled.

The publication of the study in 1998 led to a significant reduction in the MMR rates in Ireland to 69%.  As a result in the year 2000 in Dublin there were 1,600 cases of Measles, 111 hospital admissions, 7 ICU cases and 3 deaths from Measles pneumonia2.  Paul Offit, who is a co-inventor the rotavirus vaccine, was outspoken at the time of the MMR  controversy.  He strongly advocated that there was no association between vaccines and autism.  He and his colleagues feel that government health officials should have taken a bolder stand in reassuring the public about vaccination.  One of his memorable quotes is that it is very difficult to un-scare people when you scare them.  Furthermore when a disease is no longer remembered as dangerous, alleged adverse effects of the vaccine become the main concern.  Unfounded theories about harm can take hold.  The internet is a major source of anti-vaccination information. The internet is a major source of anti-vaccination information.  More recently the film ‘Vaxxed: from cover up to catastrophe’ reignited the claims between MMR and autism. It has had screenings in Ireland.

The promotion of the positive value of vaccination is of central importance.  Every opportunity must be taken to remind families of the importance of vaccines in keeping children healthy.  The role of GPs is central because they are the doctors who vaccinate all the nation’s children.  The importance of their work should be highlighted and appreciated.  They need every support in the undertaking of this important national task. The practice nurse is central to a high vaccine uptake.  She is in a position to promote vaccination at every GP visit.  She sends reminders to parents if they fail to attend for their child’s vaccination.  She is able to both reassure and encourage parents with concerns about vaccination.   

Highlighting the dangers of communicative diseases is more useful than trying to refute anti-vaccine myths.  Parents’ decision to vaccinate their child is based not only on their worry about safety but also about their perception of benefit.  Highlighting the severity of Measles is more effective than getting involved with vaccination opponents.  Social media is an underutilized tool to reach parents about vaccination.  It is an information source widely used by young parents.

The vaccination rates in Ireland are good, with a 92% MMR uptake.  However there is no room for complacency.  It would be very worrying if the Italian experience was replicated in this country.  Ensuring a high vaccine uptake is a matter for the Government, for society, for families, and for the medical and nursing professions.

JFA Murphy

Editor

References

1. A political party’s shot in the arm. The New York Times. Thursday September 27, 2018
2. McBrien J, Murphy JF, Gill D, O’Donovan C, Cafferky M. Measles outbreak in Dublin 2000. Ped Infect Dis J 2003;22:580

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