Staggering spread: On vaccines

Governments must do more to increase public awareness of vaccine importance

December 12, 2019 12:02 am | Updated 09:21 am IST

Even as reported measles cases globally during 2000 to 2018 decreased by 59%, there has been a spike since 2016. Compared with over 1,32,000 reported cases in 2016, the numbers shot up to over 3,53,000 in 2018. While the numbers in 2018 were more than double the previous year, the numbers in 2019 have already surpassed those of 2018. By mid-November 2019, over 4,00,000 cases were reported globally. Since measles surveillance is generally weak, WHO and the Centers for Disease Control and Prevention resorted to estimating the number of measles cases and deaths. Based on an updated estimation model, there have been nearly 10 million cases and over 1,42,000 measles deaths in 2018. Last year, the Democratic Republic of the Congo, Liberia, Madagascar, Somalia, and Ukraine accounted for 45% of all reported cases. The situation worsened in Congo by November, with a nearly four-fold increase in cases (from 65,000 in 2018 to 2,50,000 in 2019) and over 5,100 deaths. The situation in Ukraine is grim. After a 50% drop in the number of cases in 2018 compared with 2017, the trend has now reversed — 58,000 cases by mid-November this year, which is 4,000 more than in 2018. There has been a decline in the other three countries mentioned that reported the most number of cases last year.

Vaccine hesitancy has been highlighted for the staggering spread in cases globally. In DR Congo, there is low institutional trust, misinformation, vaccine shortage and even attacks on health-care centres and workers leading to the spread of both measles and Ebola. The Philippines and the small Pacific island of Samoa serve as a textbook case of the sudden emergence of vaccine hesitancy. Mass immunisation using a newly approved dengue vaccine in Philippines, before the risks associated with the vaccine were reported by the manufacturer, shattered public trust in vaccines; so low vaccine coverage led to measles and polio outbreaks. In Samoa, an error in preparing the measles, mumps, and rubella (MMR) injection led to the death of two infants. Fear-mongering led to a fall in vaccine uptake, leading to an outbreak of measles. But in many European countries and the U.S., vaccine hesitancy has been on religious grounds and primarily due to anti-vaccination campaigns spreading fake news about vaccine safety. To counter rising hesitancy, about a dozen European countries have already introduced laws making vaccination mandatory. New York City too introduced such a law when the U.S. nearly lost its measles elimination status. Such laws may prove counterproductive in the long run, and the only way to increase vaccine uptake is by educating the public. With 2.3 million children not vaccinated against measles last year, India has much to do to protect its young citizens.

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