Anti-vaccine scepticism, conflict and poor access fuelled a 50% increase in measles cases last year. The Guardian reports that this is according to the World Health Organisation which said the resurgence was happening at a global level, including in wealthy nations where vaccination coverage has historically been high. “Our data is showing that there is a substantial increase in measles cases. We’re seeing this in all regions,” said Katherine O’Brien, WHO’s director of immunisation and vaccines. “We’re having outbreaks that are protracted, that are sizeable and that are growing. This is not an isolated problem.”
The figures are a worrying sign of the vast reach of vaccine-scepticism, said Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine in the report. “It’s very serious. Historically measles is often the first vaccine-preventable disease to emerge when vaccine coverage drops. The public health community had been in denial about the dangers of vaccine scepticism. It hasn’t been taken seriously enough for too long. Measles is a canary in the mine … you need to look at what other vaccines are not being given,” she added.
The report says mistrust of vaccines has been fuelled by social media, populist leaders and suspicion of experts. In France, Marine Le Pen, who leads the far-right National Rally, has opposed an expansion of the list of mandatory vaccinations, while in Italy, members of the Five Star Movement have previously suggested vaccines were unsafe. In the US, Donald Trump has also expressed scepticism over vaccines, having invited Andrew Wakefield – the discredited gastroenterologist who has claimed the MMR vaccine was linked to autism – to his inaugural ball.
The report says in poorer countries and marginalised communities, misinformation is often further complicated by conflict and a lack of access to healthcare.
The highly contagious disease can cause severe diarrhoea, pneumonia and vision loss. It can be fatal in some cases and remains an important cause of death among young children, according to the WHO. The disease can be easily prevented with two doses of a safe and efficient vaccine that has been in use since the 1960s, the UN agency says.
In 2018, measles caused approximately 136,000 deaths around the world, according to the WHO’s preliminary figures. The Philippines is among the countries struggling to contain a measles crisis, with at least 70 deaths, mainly of children, in the past month. The spike in cases follows a scandal around a dengue vaccination. Dengvaxia, which was given to school children across the country, was accused of putting children at risk of contracting a more serious form of the disease. Links were made to the deaths of several children, though nothing was ever proved.
Countries have until April to report measles cases registered in 2018 to the WHO. But the agency is quoted in the report as saying that the data it had received so far showed that about 229,000 cases had already been reported, compared with 170,000 for 2017.
Less than 10% of actual measles cases are reported, according to O’Brien, who said the true number of infections was in the millions. “So, when we see the reported cases increasing by 50%, we know that we’re heading in the wrong direction,” she said.
Up until 2016 the number of measles cases had been steadily declining but since 2017 the number had soared, according to Katrina Kretsinger, who leads WHO’s expanded immunisation programme. “There are a number of outbreaks … which are driving some of these increases,” she said, pointing to significant outbreaks in Ukraine, Madagascar, the Democratic Republic of the Congo, Chad and Sierra Leone. In Madagascar alone, from October 2018 to 12 February 2019 a total of 66,278 cases and 922 deaths had been reported, the WHO said.
“We’re backsliding on the progress that has been made,” O’Brien said. “And we’re not backsliding because we don’t have the tools to prevent this. We do have the tools to prevent measles. We’re backsliding because of the failure to vaccinate.”
Facebook has said it is “exploring additional measures” to address anti-vaccination posts, after concerns were raised when the subject appeared in groups and pages across the social network. The report says the company admitted that the task was challenging, as it tried to strike a balance between freedom to express opinion and the safety of its users, but said it was committed to tackling the problem.
“We actively work across multiple fronts to prevent false and misleading content from getting broad distribution on Facebook. Anti-vax content is eligible for fact-checking, and we’re working on even more ways to efficiently detect and address it,” a spokesperson for Facebook said.
A report in The New York Times says that the one-day immunisation clinic at David Douglas High School in Portland, Oregon was hectic on a recent Saturday, with a wait of 45 minutes to over an hour just to see a nurse. But Cameron Wagner said that after balking this long at getting her 4-year-old son vaccinated, out of concerns about potential side effects, a few more minutes would not matter. “I’ve talked to more doctors and have weighed the options, and decided to come in and get a shot,” said Wagner, 46, a massage therapist.
The report says measles, which has broken out in the Pacific Northwest and elsewhere this year, was a major force in her changed thinking. She said she had been keeping Lux, her son, out of play spaces and other crowded public areas in recent weeks as alarming reports flooded the news, and she was tired of it.
As the outbreak has flared, vaccination rates have soared in a state where the percentage of residents who decline vaccines for non-medical reasons – 7.5%, according to the US Centres for Disease Control and Prevention – is the highest in the country. Parents of unvaccinated or under-vaccinated children like Lux have come forward, raising health officials’ hopes that perhaps a corner has been turned. In Oregon and southwest Washington, where measles cases have clustered, about triple the number of children have been vaccinated this year, compared with the same period in 2018.
The report says since 1 January, 10 states, according to US federal health records, have reported cases of measles, which was declared eliminated as a major public health threat nearly 20 years ago.
The report says refusal or resistance to vaccination – which health experts say can raise the chances of an outbreak by putting at risk people who cannot be immunized for medical reasons – may be connected to a broader anti-vaccination movement, including concerns that vaccines lead to autism, an idea that has been widely debunked. But fears incited by the outbreak could trump those concerns, experts say.
“I’m an optimist,” said Dr Jennifer Vines, the deputy health officer for the Multnomah County Health Department. “But it’s hard to predict long-term,” she added.
“We do a disservice if we sort of denigrate or shout at families who choose not to vaccinate, because it’s understandable: They don’t want to do any harm to their kid and they’ve heard so much that’s negative,” said Dr Matthew F Daley, a paediatrician and researcher who works on public vaccination issues. “We need to meet them where they’re at.”