Measles and whooping cough cases are on the rise

When country doctor Edward Jenner inoculated 8-year-old James Phipps with pus from a cowpox lesion on a milkmaid’s hand, little did he know that he had started a long lasting revolution in preventive medicine.

Photo: Measles and whooping cough cases are on the rise
Photo: Measles and whooping cough cases are on the rise

More than 300 years later, vaccination is still the hallmark of disease eradication and control, especially in the developed world, where one can safely say that we owe most of our present quality and longevity of life to vaccines’ unique protective effect.

Despite their glaring success, the existence of vaccines has been anything but a bed of roses. The battle with viruses has been particularly vicious and new strains, particularly mutations from animal pathogens, are continuously emerging. The safety of vaccines has been another tough issue – the link between the MMR vaccine (or more closely its preservative thiomersal) and autism has been among global safety issues that almost completely tarnished the allure of vaccines and surrounded them with scepticism sometimes bordering on outright hostility.

The recent increasing government regulation on their production and research does not render vaccines a profitable market asset and only one or two major pharmaceutical companies produce them for public use. Thus, having so few suppliers has sometimes resulted in insufficient vaccine supplies, not to mention an increasing lack of public trust, especially following a string of scandals and lost lawsuits.

Although each EU Member State has its own vaccination schedule, a large number of children are still going unvaccinated for one reason or another. During a recent media seminar organised by the Directorate-General for Health and Consumers on Why is it important to be vaccinated? paediatrician Susanna Esposito addressed the perception of vaccination and obstacles against its efficient use. From her experience and studies at the University of Milan, she explained, the factors that affect vaccination include lack of information on vaccination impact and on the safety and efficacy of vaccines and that vaccines are not considered important either by attending healthcare professionals or parents. Factors that can promote vaccination include a good trusting relationship between doctor and patients, having previous positive experiences with vaccines, being more aware and educated on the importance of vaccination even when there are no pressing health hazards and knowledge on the safety of vaccines.

A classic example on the effect of public perception on vaccination is the measles issue. MMR vaccination decreased worldwide for various reasons but especially following the allegation that this vaccine or, more precisely, its adjuvant thiomersal, increased the likelihood of autism in young infants. Unfortunately, even though the allegation was disproved, the perception still held and the number of measles cases quadrupled since 2008 with several countries experiencing large outbreaks in 2010 and 2011.

The re-emergence of measles spurred the European Centre for Disease Prevention and Control (ECDC) to conduct a consultation process with experts, following which it issued a guide for healthcare professionals to enhance childhood vaccination uptake and tackle resistance to vaccination and lack of access to vulnerable groups. Ten interventions that could contribute to increase vaccination in the EU were elucidated, including investing more in educating physicians and nurses to more efficient and empathic communication with patients, efficient alert systems to remind people about vaccination, making vaccination more accessible, motivating local authorities and NGO’s to address under-served groups, using mass media to promote vaccination and monitoring the web to understand concerns about vaccination and provide answers through trusted web sources, among others.

The European Commission has also joined the ECDC to tackle this challenging situation. Following agreement on the need to strengthen childhood immunisation at EU level, in the 2011 Council Conclusions on childhood immunisation, the EC, ECDC and the European Medicines Agency (EMA) devised a number of measures to support EU countries. Some of these include advising them on best-practice measures during outbreaks of vaccine-preventable disease, funding projects on immunisation through the Health Programme, improving data for monitoring vaccination coverage (via the Venice `network, an overview of vaccine recommendations, funding and coverage, across Europe), encouraging European associations of healthcare professionals to help advocate childhood immunisation to parents and providing objective and evidence-based information to healthcare professionals (e.g. European public assessment reports) and the public (e.g. ECDC TV). The Commission is also assisting with the introduction of vaccines against cancer and promoting seasonal flu vaccination for risk groups aiming to vaccinate 75% against seasonal flu each year by winter 2014/2015.

Centrally, it seems that the structure both to promote and tackle the resistance to vaccination (PromoVax project) and to monitor vaccine uptake in the European Community (Venice project) is in place. There also appears to be a tangible effort to learn from mistakes made during the last pandemic and find ways to create a more efficient system both for disease surveillance (Venice) and tandem action if the need arises (FastVac, FluModCont, FluResp, FluSecure). Presently, the greatest hurdle appears to be how much the Member States are willing to take this available wealth and support on board and move on to new ways of working. The data and infrastructure are there – we only need to use them.


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