Why does the EU have such a low MMR vaccination rate?

Misinformation, misinformation, misinformation. Why are we experiencing the rise of vaccine-preventable disease in the EU?

In the first six months of 2018, more than 41,000 people contracted measles in Europe — more cases than all of 2017. This comes after ten years of positive progress. In 2016, Europe experienced the lowest number of measles cases for a decade, whilst more people than ever are receiving MMR vaccines across the EU28.

So what’s causing the rise in outbreaks? The World Health Organization (WHO) attributes the upward trend to something known as “vaccine hesitancy.”

Vaccine hesitancy is not caused by a lack of preventative health products. We already have a well-established antidote to measles, mumps and rubella. Instead, the troubling situation we find ourselves in today is down to emotional responses to widely spread misinformation — causing a subsequent decrease in people vaccinating against measles.

Just a few years ago, the tin-foil hat conspiracy theories linking MMR with autism in children (first aired by the disgraced British doctor Andrew Wakefield in 1998) would have been quickly dismissed.

But in an era of emotionally volatile social media use, people are encouraged to come to immediate judgements and mistrust authority. This is a very dangerous combination when it comes to vaccine-preventable diseases.

In this turbulent environment, it’s little wonder that misinformation about the side effects of measles, mumps and rubella vaccines run wild.

Vaccine hesitancy is listed amongst the ten greatest threats to global health.

To ensure we achieve what the WHO calls “herd immunity”, we need to achieve 95% coverage across the board.

Today, we only have 90% coverage in the EU. In the UK, 2017-18 data reveals that we achieved 91.2% coverage, the lowest since 2011-12.

In France, where we are seeing the most headline cases of children contracting measles, the coverage figures are 85%.

Whilst this may indicate we’re not too far away, without reaching 95%, it’s not enough to halt the spread of measles in the UK and across the EU. This explains why we are where we are today.

If we want to increase vaccine coverage and restrict the spread of infectious disease, we need to prevent the spread of infectious misinformation online.


Cutting through the misinformation

Not everyone is likely to believe misinformation. In a 2018 University of Queensland study of more than 5,000 people across 24 nations, anti-vaccination beliefs were highest amongst those who also believed other conspiracy theories, such as 9/11 and Holocaust denial.

A similar Australian study suggested that anti-vaxxers have a common set of ethical values: a distrust of authority and a high value on individual “liberty”.

Anti-vaccine sentiment is not an issue related to science. It’s a mindset that’s becoming increasingly common. Worryingly, it is young people who are most reactive to misinformation.

Recent research by The Vaccine Confidence Project (VCR) — a part of the London School of Hygiene & Tropical Medicine (LSHTM) — revealed that people aged 18-35 are more sceptical of vaccinations than the over 60s.

Today, the European region has the lowest level of confidence in the safety and effectiveness of vaccines, contributing to the decline in immunisation rates and increases in measles outbreaks, which in the EU is at its highest for seven years.

According to the WHO, vaccines prevent three million premature deaths every year. Something needs to be done to educate and reverse the dangerous positions which lead to increasing outbreaks in the EU.

MMR: the regional differences

If we consider the overall opinion of vaccinations across the EU, it’s difficult to understand why more people are turning their backs on MMR immunisation.

The same VCR study across all 28 EU member states suggests that the perception of vaccinations are, on the whole, positive.

90% of people questioned think they’re important, 82.8% of people thought think they’re safe, and 87.8% think that they’re effective. Meanwhile, 78.5% think they’re compatible with religious beliefs.

When we look at the country-by-country data, some striking trends emerge. Take France, the home of a number of recent high-profile measles outbreaks. Only 69.9% of people questioned in the study believe that vaccines are safe. France also happens to have the third highest cases of reported measles in the EU28.

Progress in vaccinations across the EU is showing a positive, upward trend. But growth in MMR immunisation isn’t universal. Nations such as Ukraine, Serbia and Bulgaria still lag behind.

We are also hearing worrying murmurings across EU politics — including Matteo Salvini in Italy and the Kukiz'15 party in Poland, for example. Much needs to be done to overturn this dangerous anti-vaxxer rhetoric.

MMR vaccination should be seen as essential to personal and public health. Though 2018 may have seen the highest ever percentage of people immunised within the EU region, it also saw record numbers of measles outbreaks. This needs to change.

How can we increase vaccine confidence?

Unlike most infectious diseases, we already have a clear scientific solution to measles. The MMR vaccine is both effective and safe. Every single outbreak should be treated as a preventable tragedy. But to get to where we need to be, we clearly need a different approach.

It’s easy to dismiss anti-vaxxer’s rhetoric as ridiculous. But to change opinions, there needs to be a more concerted effort to better inform doubters the clear and obvious benefits of the MMR vaccine.

As scientists, we know that it works. As people, we know that it’s essential to public health. Without expressing these sentiments simply and calmly, we’re unlikely to educate those converted by misinformation.

This will mean that every aspect of society needs to be aligned. From the science community to politicians, to people discussing vaccines on social media, a balanced, informative approach is essential. If we are going to reverse the alarming trends we’re currently seeing, it’ll take a lot more than shouting down trolls in Twitter spats.

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