Confidence Commentary: Blog archive

To wipe out measles, governments must regain social trust

Heidi Larson | 28 Feb, 2018

Also in TIME Magazine (click on title) :  The Vaccine-Autism Myth Started 20 Years Ago. Here’s Why It Still Endures Today

To wipe out measles, governments must regain social trust

Published in the Financial Times 

Europe’s measles outbreaks have made headlines in recent weeks, with more than 21,000 cases, hundreds of hospitalisations and 35 deaths reported in 2017. The World Health Organization called the numbers “a tragedy we simply cannot accept”.While some of these patients were too young to be vaccinated, or had other health concerns that made vaccination inadvisable, the majority of cases are of people who shunned immunisation. Among those, some cited safety fears and others ideological reasons, or simply their distrust in “the system”.

This week marks 20 years since Andrew Wakefield published his faulty research linking the measles, mumps, and rubella, or MMR, vaccine to autism, sparking a public panic. Most people who still cling to the debunked myth have never read Mr Wakefield’s article, but the dangerous rumours it sparked have nevertheless gone global.  The UK’s immunisation coverage rates have only recently recovered to their pre-autism-scare levels. The rest of the world remains sceptical. Internationally, more people are refusing the vaccine. In south India last year, Facebook and WhatsApp campaigns against the measles vaccine cited the autism connection, prompting a drop in vaccine acceptance. In Malaysia, the ministry of health has worked to overcome public anxiety as vaccine refusal rises.

But the measles outbreaks in Europe cannot be blamed on the autism rumour alone. Reluctance and refusal to vaccinate reflects deeper issues around public trust in government, anger about vaccine mandates and resistance to medical treatments that are perceived as “not natural”. Spurious claims spread quickly via social media.

Last week, Italians marched in Rome to protest against fascism, neo-racism, labour reforms and mandatory vaccines. In the Philippines, the measles vaccine suffered collateral damage from public distrust around the dengue fever vaccine Dengvaxia. After its manufacturer, Sanofi Pasteur, reported findings that Dengvaxia provides valuable protection for some, but higher risks for others, fears spiralled into a general distrust of the country’s immunisation programme. Some parents refused measles vaccinations for their children and outbreaks of the disease increased.

In Brazil in 2016, when links between the Zika virus and microcephaly were being investigated, rumours began to swirl that the MMR vaccine was the cause of the birth defect, reflecting entrenched distrust in the state. Governments are at the heart of every element of vaccination policy, from regulation of safety controls to approving immunisation schedules. So gaining public trust will not only be key to the sustainability of routine immunisation programmes, but especially critical in the face of epidemic threats.

This year marks the 100th anniversary of the 1918 Spanish flu pandemic that infected 500m people, causing debilitating illness and killing between 40m and 50m. The threat is still present: the World Bank estimates that, in addition to millions of deaths, devastating illness and social disruption, the annual global cost of moderately severe to severe pandemics is roughly $570bn, or 0.7 per cent of global income. In 2009, during the swine flu pandemic of the H1N1 influenza virus, poor public co-operation and low acceptance of the vaccine was a wake-up call. The public might fall for faulty science, but the more worrying trend in 2009 was the lack of civic responsibility and co-operation.

Governments should see in this an urgent need for a new social contract. The long cherished dream of eliminating measles is not an impossible task. Every country that achieved the goal would also demonstrate the strength of its citizens’ trust — a measure of its ability to manage future threats. 




From the Center for Vaccine Ethics & Policy
Vaccines and Global Health: The Week in Review

Literature Literature archive

Y Ophir K Hall Jamieson 2018 Journal of Public Health,
Nie J, Tucker JD, Zhu W, Cheng Y, Wong B, Kleinman A. 2018 Developing World Bioethics 18(1 ):1471-8847
L Garret 2018 The Lancet Vol 391: 827-828

Videos Video archive

Key figures share their perspectives on a controversy that led to the suspension of Ebola vaccine clinical trials in Ghana.

Drs. Heidi Larson and Pauline Paterson of the Vaccine Confidence Project join episode 50 of the Public Health United podcast with Nina Martin, November 2017.

Drs. Larson and Paterson join a discussion on vaccine confidence at Hong Kong University.  September, 2015.

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