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Vaccines: The Anachronistic Emergency

by Giorgia Andrea Bordignon

As an Italian, I am quite used to reading in the news words like “vaccination emergency” and “measles outbreak”. However, I did not expect this magnitude of the phenomenon throughout the whole European Union.

At the beginning of the year the Committee of the European Parliament for Environment, Public Health and Food Safety (ENVI) has long discussed with concern about the drop in vaccination rates in Europe. Now also the Parliament itself has come forward, approving a resolution on the 19th of April expressing worry about the consequences of these gaps in vaccination coverage, which have already brought outbreaks of avoidable diseases.

But let us look at some figures. In the European Union, during 2017, there were 14900 cases of measles, a perfectly preventable disease, and 37 fatalities. The number has tripled in just one year, with most of the cases being reported in Romania (5608) and Italy (5098), making two thirds of the cases just within these two countries, but the rest of Europe was not spared. The majority of the infections occurred in unvaccinated individuals, and the proportion of those unvaccinated ranged from 72% in 25‒29 year-olds, to 96% in children aged <1 year, who are too young to receive the vaccination. The coverage has been dropping throughout the whole continent: according to the World Health Organization, to achieve the eradication of a disease it is necessary to reach 95% of vaccination rate in the population, but in 2017 only 6 countries in the Union reached that goal: Portugal, Spain, Croatia, Hungary, Czech Republic and Sweden. This threshold is fundamental to attain the so called “herd immunity”, the situation where the immunity of a significant part of the population provides protection for those individuals who cannot be immunized by vaccines, e.g. people with immunodeficiencies. It is also very important to remember that vaccination prevents an estimated 2.5 million deaths each year worldwide and reduces disease-specific treatment costs, including antimicrobial treatment, according to the resolution.

In Italy the situation has gone so far that the Government has decided to reinstate the obligation for vaccines for children, after it had been canceled in 1999: measles cases in the country represented a 500% increase compared to 2016. A new decree, in fact, prohibits school attendance for children up until the age of six who are not in line with the vaccination programs. The decision did not go without protests: several so called “no-vax” associations objected to the choice, and also some exponents from the Five Stars Movement, Italy’s major political party, called it a “third world measure”. Nonetheless, thanks to this new law Italy has been slightly recovering in the first months of 2018, but there still are some regions where the coverage is well below 95%. As far as the Union is concerned, 14 out of 28 countries have at least one mandatory vaccination comprised in the vaccination program.

According to the MEPs, the cause of this decrease is waning public confidence in vaccination. But what about the cause of the waning itself? Living in a time when social networks are one of the most used source of news, it should not come as a surprise that the blame falls on misinformation. As a matter of fact, the fake news article and mother of the vaccination emergency that is striking Europe in 2018, turns 20 this year: the publication by the English doctor Andrew Wakefield that linked vaccines to autism was published on “Lancet”, a medical journal, in 1998. And despite the fact that it was later proved wrong by many medical organization and caused Wakefield’s license to be revoked, it is still mentioned today in several pieces of anti-vaccination propaganda. Wakefield went then on to release a documentary called VAXXED that explicitly accuses the governments of covering up the effects of vaccines on health.

The key to solving this emergency is therefore to restore confidence in people to fight the wall of disinformation with real, accountable and verified data, and most important of all with transparency. In fact, the MEPs have called for greater transparency in the production and evaluation of vaccines and their adjuvants, and have encouraged the funding of independent research programs on the possible side-effects of vaccines.

But can the European Union really do anything about vaccines? Well, according to the European Court of justice no, it cannot. In 2014 a case was brought before the ECJ by a Slovenian Court, asking if the obligation for the vaccination of a minor was in accordance with article 168 TFEU on the protection of public health or if it was a right of the parent, protected by the European Charter of Fundamental rights, to refuse the vaccination of a child. The Court did not go as far as responding to the question, stating that there was a clear lack of jurisdiction.

So, the vaccination policy is a competence of national governments, but the European Commission can help to coordinate the programs of EU member states. In fact, the Commission is supervising the preparation of a Joint Action on vaccination co-founded by the Health program that will address vaccine hesitancy and seek to increase vaccination coverage in the EU. To do so, the joint action will work to increase the transparency and therefore the trust in national vaccinal programs.

In conclusion, it is clear that there is no straightforward competence of the Union in the sector of vaccines, nonetheless the Institutions are taking action to address a problem that we would not expect to be addressing in 2018. Reviving people’s confidence in the public health system seems to be the only viable way at the Union level: no obligations, but information and transparency. Vaccinations are one of the most important tools for the protection of public health; no conspiracy, no cover-up, only the possibility to act in order to eradicate diseases that could already be long gone, and yet we are still counting their victims today.

 

References:

  • Measles and Rubella monitoring report , European Centre for Disease Prevention and Control, 2016-2017
  • Vaccination greatly reduces disease, disability, death and inequity worldwide, Bulletin of the World Health Organization, 2008
  • European Parliament resolution of 19 April 2018 on vaccine hesitancy and the drop in vaccination rates in Europe, 2017/2951(RSP)
  • Video Conference of the plenary vote in the European Parliament (19/04/18) http://www.europarl.europa.eu/ep-live/en/plenary/search-by-date
  • “Portale Vaccinazioni”, http://www.salute.gov.it/portale/vaccinazioni/homeVaccinazioni.jsp
  • Mandatory and recommended vaccination in the EU, Iceland and Norway, eurosurveillance.org
  • Case C-459/13: Order of the Court (Ninth Chamber) of 17 July 2014 (request for a preliminary ruling from the Najvyšší súd Slovakia)
  • Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A, Davies SE, Walker-Smith JA, Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children, The Lancet, 28 Feb 1998