Measles is back. Reported cases of the disease – which had virtually disappeared for decades – have spiked in Europe and the United States, with 110,000 deaths worldwide in 2017. Deliberately unvaccinated children are the main victims of this epidemic – and the primary cause.
Anti-vaccine activism has been around as long as vaccination itself. But it has surged since 1998, when, in a landmark case of medical “fake news,” Andrew Wakefield and his co-authors published a paper in The Lancet, a leading medical journal, asserting that they had found a link between the measles, mumps and rubella (MMR) vaccine and autism.
A thorough investigation subsequently revealed that the paper was entirely bogus. Unfortunately, by the time The Lancet retracted the paper in 2010, it had breathed new life into the anti-vaccine movement, fueling rising mistrust of the MMR vaccine and declining vaccine uptake.
The backlash was not limited to the MMR vaccine. Unsubstantiated claims about the supposedly malign effects of other vaccines began to circulate on websites, blogs and social networks. For many, those claims carried more weight than scientific evidence, medical experts’ advice, or public-health authorities’ recommendations, which anti-vaccine activists insist are distorted by conflicts of interest, despite strict rules on the subject.
The gaps in vaccine coverage that have resulted are taking a serious toll. Vaccine coverage is now insufficient in the US and many European countries to support so-called herd immunity, which is achieved when a large enough share of the population is vaccinated – over 90% in the case of the measles virus – to disrupt the chain of transmission. Herd immunity protects those who are not yet vaccinated or cannot be immunized for sound medical reasons – say, because they are immuno-compromised.
Vaccination is about more than individual welfare; it is an act of social solidarity
In this sense, vaccination is about more than individual welfare; it is an act of social solidarity. That is why a growing number of governments are devising ways to induce parents to vaccinate their children. Already, several US states and European countries – including, most recently, Italy and France – have enacted laws making several vaccines compulsory and prohibiting unvaccinated children from being enrolled in preschool and childcare centers.
‘No jab, no play’
Australia has taken this a step further. On top of its “no jab, no play” policy of keeping unvaccinated kids out of preschool and childcare, it has implemented a “no jab, no pay” policy of withholding child benefits from parents who do not vaccinate their kids. The policy is strictly enforced; there are no exemptions for families who object to vaccination on philosophical or religious grounds.
The financial incentive has boosted vaccination rates, but only modestly. From December 2015 (after the policy was introduced) to March 2017, the immunization rate for one-year-olds increased by around 1 percentage point.
But with thousands of children remaining unvaccinated, even as their parents have had their government benefits reduced, it seems clear that mandatory vaccination will not be enough to restore and maintain vaccine coverage in the long term. The key lies in education, particularly of young people.
Education programs on the benefits of immunization typically target parents and health professionals. But young people can play a pivotal role in reversing the shift away from vaccination. Discussions about the uptake of the vaccine for human papillomavirus (HPV) – the most prevalent sexually transmitted disease – may provide an important opportunity.
Usually acquired during adolescence or early adulthood, HPV is responsible for most cervical tumors in women and many oropharyngeal tumors in men. But since 2006, there have been safe and efficient HPV vaccines that could avert more than 300,000 cancer deaths each year.
HPV vaccines are currently recommended for administration in pre-adolescent girls and boys. But the global HPV immunization rate is insufficient to ensure herd immunity, because of resistance among parents. That is why education should also target young adolescents, who can thus be empowered to become vaccine advocates.
Young adolescents are well able to understand the importance of the HPV vaccination for themselves, their sexual partners, and their community. In fact, this is the period of a person’s life when beliefs and attitudes toward health issues are formed. They just need accurate information delivered effectively, through educational programs that go beyond school-based teaching methods to take advantage of comics, game-based learning tools, social media and other digital technologies. In order to be credible and efficient, these initiatives must be kept independent from vaccine manufacturers and lobbies.
Giving young people incentives to make informed decisions and discuss the HPV vaccine with their parents could lead to broader acceptance of other life-saving immunizations. Because the effectiveness of immunization programs is a key determinant of health, such a shift would be a public-health coup.
In the fight for climate action or, in the US, gun control, youth movements are already changing mindsets and shaping political agendas. Now is the time to mobilize youth to overcome resistance to vaccination as well, so that we can leave diseases like measles in the past, where they belong.
Michel Goldman, the founder and co-director of the Institute for Interdisciplinary Innovation in Healthcare and professor of immunology at the Université Libre de Bruxelles, served as executive director of the Innovative Medicines Initiative from 2009 to 2014.
Copyright: Project Syndicate, 2019.