ROME — This year was supposed to be the year that measles was eradicated in Europe. It was a lofty goal set a decade ago when vaccines, though not mandatory, were not-so-subtly required for school admission in a growing number of European countries. But instead of eradication, Europe is now facing one of the worst outbreaks of the preventable diseases of measles and rubella in recent memory. The number of cases of measles in Europe has grown by 348 percent since 2007, climbing from 7,073 cases then to 31,685 cases in 2013 according to the World Health Organization.
The highest number of measles cases in Europe (PDF) last year were reported in France, Germany, Italy, Spain, Romania and the United Kingdom. But, unlike in the United States where the politically charged anti-vaxx campaign has been blamed for kids spreading the disease at daycare centers and Disneyland, European disease control experts blame apathy and mistrust in the health care providers.
“We are seeing increasing ‘vaccine hesitancy’ in parts of Europe,” Lucia Pastore Celentano, head of the Vaccine Preventable Disease Program at the European Center for Disease Control or ECDC, told The Daily Beast. “This is different to being an ‘anti-vaxxer’. Vaccine-hesitant individuals hold varying degrees of indecision about specific vaccines or vaccination in general. This is a result of a lack of trust in the vaccine or the healthcare provider, complacency towards the disease itself, because we no longer have direct experience of the diseases, and the inconvenience of taking a child to be vaccinated.”
ADVERTISEMENT
Celentano says that European parents often make their decision on a vaccine per vaccine basis, opting not to vaccinate for childhood diseases like chicken pox with a far greater regularity than in the United States, but sticking close to the government recommendations for measles, mumps, and rubella (MMR). Either because of—or in spite of—social health care systems, vaccinations in Europe are automatically offered rather than seen as an option. Parents have to jump through hoops in many European countries not to vaccinate.
But the bottom line is that even in Europe, where social health care systems often dictate the norms, for many parents it is no longer a clear decision to vaccinate their child. “Some are swayed by the influence of what they read on the Internet or what they are told by their social networks and opt against following the advice of health professionals,” Celentano says. “Others will vaccinate their children even though doubt has crept into their minds.”
Other health care professionals say that because the societal culture is so different, it is impossible to place non-vaccinators in Europe in the same group as negligent anti-vaxxers in the United States, in part because most European governments hold more sway among their citizens. “A European in general is much more comfortable with the expectation of government intervention when it comes to health care,” says Dr. Heidi Larson, an American anthropologist who currently leads the team studying public trust in vaccines and the implications for immunization programs and policies at the London School of Hygiene and Tropical Medicine. “There is no way anyone in the United States would put up with the type of government intervention as here.”
She says that hasn’t affected the measles and other infectious disease outbreak, but it has made the dialogue about the diseases rather than a political agenda. Until the late 1800s, vaccines were mandatory in most of Europe—where they were available. England was the first country to allow people to opt out with its conscientious objector legislation in 1898. (The term ‘conscientious objector,’ usually associated with opting out of military service, originated with England’s vaccine program.)
Unlike in Europe, Larson blames a barrage of convenience vaccines for non-threatening diseases in the United States for the backlash. “There is this sense in the United States that enough is enough,” Larson told The Daily Beast. “It is very interesting that the debate in the United States has gone from vaccinating as a civic duty to not vaccinating as a civil right.”
In many European countries, elementary school admission is the first check point for vaccines, which are offered by school districts in some countries. In Italy, which in 2012 saw a 90 percent coverage rate for the first dose of measles vaccines fall to 88.1 percent in 2013, public schools can refer parents who refuse to vaccinate for measles, mumps, rubella and diphtheria to the local health board, according to Italy’s health ministry. They will have to explain their choice, and—in what amounts to trying to shame them into vaccinating—may be required to appear before the health board each year as long as they refuse to vaccinate. When the child reaches the age of 18, they will be asked to take the missed vaccinations “of their own free will” according to the Health Ministry’s website on vaccine protocol. Private schools across Europe can turn away unvaccinated children on that basis alone.
In the United Kingdom and France, measles was nearly eradicated before Dr. Andrew Wakefield in 1998 made unsubstantiated claims that MMR vaccinations were tied to autism in a controversial report. After that, vaccination rates plummeted and many of the victims of today’s outbreak, which has risen to 23,000 measles cases in France in the last five years, are children who weren’t vaccinated then.
Then, according to the ECDC, there was a return to vaccination for basic contagious diseases, which should manifest itself in fewer cases in the coming years. But that trend is starting to reverse again, which worries Celentano. “There are some countries in Europe with high vaccination rates that are starting to see affluent, well-educated parents increasingly vaccine-hesitant and opting not to have their children vaccinated,” she told The Daily Beast. “But waning confidence in vaccines can take years to manifest into higher rates of vaccine refusals and consequent outbreaks of vaccine preventable diseases.”
Larson worries that the anti-vaxx controversy in the United States now will have an impact on hesitant parents in Europe. She says she believes a garden variety of basic vaccines should be made mandatory with a few exemptions for children with underlying conditions. “The anti-vaxxers have lost their sense of civic responsibility,” she says. “This is not just about them.”
