Massive measles outbreaks in Europe: A harbinger of things to come in the US?

If any of you are bloggers out there who like to write about studies, have you ever decided that you wanted to write about a study and discovered as you started writing that your university doesn’t have access to the journal? Yeah, that happened to me last night. I had wanted to move on from writing about antivaccine nonsense, as it seems that that’s all I’ve been writing about for the last several days (probably because it almost is), but I couldn’t because I couldn’t count on someone getting me a copy soon enough to be able to write about it last night. So until I get a hold of the paper vaccines it is again, because I saw an article that reminded me very much of just the sort of thing antivaxers could bring upon us if we let them.

Remember yesterday when I wrote about Kent Heckenlively’s unbelievably brain dead proposal for a five year moratorium on childhood vaccines. Yes, it is exactly as ignorant and idiotic as it sounds. As I thought about it more, I was reminded of another post that I had written back in March, about a massive measles outbreak in Romania that at the time had infected 3,400 and resulted in the deaths of at least 17. Then it occurred to me. Wht’s happening in Romania now would be a mild harbinger of things to come if antivaxers ever managed to see their vision of stopping or even significantly decreasing the use of childhood vaccines.

That’s why it’s worth an update, and unfortunately I saw one yesterday that tells me the measles outbreak in Romania is as bad as ever. But it goes beyond just Romania. Behold the horror:

Thirty-five people have died in the past year from measles outbreaks across Europe, the World Health Organization has warned.

It described the deaths – which can be prevented with vaccination – as an “unacceptable tragedy”.

A six-year-old boy in Italy was the latest to die from the infection. More than 3,300 measles cases have been recorded in the country.

The most fatalities – 31 – have been in Romania.

But there have also been deaths in Germany and Portugal since June 2016.

Dr Zsuzsanna Jakab, the WHO regional director for Europe, said: “Every death or disability caused by this vaccine-preventable disease is an unacceptable tragedy.

“We are very concerned that although a safe, effective and affordable vaccine is available, measles remains a leading cause of death among children worldwide, and unfortunately Europe is not spared.

It is criminal that a vaccine-preventable disease like the measles is a major cause of death in children in developed nations. We have Andrew Wakefield to “thank” for this. Death and disease in Europe and all over the world are his legacies and will remain his legacies. He is to blame for this.

The Italian child who died was a six year old boy suffering from leukemia who reportedly caught the measles from an older sibling whom the parents had decided not to vaccinate even though their son with leukemia had a compromised immune system and couldn’t be vaccinated himself. If that’s not a case of child neglect, I have a hard time envisioning what is. In essence, the parents’ negligence resulted in the death of their child with leukemia.

As I noted when I wrote about the Romanian measles outbreak, the antivaccine movement is very active there, complete with the usual conspiracy theories, such as the belief that the US purposefully infected people with HIV using polio vaccines and a direct link between vaccines and widespread HIV in Romanian orphanages. As in the US, in Europe a lot of this is driven by social media, where conspiracy theories about big pharma, national governments, the European Union, and Western governments combine with the usual fear mongering using dubious testimonials and bogus scientific studies.

In the face of this, many countries in Europe still do not have mandatory vaccinations, as a survey from 2010 reported:

In total 15 countries do not have any mandatory vaccinations; the remaining 14 have at least one mandatory vaccination included in their programme. Vaccination against polio is mandatory for both children and adults in 12 countries; diphtheria and tetanus vaccination in 11 countries and hepatitis B vaccination in 10 countries. For eight of the 15 vaccines considered, some coun- tries have a mixed strategy of recommended and mandatory vaccinations.

Until recently, these strategies worked reasonably well, and vaccine compliance was high. However, in the wake of this outbreak, EU public health officials have been playing catchup with vaccination campaigns. Progress has been hard-won:

The Region has been progressing towards measles elimination. A total of 37 countries have interrupted endemic transmission, according to the assessment of the Regional Verification Commission for Measles and Rubella Elimination based on 2015 reporting. However, remaining pockets of low immunization coverage allow the highly contagious virus to spread among those who choose not to vaccinate, do not have equitable access to vaccines or cannot be protected through vaccination due to underlying health conditions.

In addition, multiple countries are taking action to increase vaccine uptake beside education programs. For example, Germany has made moves to tighten its vaccine requirements:

Parents in Germany who fail to seek medical advice on vaccinating their children could face fines of up to €2,500 (£2,175; $2,800).

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

A mother of three died of measles in the city of Essen this week.

The government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations – unlike Italy.

What’s Italy doing? In Italy, there have been three times more measles cases this year already than there were in all of 2016. So in response, in May Italy made 12 vaccinations compulsory for children, including:

  • polio
  • diphtheria
  • tetanus
  • hepatitis B
  • haemophilus influenzae B
  • meningitis B
  • meningitis C
  • measles
  • mumps
  • rubella
  • whooping cough
  • chickenpox

Parents of children who aren’t fully vaccinated according to schedule by age 6 could face a fine. It’s not clear what they will do beyond that, but it’s a strong statement.

Meanwhile, in France, distrust of vaccines is very high. A recent survey indicated that only 69% of respondents trust vaccines, with only 52% believing that vaccines have more benefits than risks. Worse, the distrust is higher among the young.

In response to low vaccination uptake, the French government has mandated that, as early as next year early childhood vaccines that are unanimously recommended by French health authorities will become mandatory. Currently, only three childhood vaccines are mandatory (diphtheria, tetanus and poliomyelitis), while eight others are only recommended. All will become mandatory now, although it’s not yet clear what the penalty will be for noncompliance. In Slovenia, mandatory vaccination policy, complete with fines, has worked to bring compliance up to 95%.

I’ve always been ambivalent about punitive measures like fines to enforce mandatory vaccination, but I suspect that’s because school vaccine mandates, in which children must be up-to-date on the CDC-recommended schedule before they can enter school and the only penalty is that unvaccinated and undervaccinated can’t attend school, have generally worked very well and, thus far, nonmedical exemptions based on personal belief has have not (yet) reached the levels that could produce a catastrophe such as what Europe is currently experiencing—you know, the sort of thing people like Kent Heckenlively are working to produce.

Truth be told, I’m still ambivalent about methods more stringent than laws like SB 277, which eliminate personal belief exemptions to school mandates. I hope things don’t get so bad that that begins to change.