ANTI-VAXXING: A PRIVILEGE OF THE FORTUNATE

Friday, 3rd of July 2015

ANTI-VAXXING: A PRIVILEGE OF THE FORTUNATE

Raoul Kamadjeu

DOI: http://dx.doi.org/10.1016/S1473-3099(15)00072-9

The news media has reported extensively on the recent measles outbreak in the USA. I cannot help but think “is this the future of measles?”

I remember my days of clinical practice in rural districts of Africa: many children had that typical miserable look in their eyes, running nose, rash, and high fever, and mothers were dreading the day when measles would come to claim the so-called measles baby—that extra child specifically earmarked for the disease. With low access to vaccination, nature was operating its brutal Darwinian mechanism, whereby children become infected and many die from the combined effects of measles and malnutrition. Children did die: in 2000, measles killed an estimated 562 000 children worldwide, mostly in low-income countries in Africa and southeast Asia¹ at a time when successful implementation of measles elimination strategies had led to the eradication of measles in the wealthy regions of the world. The Pan-American Health Organization (the WHO grouping of countries in North and South America) region was declared free of indigenous measles virus in 2002,² followed by the Western Pacific Region in 2010.³

However, things have changed since 2000. With the support of the Measles and Rubella Initiative and the successful implementation of measles control and elimination strategies, measles deaths worldwide decreased by 78% between 2000 and 2012, from an estimated 562 000 to 122 000.¹ This success prompted the WHO African Region to set a target year for measles elimination of 2020.⁴

As often happens, vaccination would soon become the first victim of its own success; with measles gone from high-income countries, the fear of measles disease waned from the collective memory of a new generation of parents who were fortunate enough to have been vaccinated as children. The mild side-effects of the vaccine, such as fever or pain, are now perceived by some people as a greater disturbance than the disease itself.

Anti-vaccine resentment has been around as long as vaccines themselves because there is no shortage of reasons to justify opposition to medicine. In remote regions of Africa, including areas where measles is still a problem of public health importance, I have witnessed vaccine hesitancy on the grounds of religion or culture. Rejection of vaccination in poor communities can sometimes be indicative of a feeling of neglect or a deep mistrust of the authorities whose priorities are perceived as misplaced.

However, despite these circumstances, a lack of vaccines is a greater problem for people in developing countries in Africa. Measles alone still causes an estimated 74 000 deaths every year in Africa,¹ mainly because vaccines are not available in poorly equipped, understaffed, and sometimes inaccessible health facilities, or because families do not know when or why they should bring children for immunisation. Therefore, immunisation programmes across Africa have increasingly developed new mechanisms to deliver vaccine to the majority of the population through various strategies at health facilities and in the community; increased government commitment towards vaccine independence and new financial mechanisms provide the necessary financial support to help to expand the range of life-saving vaccines delivered through the Expanded Program on Immunization.

At this stage in the fight against vaccine-preventable diseases, responsible governments should not allow such efforts to go wasted on the altar of freedom of choice. Although vaccination programmes should not take their relevance for granted, legal frameworks placing the health of the community above the individual choice should be established or clarified. Just as parents cannot choose to not educate their children for whatever reason, they should not be given the choice to opt-out their children from vaccination. The most successful public health intervention of all time should be more vocal than anti-vaxxers.

I declare no competing interests. I am a concerned citizen and a public health specialist working in the specialty of immunisation. The views expressed here are my own and do not whatsoever reflect the position of my past, current, or future employers.

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