Vaccine-preventable diseases on the rise
Diphtheria, hepatitis B, measles, meningitis, mumps, tetanus, tuberculosis, and yellow fever – according to the World Health Organization (WHO) these are some of the most common vaccine-preventable diseases which are currently on the rise across the world. In New York, officials have declared a public health emergency due to a measles outbreak, of which most of the patients are children. In Italy, an anti-vaccination politician has recently changed his opinion after becoming infected with chicken pox. What’s the solution?
The first vaccine
In 1796, the physician Edward Jenner observed that milkmaids remained immune from smallpox that was affecting people in the local area. Jenner’s successful experiments with cowpox demonstrated that infecting a patient with cowpox protected them from developing smallpox, and more importantly, formed the idea that infecting human patients with a similar yet less invasive infection could prevent subjects from developing a worse one. Known as the father of immunology, Jenner is credited with creating the world’s first vaccine. Coincidentally, the word ‘vaccine’ originates from vacca, the Latin term for cow, and that the Latin term for cowpox was variolae vaccinae, meaning ‘smallpox of the cow’.
A rise in cases
Yet, over 200 years later, outbreaks of vaccinable diseases are still present, and in some areas of the world are on the rise. England has seen over 900 cases of measles in 2018, including 38 confirmed in London as of November and an outbreak of mumps in Nottingham.
From 2017 to 2018, the number of measles cases in Europe tripled to over 82,000 cases, over 53,000 of which were in the Ukraine. Travellers going to and from Northern Ireland are being warned to ensure they have been vaccinated against measles as, according to UNICEF, the number of cases increased by 244% during 2017-18. The WHO has reported that the number of measles cases reported in the first three months of 2019 has quadrupled in comparison to cases reported at the same time in 2018, with the Ukraine, India and Madagascar being the worst affected.
Vaccine autism scandal
Vaccines have been introduced to the public’s attention with controversy. In 1995, gastroenterologist Andrew Wakefield and 11 other scientists claimed that the MMR vaccine gave patients an increased risk of bowel disease. Wakefield took this study further and hypothesised that the MMR vaccine disrupted the intestinal tissue, causing bowel disease and, as was highly publicised in the media, autism in children.
Whilst this claim has long since been debunked by the scientific community, the false assertions of Wakefield changed public opinion toward vaccines and gave rise to fears that resulted in lower rates of vaccination. This is what has led to the recent increase in cases of vaccine-preventable diseases.
Wakefield’s lasting legacy – the rise of anti-vaxxers
Some members of the public have the impression that diseases like measles are harmless and don’t require a vaccination, or that vaccines in general are unsafe. Influenced by the proliferation of fake news on social media sites, anti-vaxxers (people who openly deny or distrust the efficacy of vaccines) are speaking out and warning a global audience against vaccines.
In addition, Russian trolls and social media bots have posted anti-vaccine messages on Twitter which erodes public opinion on vaccines, Mark Dredze from Johns Hopkins University commented. With these headlines the WHO lists ‘vaccine hesitancy’, the disbelief that vaccines work to prevent humans from contracting certain diseases, among the top ten threats to our global public health for 2019.
In some religious communities facing measles outbreaks, false ‘vaccine safety handbooks’ are being distributed to members, sharing incorrect messages about vaccines, including Wakefield’s assertion of vaccines causing autism. Simon Stevens, Head of NHS England, commented that vaccine deniers were having a negative impact on public opinion, and that parents were basing their decisions not to vaccinate their children from seeing fake messages in the media, causing healthcare providers to lose the public battle when it comes to informing the public about the usefulness of vaccines.
The rise of vaccinable diseases is a growing problem. Measles for instance, is a highly infectious RNA virus transmitted via droplets, through the upper respiratory tract. The incubation period lasts from 10 days to two weeks, at which point patients infected with measles experience symptoms of sneezing, cough, fever, lethargy and eventually a rash, starting on the forehead and spreading to the limbs. Whilst the MMR vaccine is intended to be administered to children, the first dose is administered at around 12 months old and the second between the ages of four and six years old, the hesitancy of parents to vaccinate their children is leaving them at risk of catching the measles virus. If left untreated, this infectious disease can cause blindness and, in 30% of cases, death.
Dr Sarah Pitt, Principal Lecturer at the School of Pharmacy and Biomolecular Sciences at the University of Brighton and is the IBMS Chief Examiner for Virology, commented,
“The reduction in deaths and serious disease from vaccine-preventable diseases was one of the great achievements of the 20th century. However, I think people have become a bit complacent. For example, they forget that the reason that we do not see children dying from diphtheria in the UK any more is because there is a safe and successful vaccine against it. The problems with inadequate coverage of the MMR vaccine are highlighted by the dramatic increase in confirmed cases of measles in the last year or so.
However, my worry is that it will leave women of child-bearing age susceptible to rubella infection. This can cause congenital abnormalities in babies whose mothers experience rubella during pregnancy. IBMS members are involved in diagnosis of infections, but they can also help to explain to the public why vaccines are so important.”
To change public opinion, institutions are taking steps to require people to become vaccinated, whether they agree with vaccination or not. Sandwell and West Birmingham Hospitals NHS Trust is refusing to hire clinical staff who have not had the MMR vaccination. Italy is now enforcing Lorenzin law, named after former Minister of Health Beatrice Lorenzin, requiring all children to receive vaccinations before they are allowed to attend school.
Charities and professional bodies like the WHO are promoting facts about vaccines, using the Twitter hashtag #VaccinesWork, and are urging others to spread correct messages to others, to combat the negative impressions of fake news and Wakefield’s lasting legacy.