Study the world map of vaccine-preventable diseases maintained by the Global Alliance for Vaccines and Immunization (GAVI) and, when it comes to measles, it is easy to conclude that large parts of the world are in the grip of an epidemic. But the name of that epidemic is not “measles”: it is stupidity. And the Middle East isn’t immune.
Nor is the developed world. The vaccination rate for the triple MMR shot, which protects children against measles, mumps and rubella, has fallen in England for the fourth consecutive year. Worried public-health officials say the blame lies with the resurgence of anti-vaccination propaganda, based on a fraudulent and wholly discredited research paper published 20 years ago that is now gaining fresh credibility thanks to the power of the Internet and social media.
This month Seth Berkley, the chief executive of GAVI, told a summit in Abu Dhabi about the growing threat of such “epidemics of disinformation.” The organization, a consortium of public and private health bodies working to eradicate preventable diseases, was “seeing more and more problems with misinformation in developing countries” as the use of smartphones and social-media apps spread.
There also appears to be a growing association between populist, anti-establishment political movements and the so-called “anti-vaxxer” movement. In the US, President Donald Trump has frequently tweeted his belief that there is a link between vaccines and autism. In August, the Italian government scrapped a law that made it obligatory for parents to have their children inoculated against 10 diseases, in a move that flies in the face of overwhelming evidence that vaccinations are safe, are effective and have saved millions of lives.
In an age of global travel, such stupidity has consequences far beyond the borders of any one state.
The target of achieving 95% coverage of vaccinations is not a random one. This is the level at which vaccination confers “herd immunity,” making it difficult for a disease to spread within any community – and, crucially, preventing members of that community infecting those of any others in which it comes in contact.
The 22 countries of the World Health Organization’s Eastern Mediterranean region have been battling against measles since 1997, when they agreed to eliminate the disease by 2010. This is a task that has already been complicated by a series of conflicts and mass movements of refugees. The last thing the region needs now is to be infected by an epidemic of misinformation.
At first, the region seemed on track to hit the target. In 2013, coverage was at 95% or above in 11 of the 22 countries, 90-94% in two and between 46% and 85% in the other nine. But then progress stalled. The 2010 target was missed, and extended to 2015, when it was missed again. The target now is 2020 and, says WHO, the region is unlikely to hit that.
First, this “failure” should be put in context. Well over 400 million people in the region have been vaccinated since the target was first set in 1997. In 2000 there were approximately 43,000 deaths from measles in the region and in 2008 there were 24,000, a reduction of 43%. The WHO estimates that since 2000 more than 2.4 million lives have been saved.
But such success is fragile. The impact of social disruption can be seen in the gap of measles-vaccination coverage between the stable nations of the region and those racked by troubles. Coverage in the United Arab Emirates, for example, has been at about 95% since about the mid-1990s and 99% since 2014. It’s a similar picture in the other five Gulf Cooperation Council nations. But in countries affected by war, and prone to mass movements of population, it’s a very different story.
Until about 2010 vaccination rates for a set of 11 inoculations were rising in Syria, with an average coverage of more than 80%. Since then, though, all gains have been lost. In 2017 measles inoculations were down to 67% for the first of two required shots, and 59% for the second. Even more alarmingly, coverage of the triple DPT vaccine, protecting children against diphtheria, whooping cough and tetanus, is down to just 48%.
In Iraq, which saw a similar slump during the worst years of strife, there are signs of inoculation rates recovering across the board. Yet other than the BCG shot for tuberculosis, which was at 99% in 2017, all other inoculations are still well below the 95% target.
Since it began work in 2000, GAVI has contributed to the immunization of 700 million children and helped developing countries to save more than 10 million lives.
Yet for a range of reasons, including government inertia, conflict and, most recently, the rise of irresponsible conspiracy theories, children’s lives are still being blighted or cut short by diseases that need no longer exist. Last year alone 20 million children weren’t vaccinated and, as a result, 1.5 million died.
All of us, from individuals to governments, have a moral responsibility to ensure that every child, in countries rich or poor, is vaccinated. Parents and governments that refuse to do so are the enemies of their children, their communities and, ultimately, the entire world.