Measles, Measles everywhere…
The first six months of this year marked a record high number of measles cases across Europe, exceeding the 12-month totals of any year in the past decade. According to the WHO 41,000 people have so far been infected with measles in the region in 2018. This is not the health record I was hoping to see broken this summer considering the strides we have made in preventing infectious disease in the past century. 37 deaths were recorded of those infected, fatalities that were completely avoidable given that measles is a vaccine preventable infection. These measles outbreaks have been directly linked to sub-optimal vaccination coverage, a growing and increasingly worrisome trend in developed countries.
As an infectious disease professional I especially struggle with understanding this regression, which goes against the overwhelming evidence demonstrating the benefits of vaccination and vaccines. How did we arrive here and where did we go wrong? Conversations around vaccines and vaccination have become highly contentious and deeply polarizing, splitting people into vaxxer and anti-vaxxer camps. A debate that often misses the point and does a huge disservice to the vulnerable groups vaccines most seek to protect. Maybe it’s time to rethink the messaging around vaccines and vaccination if we hope to reverse this trend.
How vaccines have literally saved the world – Lest we forget
A good starting point is reminding ourselves exactly how far we have come thanks to vaccines. A fact that gets lost in the discourse as many take for granted these valuable disease-preventing tools that were not always available to humanity. Edward Jenner first used material from cowpox lesions to create immunity to smallpox in 1796. 
Over the 200 years that followed, his innovation underwent medical and technological changes eventually resulting in the eradication of smallpox eradication in 1977, saving over 5 million lives a year. Over that same time period, vaccines were developed to protect from most of the deadliest childhood diseases and effectively raised the average life expectancy by 30 years over the past century. The numbers are compelling and vaccination remains one of the greatest medical triumphs of our generation.
The message certainly seems to have resonated at least on a certain level and global vaccination coverage remains at a steady 85% over recent years without significant changes. While this is reassuring to a certain degree, the recent outbreaks of vaccine preventable diseases and the noted decline in vaccine uptake marks a chink in the armour and should be a warning against complacency. My greatest fear is, if the reasons behind declining vaccination uptake are not addressed, we risk losing the hard earned gains we’ve made in global vaccination coverage, a setback we cannot afford
The rise of Anti-Vaxxers – It’s not the full story
People who oppose vaccination, often referred to as “anti-vaxxers”, bear the brunt of the blame for low vaccine uptake, a lazy mistake that I’ve been guilty of making in the past. In reality, anti-vaxxers are a small minority with estimates of these groups in Europe and the United States hovering around only 2-3% of the population. 
While there is a lot of fear that anti-vaxxers may influence the public view on vaccination and drive the decrease in vaccination uptake, a closer look reveals the problem to be way more complex. The anti-vaxxer movement has always co-existed with the vaccine revolution but gained steam in the late 1990s. In 1998, a fraudulent study published in the Lancet, which is now widely disproved, suggested a link between the Measles, Mumps and Rubella vaccine (MMR) and autism, giving fuel to the movement. Despite the researcher and study losing all scientific credibility, some people continue to hold the view that the connection still exist. With that being said, it is very difficult to find an anti-vaxxer group that has consistently impacted on the uptake of vaccines to fully explain the sharp declines that we are now seeing. The coverage and attention given to anti-vaxxers is disproportionate to the impact that they have and in essence diverts attention away from more concerning drivers of vaccination decline.
The hidden issues – Poverty , Inequality and Lack of Information
With the media being mostly pro-vaccination, targeting anti-vaxxers makes for a good story and enables avoidance of less popular issues. Poverty and exclusion, as well and inadequate supply and access to vaccination services locally and globally, are still the main reason why vaccination rates are declining.
In the US, children from families living in poverty tend not to have a regular relationship with a pediatrician, as a result they miss out or are late to vaccinations despite federal programs providing vaccines at no cost. Furthermore, across Europe and the US, advice on child health and vaccination services is not usually readily available in economically deprived areas. These areas disproportionately represent newly arrived migrant settlements and other vulnerable minority groups. We cannot also ignore the growing proportion of parents who, though not against vaccination in general, may delay or pick and choose which vaccines their children receive based on preconceived erroneous ideas on the adverse effects of vaccines. The common theme connecting these issues is access- to information, healthcare, and to the appropriate messaging.
Winter is coming… and so is flu season
Ironically I routinely have patients in my clinic asking about vaccine availability to emerging infectious disease threats such as Zika and Ebola yet at the same time declining my offer to get a flu shot. This attitude highlights the false perception that somehow, vaccination against common infections is less important and can be overlooked, as opposed to the latest infection grabbing the headlines. 
This is the dangerous complacency that puts us all at risk of large outbreaks and losing the ground that we have made with the vaccine revolution. Last year’s flu season, by CDC estimates, was the worst in almost a decade, breaking records just like this year’s measles crisis across Europe. Ultimately we have come too far and should know better than to ignore our most potent tools to fight infection. This message may sound trite but is still as valuable and important today as it was 50 years ago, vaccines prevent disease and save lives. Ignoring that simple fact makes us all less safe!
Written by Boghuma Titanji
