In 2019 the World Health Organization included vaccine hesitancy as one of the ten main threats to global health in 2019 due to the global resurgence of measles, one of the world’s most contagious diseases. Here we talk to Ximena Alvira, Clinical Consultant for Elsevier Health Solutions, about the growing concern that public health is being severely damaged by vaccine preventable diseases.
How serious is the problem of slowing vaccine uptake?
The problem is so serious that the World Health Organization included vaccine hesitancy as one of the ten main threats to global health in 2019 due to the global resurgence of measles, one of the world’s most contagious diseases. To date, measles outbreaks have occurred in all regions and many countries, taking the lives of more than 140,000 people only in 2018. Additionally, in 2019, four European countries (Albania, Czech Republic, Greece and the United Kingdom) lost their measles elimination status. But several initiatives are in place to control the situation, such as The Measles & Rubella Initiative and the 13th General Programme of Work 2019-2023, and fortunately, vaccine uptake is not slowing down in every country, or for every disease. According to recent data from the WHO, some vaccines have seen a steady progress in uptake, such as rubella, yellow fever, rotavirus, pneumococcal conjugate, and inactivated polio vaccines. Human Papillomavirus Vaccine coverage has also observed a gradual increment in uptake since it was launched in 2006.
Given current trends and the population health data, where would you suggest we are seeing the most damage to public health?
As mentioned before, the World Health Organization included vaccine hesitancy as one of the ten main threats to global health in 2019. Therefore, public health is being severely damaged by a vaccine preventable disease. As Dr. Tedros Adhanom Ghebreysus, Director-General of the World Health Organization said: “the fact that any child dies from a vaccine-preventable disease like measles is frankly an outrage and a collective failure to protect the world’s most vulnerable children”. Then there’s economic and human resource allocation to treat diseases that could be prevented via vaccination but are resurging due to hesitancy and complacency.
For example, the situation with measles infection is not only the deaths it can cause, but the lifelong disabilities it can lead to, like permanent brain damage, blindness or deafness. In addition, recent evidence indicates that the measles virus harms the body’s immune system’s memory for months or even years after infection, producing long-term health consequences and leaving the person vulnerable to other potentially deadly diseases. This is a huge population health problem of which we do not know the extent yet, that could have easily been prevented by effective immunization coverage.
Can you outline to what extent misinformation is currently damaging vaccinations programmes?
As a headline of a leading scientific journals stated “The biggest pandemic risk? Viral misinformation”. Misinformation leads to mistrust in public health organizations and encourages an anti-science sentiment that puts us all at risk and could reverse decades of progress made in tackling preventable diseases. For example, since late October, a measles outbreak in Samoa has killed 53 people, including 50 children. The disease is believed to have spread from an infected visitor from New Zealand. Only about 31% percent of the population was vaccinated before the outbreak, leaving the remaining 69% vulnerable. This is a clear example of the magnitude of the problem, and that while we could be tempted to think that the low- or middle-income countries are the most affected, some wealthier countries are also fighting measles outbreaks. Therefore, misinformation may not only impact the efficacy and safety of vaccines, but also the dissemination information on the progress and challenges in achieving universal immunization coverage.
What steps can be taken to improve trust in the safety and efficacy of immunization programmes?
We must take time and care in understanding how the population, patients and healthcare professionals alike, are consuming information, and accordingly, design campaigns to counter misinformation with care, through an honest, evidence-informed communication. We must acknowledge language and literacy barriers, and make sure that patient education is exercised and reinforced continuously. Also, the creation of safe spaces to encourage candid dialogue. It is not only mistrust in the safety and efficacy of vaccines that must be addressed, also vaccine complacency – where perceived risks of vaccine-preventable diseases are low and vaccination is not deemed a necessary preventive action – must be considered when striving to maintain an effective immunization programme.
Consumer oriented sites like “Salud sin Bulos (Health without hoaxes)” may help disperse some of the myths about vaccines, and improve our trust in them.
The spread of information (or mis-information), has obviously played a huge part in fueling the anti-vax movement. Do you feel that technology can also have a role in reversing these trends?
Sadly, false news spread faster and more widely than true ones. Technology is an extremely powerful vehicle to deliver information in this globalized world where information on anything is a click away. The issue is where that information is coming from. The sources we are using to base our decisions on. And this is where social media plays a very important role. If we consider that an estimated 2.65 billion people were using social media worldwide in 2018, and that this number is projected to increase to almost 3.1 billion in 2021, many efforts should be placed on reinforcing the message that vaccines work.
Recently, Facebook declared its commitment to ensure that users find facts about vaccines across Instagram, Facebook Search, Groups, Pages and forums where people seek out information and advice. The purpose is to ensure that vital health messages reach people who need them the most, regardless of the language. By making sure avid users of social medial can access authoritative information on vaccines, the spread of inaccuracies, misinformation, and disinformation can be reduced.
Indeed, every digital and technology organization, including ourselves, have a responsibility to their users to make sure they can access reliable, accurate, and current facts about vaccines.
To what extent do you feel that healthcare organisations and professionals can play a more active role in encouraging uptake of immunization programmes?
Indeed, healthcare, as well as digital and technology organizations, have a responsibility to their users to make sure they can access reliable, accurate, and current facts about vaccines. Regarding professionals, every contact with a patient is an opportunity to counter misinformation, detect early signs of rumors and frights about vaccines, address them before they snowball, and reinforce the benefits of immunization.
Ximena Alvira is an enthusiastic and passionate medical doctor and doctor in neuroscience with broad experience in clinical practice, research, and medical writing. Ximena started out in Elsevier as a Knowledge Representation Expert where, together with the Spanish team launched ClinicalKey for the Spanish-speaking markets. Among other roles, she was responsible for the overall quality process of the Spanish edition. In her current role as Clinical Consultant for Elsevier Health Solutions, Ximena uses her expertise and insight to engage with customers, clients and providers worldwide to demonstrate the value of Elsevier’s solutions in helping them to achieve their goals and improve outcomes.
Before joining Elsevier in 2012, Ximena practiced emergency medicine at several places, such as the renowned Massachusetts General Hospital and Beth Israel Deaconess Medical Center in Boston, USA. Her passion for research about the human brain, eventually led her to earn her PhD in Neuroscience, from the Autonomous University of Madrid, Spain. Her passion for science communication and the dissemination of knowledge, kick-started her career as medical writer, which is still ongoing. To date she has edited and proofread multiple journal articles for publication in peer-reviewed journals, and delivered more than 60 scientific publishing workshops around the world.