Time to speak out

Reaching the more marginalised members of society – forexample, impoverished refugees or nomadic travelling communities – has alwaysbeen a challenge for childhood immunisation programmes. However, a study onmeasles vaccination in Londonpublished recently in the British Medical Journal identified an additionalgroup of children with a heightened risk of being unvaccinated: children of theaffluent middle classes. Had the study been carried out in many other regionsof western Europe, the results would have been similar. Resistance tovaccination by some sections of mainstream society has become as much of achallenge for public health professionals as reaching out to people onsociety’s fringes.  It is no coincidencethat the lowest rates of vaccine coverage on our continent are found among theaffluent countries of western Europe.

How is it that an educated, intelligent, responsible adultcould make the conscious choice not to vaccinate their children against deadlydiseases such as measles? It may be that the very success of immunisationprogrammes is partly to blame. Measles, along with other child killers such asdiphtheria and pertussis (whooping cough) have become something of a rarity inmost west European countries.  Ourgrandparents may remember their lethal effects, but few young Europeans haveever seen a person with measles or diphtheria. We have lost our fear of thediseases, and instead worry about the vaccines.

There is a lot of misinformation circulating about childhoodimmunisation. Self-appointed experts and pseudo-scientists peddle crazy ideason the internet, based on twisted science or even downright lies. Sometimes themainstream media latches on to a rumour or bit of speculation and builds itinto a scare story. The reason European immunisation week was created was togive the public health community an opportunity to speak out in favour ofimmunisation, and to counter the propaganda of the anti-vaccine lobby.

Events in the opening months of 2008 demonstrate preciselywhy the public health community needs to speak out. We have seen an upsurge inmeasles across Europe in the first quarter of2008, with more than 1300 cases being reported. This compares to fewer than 800measles cases in the same period of 2007. Significant outbreaks have been seenin Austria, Switzerland and the UK. Hundreds of thousands ofpeople, some of whom may be unvaccinated against measles, are expected totravel to Austria and Switzerland forthe European football championship (Euro2008) this summer. While we are notlikely to see a significant outbreak at the championship itself (only aminority of fans will be unvaccinated), Euro2008 could magnify still furtherthe upsurge of measles. Few countries in western Europe have reached the 95 percent vaccine coverage rate needed to eliminate measles. Because of this, Europe is still experiencing sporadic outbreaks of thedisease. Indeed, looking at the 2008 data, we seem to be moving backwards inour efforts to control it. The WHO goal of eliminating measles from theEuropean continent by 2010 seems to be slipping from our grasp.

Over the last few weeks, the ECDC has been alerting EUpolicy makers and the general public to the measles situation in Europe. The ECDC has given practical assistance to theauthorities in Austriato support their efforts to contain the current measles outbreak, and to assesswith the Austrians the risk of Euro2008 magnifying the measles outbreak. In addition,to mark European immunisation week, our scientific journal, Eurosurveillance,published a special edition on measles.

Raising public awareness of the benefits of immunisation iscentral to increasing vaccine coverage in Europe.Childhood immunisation has been one of the great success stories of publichealth in Europe. In the first half of the20th century, thousands of children on our continent died every year frominfectious diseases.  Some of thosediseases have been consigned to the history books. After a successfulimmunisation programme, smallpox was eradicated worldwide by 1980 and Europe has been polio-free since 2002.  By the end of the 20th century, it had becomerare for children in EU countries to die of infectious disease. Our challengein the opening years of the 21st century is to keep it that way.

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