By The European Academy of Paediatrics (EAP)
Today we want to talk to you about why, in the Europe of the twenty first century, children are needlessly suffering, and sometimes even dying, of easily preventable diseases like measles.
What’s the problem?
Vaccination rates are falling and that means decreasing immunisation coverage is undermining progress towards eliminating some infectious diseases, and is leading to an increase in vaccine-preventable disease. For instance, measles has caused 49 deaths in the EU (from both adults and children) between 2016 and the beginning of 2017. Furthermore, 14,732 measles cases were reported in the EU/EEA area between February 2017 and January 2018 – which represents a 68,45% increase from the values registered between February and December 2016 (4,648 cases) – with Romania, Italy, Greece and Germany leading the list. We need to explore the reasons behind ‘vaccine hesitancy’, and to address them.
Vaccine hesitant parents are parents who refuse or delay vaccines. We know that the number of ‘vaccine refusers,’ (who are absolutely non-responsive to any pro-vaccine arguments or actions), has remained constantly small, but the group of vaccine-hesitant individuals is extensive and still growing. It is the latter group that may be open to solid, consistent, and evidence-based vaccine promotion.
How did it happen?
Knowledge gaps, misconceptions and vaccine-related myths have threatened confidence in vaccines. Misconceptions spread quickly via the internet, propagated by sensationalist websites that fail to reference the sources behind their claims. The internet is a primary source of health information for many people, and about 42% of parents consult the internet for vaccine information. It is increasingly difficult for both parents and doctors to filter data obtained on the internet. but also by a young generation that is able to efficiently use social media to get their messages across. Thus, websites opposing vaccines and presenting anecdotal reports as scientific data often appear professional.
Mainstream media have also had a role in spreading vaccine misinformation. In 2015, a documentary shown on one of Denmark’s national television stations described three previously healthy girls suffering from nausea, headache and abdominal pain after vaccination against the Human Papilloma Virus (HPV). HPV immunisation rates in Denmark subsequently fell from over 90% to below 50%. Meanwhile, large studies have shown no evidence of a causal relation between the HPV vaccine and the symptoms described in the documentary. Unfortunately, the effects of misinformation linger on despite these studies.
The most infamous case of widespread vaccine misinformation dates from 1998, when Andrew Wakefield published data linking the MMR vaccine to autism and inflammatory bowel disease. The General Medical Council later ruled his study fraudulent, unethical, and containing falsified data, and Wakefield was struck off the medical register. Numerous large studies and meta-analyses have disproven his claims, but even today, doctors regularly find themselves dealing with the uncertainty and mistrust that his fraudulent research has spread.
What can be done about it?
Various public health authorities like the European Centre for Disease Control (ECDC) have taken a responsibility to address these myths, and right the wrongs that false research has caused. One of the most impactful efforts towards vaccine confidence has been the recent European Immunisation Week (EIW) 2018, celebrated between 23 and 29 April. During EIW, health professionals and organisations sought to deconstruct vaccination myths using solid, evidence-based data, using all the communication tools at their disposal, including social media
Mainstream media should understand their responsibility to provide the public with correct and solid evidence, and be aware of the potential public health disasters (including increased child mortality) that misinformation can lead to. Furthermore, health ministries should respond immediately to falsehoods spread via the media and warn the public about unfounded media reports, with the aim of limiting the damage caused. The Vaccine Confidence Project was founded to monitor public confidence in immunisation programmes, providing an information surveillance system for early detection of public concerns regarding vaccines; as well as tools for early response.
A declining supposed risk for acquiring vaccine-preventable disease, and a lack of recognition for the potential morbidity and mortality of these illnesses, also undermine immunisation programs. Ironically, these misconceptions are probably a result of the success of immunisation programmes to control diseases, and of the reduced exposure to complications experienced by families. In contrast, parents focus on adverse effects of vaccinations that are much more apparent and distressing to them. The challenge here is to convince parents to protect their children from relatively uncommon diseases, while addressing their fears about side effects of immunisation.
What is EAP doing about it?
EAP is trying to better understand and document the drivers for public distrust in vaccines, and researching ways of restoring vaccine confidence. As such, EAPRASnet, the practice-based research network within the EAP, is currently undertaking an EU-wide Vaccine Confidence Survey on parental behaviour towards immunisation of their children, in collaboration with the London School of Hygiene and Tropical Medicine.
As EAP, we recommend that proper teaching of vaccinations and vaccine-preventable diseases is included in the curricula of undergraduate medical and healthcare-related studies, as well as more training courses for health care professionals.
We also stress the importance of educating children and adolescents, starting in early childhood. Finally, we urge mainstream media networks and companies to take it upon themselves to publish vaccine-related information with the utmost responsibility. Failing this, we believe health authorities must ensure early detection of public concerns regarding vaccines, and address them accordingly to restore sustained vaccine confidence.
The EAP is ready willing and able to work with governments and media and share the extensive evidence demonstrating the effectives and safety of vaccines; and we hope that all of you reading this will support us in our important work to stop this needless suffering of Europe’s children.
Disclaimer: The views expressed on the text above belong solely to the guest author.