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In other words, an underfunded public health infrastructure may be more to blame for the uptick in measles than anti-vaxxers. “The [public health spending] cuts were mainly on prevention — like preventive clinics and also staff,” the study’s lead author, Veronica Toffolutti, a health economist at Bocconi University in Milan, told me. “Many people were not hired anymore as staff.” And without staff and services in place to vaccinate people, more people aren’t getting vaccinated, and measles is spreading.
- Ukraine has registered about half of Europe’s 41,000 cases. “In Ukraine, there’s anxiety about the MMR vaccine and child development,” Heidi Larson, a vaccine confidence researcher at the London School of Hygiene & Tropical Medicine, said. Even more important: “They have a history of supply problems.” These irregular supplies date back to Ukraine’s separation from Russia, and it’s propelled the spread of measles there.
- When asked by the Guardian about why people weren’t getting vaccinated, experts in England spoke mainly of an increasingly strapped and fragmented National Health Service, the country’s public health system. They also mentioned the fact that there is no system in place to remind people to get their shots, among other barriers to access. “The government needs to work with the NHS and local authorities to prioritize immunization services and learn lessons from regions that are performing well,” Doug Brown, the chief executive of the British Society for Immunology, told the Guardian.
- Greece is among the handful of European countries that have recorded more than 1,000 measles cases this year. It also happens to be a place that saw its per capita GDP fall by 25 percent between 2007 and 2014 — and along with it, its public health system has been decimated. “In Greece, it’s important to consider the economic reasons for some of the cases or the access reasons,” said Larson. So, she summed up, “We shouldn’t dismiss the hesitation and refusers, but I think too many articles act like that’s the only reason — and it’s not.”
Why vaccines are so important when it comes to measles
The measles problem that’s surfaced across Europe might mean that even more vaccine-preventable diseases — rubella, mumps, diphtheria, hepatitis — could begin to rise, since measles is typically the first to start spreading when people aren’t getting their shots.
That’s because measles is incredibly infectious and needs the highest amount of coverage to give the population something called herd immunity: In order for any vaccine to be effective, you need to have a certain percentage of people in a population immunized. This means diseases can’t spread through populations very easily, and it protects even those who aren’t or can’t be vaccinated.
With measles, 95 percent of people need to get the shot to prevent the virus from spreading. “So it’s one of the first vaccine-preventable diseases to show its face when there’s under-vaccination,” Larson said.
And many countries in Europe are under-vaccinated. “Italy, France and Serbia, for example, have lower child-vaccinations rates than Burundi, Rwanda and Senegal,” the Economist recently reported.
To boost vaccination rates, many countries in Europe have been cracking down on vaccine-refusing parents, experimenting with fines and sanctions. And, to be clear, vaccine refusal is a problem. France, for example, has one of the highest rates of vaccine skepticism in the world: According to one study, 41 percent of people there disagreed that vaccines are safe. In Germany, it’s not unusual to go into pharmacies and find homeopathic “cures” for many ailments, or even homeopathic hospitals.
“The vaccine acceptance issues are a bigger piece of the pie than they were historically,” Larson said.
But Europe’s vaccine problems are much larger than anti-vaxxers. And the story of measles may be the canary in the coal mine for an infectious diseases problem that’s even more dire than it appears right now.