A top ten threat to global health

When I was a kid, in the years before vaccines were in common use, I had every possible communicable disease: measles, mumps, rubella, chicken pox, scarlet fever and rheumatic fever. I was pretty sick with some of them, even enduring temporary loss of sight as the result of a serious case of mumps.

I have to admit that, for the most part, I enjoyed the drama and attention these sicknesses brought. However, I imagine my mother had quite a different perspective: with four kids under six, it was never just one of us who was sick.

I particularly remember when all of us had the chicken pox at the same time, and the London, Ontario, public health department put a quarantine sign on the front door of our house. We enjoyed the excitement of the family doctor making house calls, our parents wearing masks and gloves, and getting to eat all the ice cream and jello we wanted because we had pox in our throats. We emerged with our long-term health intact and nary a thought to how serious those illnesses actually had been.

Of course, we had access to high quality and readily available medical care, which was not the case for children in most other parts of the world, and they suffered the consequences of those diseases in ways my siblings and I could not even have imagined.

Anti-vaxxers

According to the European Centre for Disease Prevention and Control, before immunization was common, measles was responsible for approximately 2.6 million deaths around the world. That number has dropped to 122,000 deaths per year, with rates in Europe and North America extremely low.

Despite clear evidence like this that vaccinations reduce deaths from communicable diseases (and, in some cases, eradicate the disease entirely), the anti-vaxxer movement, around since at least the 1700s, is strong – perhaps even stronger than ever – today.

When the first vaccine – for smallpox – was introduced in England and western Europe in the late 1700s, it was treated with some suspicion, even though it lowered the rate of the disease almost immediately. This was due, in part, to a general mistrust in medicine and doctors. Some opposed vaccination because of their religious beliefs, and there were also legitimate concerns about safety and sanitation.

Over the next century, as vaccinations for more diseases became available, the anti-vaxxer movement remained strong. The distrust at the heart of opposition to vaccination– the concept of introducing a little bit of a disease to a child’s small body to prevent the child from getting the disease was a hard sell — was given weight when, in 1955, 120,000 doses of the polio vaccine were mistakenly produced with live polio virus, resulting in 40,000 cases of polio, 53 of which led to paralysis and five to death.

In the 1970s, a report from a hospital in England alleging neurological conditions in children given the DTP (diphtheria, tetanus and pertussis (whooping cough)) vaccine led to a decline in the number of children receiving the vaccination from 81% to 31% and the outbreak of three major pertussis epidemics.

In 1998, British doctor Andrew Wakefield linked the MMR (measles, mumps and rubella) vaccine to increased risk of autism. This received wide attention and, although his findings were refuted a year later, led to a huge growth in the anti-vaxxer movement around the world.

Anti-vaxxers and populism

Jonathan Kennedy, a researcher at Queen Mary University of London found that “the higher the level of populist votes in a country, the higher the proportion of the population that believes vaccines are not effective.” In his recently published paper, he notes that both stem from a similar dynamic: a “profound distrust in elites and experts.”

This seems consistent with the work of communications consultant Jim Hoggan who, in his book “I’m Right and You’re an Idiot: The Toxic State of Public Discourse and How to Clean It Up,” talks about what he calls “cultural cognition,” the phenomenon that people don’t change their views if the evidence contradicts the values of their community.

Where are we now?

Anti-vaxxers are going strong in 2019. Despite the debunking of Wakefield’s claims, a recent Ipsos Mori poll in Europe found that six out of 10 adults think there is a link or are not sure between vaccination and autism, and one-third of Canadians believe the science on vaccination is unclear.

The World Health Organizations (WHO) has identified “vaccine hesitancy” as one of the top ten threats to global health in 2019.

The London School of Hygiene and Tropical Medicine’s Vaccine Confidence Project notes that WHO has found a 50% spike in measles around the world. In Europe, the rate of measles is at a 20-year high.

It seems unlikely, especially in a time of growing populism in North America and western Europe, that the anti-vaxxer movement is going to go away. As the numbers above indicate, this has huge implications for public health, because even one unvaccinated child can lead to increased levels of disease for whole communities of children.

Not surprisingly, this is an especially serious problems in those parts of the world that do not have the resources for public health education and services or to respond to epidemics of diseases long thought to be eradicated or at least under control.

Science and medicine are not to be swallowed without question, but the issue of vaccination seems to be one area where the evidence of its value should be believed and acted on.

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