Mussels are often accused of the fact that vaccines are as successful individuals forget about how dangerous this disease is. They let themselves become complacent or manipulated by frivolous observation. Coverage of vaccination falls and inevitably focuses occur. But now with a sudden global rise in measles – which is rising by almost a third after years of steady decline and leading to 110,000 deaths – we are getting less and less of a point.
Much of this increase is due to the collapse of health systems in Venezuela, but the increasing number of cases in Europe, where cases increase by more than 450%, and North America is also a major cause of concern, now we have generations of parents who grew up had ever seen the measles firsthand. This raises the question of how we engage and proclaim the importance of vaccination to a growing number of people who have no memory of the disease at all.
People often talk about measles as a harmless disease, but it is far from it. Until recently in the 1980s, more than 2.5 million people killed each year, mainly children. Those who survived risked permanent blindness or brain damage. Even with the best health systems, a small percentage of the cases lead to the brain cycle essentially dissolving without any treatment possible. It is also one of the most contagious diseases ever seen. It is so virulent that it is possible to catch it from someone as soon as you enter the same room, even hours after you leave.
This is one reason why it is so important for vaccine coverage to stay at 95% or more. Compared to other diseases, this is relatively high, but given the infectivity that is necessary to maintain the immunity of herds, where enough population is protected to prevent the spread of the virus. Once it falls below this level, the outbreaks are inevitable.
In fact, it is not only the percentage of children counting, it is also important when they are vaccinated. Last year in the United Kingdom, for example, 95% of five-year-olds had received at least one measles vaccine shot, and so far in the year 2018 there have been nearly 1,000 cases. One reason for this is that at the age of two, only 92% of the children were protected and in the London area it was less than 90%. Since the first measles dose is intended to be given to one-year-olds, the difference suggests that coverage is starting to dwindle or that parents may be delayed.
This must be stopped because it puts younger children at risk, as well as people who can not be vaccinated, such as those with a damaged immune system. It effectively creates a window of opportunity for the virus, contributing to the perpetuation of its existence, not only locally but globally. This is because measles knows no borders and is experienced in international travel. Often, US outbreaks can be traced back to unvaccinated people who travel abroad and bring back the virus.
And it works in two ways. In 2009 the medical magazine the Lancet reported that cases of measles were exported from Europe to poorer countries in Latin America, a region that had previously eradicated the disease. The difference is that while parents in Europe may have opted not to vaccinate their children, this option jeopardizes the victims of vulnerable children in poor countries because high levels of malnutrition and limited health care make the virus much more deadly.
Today, global coverage of measles amounts to only 85%, which is a real step forward in the past decades. But as long as vaccine hesitancy remains a problem in rich countries, progress and efforts to control and perhaps one day to eradicate this disease will continue to be undermined.
So the question is how do we encourage a generation of parents who have never had reason to fear measles, insist on vaccine schedules and without having to cause events? As is the case, the best promoter for the measles vaccine is the virus itself. At this time, many parents who have never witnessed this disease and therefore never considered a threat, find out, through the misery of their children, that measles is not a picnic. This is evident from the fact that in rich countries, whenever an outbreak occurs, there is usually a fight for vaccination.
Part of the solution should include better engagement with parents and in ways that do not require prior knowledge of the disease and is not based on the fear of communicating that knowledge. Because fear as a driving force will become less and less effective as the number of parents who have never met measles continues to grow.
No parent wants their child to suffer or die. And most likely, many of these reluctant parents simply do not know and will be terrified of the global impact of delaying or losing their children's vaccinations to other children. These are people who live in countries that have a history of generosity in causes that support vulnerable children. Perhaps aware of the positive impact that home vaccination may have on the lives of the poorest children throughout the world, we can encourage parents to boast vaccination and protect their children, thus creating a generation of vaccine activists that will not I have to repeat the story.
Seth Berkley is Chief Executive Officer of Gavi, the Vaccine Alliance