Confidence Commentary: Blog archive

Message for the New Year: The answer is blowin’ in the wind

Heidi Larson | 4 Jan, 2017

Looking back at 2016 and thinking about the new year, one of the news items that struck me as having a poignant message for 2017 was from Nigeria.

 Last August, two cases of polio were confirmed in Borno State. Nigeria had not seen a new case of polio in two years, and the country – along with the entire African continent – was on the verge of being declared polio-free.  What happened?

The polio cases occurred in Borno state – stronghold of militant Islamist group Boko Haram – difficult and dangerous to access, both for vaccinating as well as monitoring. The cases were found after an area of the state had been “newly liberated” from Boko Haram allowing increased freedom of people – and viruses – to travel.  After analysis, the strain was found to have been circulating for a while; the cases were not imported from another area, but were indigenous cases – putting Nigeria back on the list of endemic countries alongside Afghanistan and Pakistan, where polio similarly persists in high-risk, conflict-ridden areas.  

The news prompted me to think back to my days working with UNICEF and other partners in the Polio Eradication initiative 15 years ago, trying to address pockets of vaccine refusals in marginalized populations in India as well as working on strategies to resolve the polio boycott in Nigeria’s Kano State, which took eleven months.  They were challenging times, but in reflection, we – and, more importantly the front-line vaccinators – were lucky to not have to navigate the life-threatening security issues that are the Achilles heel of the polio eradication effort today.  Had we known what was ahead, would the polio eradication effort worked harder and faster? 

If we look around at the public health landscape at the start of 2017, there are a number of challenges ahead, not the least of which is growing anti-microbial resistance, which is becoming increasingly urgent. Another area, which is keeping a number of people awake at night and which I would consider the number one concern of the Vaccine Confidence Project, is the threat of a highly fatal flu pandemic.

In a 2016 year-end interview on BBC Radio with the UK’s Chief Medical Officer Sally Davies, Bill Gates revealed his concerns about the vulnerability of the world to the next flu pandemic. In short, his assessment was that we’re not ready for the next “big one” when it comes to epidemics. “I cross my fingers that some epidemic like a flu doesn’t come along in the next 10 years,” says Mr Gates, confident that we will develop better tools and approaches over the next decade, but soberly expressing concerns that if we are faced with a quickly spreading fatal strain of the flu today, “it would be a tragedy.”  In short, we couldn’t manage it. 

At the end of November, in an interview in the Wall Street Journal, the Director of the US Centers for Disease Control, Tom Frieden, shared a similar sentiment. “Frankly, pandemic influenza is what worries us most.”

According to WHO, the “normal” seasonal flu epidemics cause serious illness in three to five million people around the world and between 250,00-500,000 people die of influenza every year. And, those are not the most virulent strains. 

If we reflect on the global panic around Ebola’s fatal spread, the total death toll was just over 11,000. This is not to underestimate the extensive social and economic turmoil it also caused, but just to put the flu risk in perspective. The 1918 ‘Spanish’ flu pandemic infected 500 million people across the world, spread as far as remote Pacific islands and the Arctic, and resulted in the deaths of 50 to 100 million people (three to five percent of the world’s population).

Why is there such a difference between our more complacent attitude towards influenza versus more panic-prone anxieties around Ebola? Known versus unknown. Familiar versus unfamiliar.  One of the challenges for pandemic flu preparedness  is the widespread perception that “it’s just the flu”.

If I were to choose one new year’s message, it is that we need to work harder in peaceful times to build resilience. We can start by taking flu more seriously – ourselves, our families and neighbours.

On that note, I’ll end with an applaud to the 2016 Nobel Prize winner for literature, Bob Dylan, who has the most apt message for the new year in his well-known song “Blowin’ in the Wind”.

 I’ll share a few lines and wish everyone a more peaceful New Year.

Yes, and how many times can a man turn his head
And pretend that he just doesn’t see?…

Yes, and how many times must a man look up
Before he can see the sky?
Yes, and how many ears must one man have
Before he can hear people cry?
Yes, and how many deaths will it take ’till he knows
That too many people have died?

The answer, my friend, is blowin’ in the wind
The answer is blowin’ in the wind



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

Literature Literature archive

N L Bragazzi, I Barberis, R Rosselli, et al. 2017 Human Vaccines & Immunotherapeutics Vol. 13 (2)
A Bechini, P Bonanni, S Lauri, et al 2017 Human Vaccines & Immunotherapeutics Vol. 13 (2)
G. Gabutti, G. Conforti, A.Tomasi, et al. 2017 Human Vaccines & Immunotherapeutics Vol. 13 (2)

Videos Video archive

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

Dr. Larson’s address to the CSIS conference on “The Global Experience in Addressing Cervical Cancer”.

Dr. Larson discusses the VCP’s 2015 report on the State of Vaccine Confidence worldwide.

Subscribe to our mailing list