“Italy is one of two main countries affected across the (European) region at the moment,” said Dr. Robb Butler, Program Manager of the Vaccine-preventable Diseases and Immunization Program of the WHO Regional Office for Europe.
The Americas were declared measles-free in 2016, something the European region of WHO is still working towards.
“Italy has had suboptimal coverage for many years now,” said Butler, adding that vaccine coverage for measles has fallen every year since 2012. The country saw a large outbreak in 2014, when 4,350 people were infected.
Of the 1,603 cases reported this year, as of April 16, 88% are known to be unvaccinated.
Butler believes the fall in confidence towards vaccines is fueled by both a rise in the anti-vaccine movement across Europe as well as complacency towards the disease, with some not receiving vaccinations due to lack of concern about the risk of contracting measles.
“Parents are under the impression measles cases have been consigned to history,” he said. “Until they see an outbreak.”
“Our advise is clear: everyone should be vaccinated,” he said.
While negative attitudes are also playing a role in Romania’s ongoing epidemic, experts add the country’s health system, and it’s inability to reach everyone in the population has an equally crucial part to play in the outbreak. “Vaccines are in good supply … but a large percentage of the population are hard to reach,” said Butler.
For example, there are 630,000 registered Roma in Romania and many more unregistered that are under-served by the system and need particular attention, said Butler.
“There’s a convergence of these different concerns,” said Heidi Larsson, Director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. “But the main issue is safety anxieties.”
Falling confidence, rising infections
“(Italy) was the second worst in the world, second only to France,” in terms of negativity towards vaccines, said Larsson.
Approximately 20% of those surveyed in Italy (20.6%) and Romania (19.8%) disagreed with the statement that vaccines were safe. In France, more than 40% disagreed, while the global average was 13%, said Larsson. France has also experienced a measles outbreak this year.
“Measles is the first thing you will see after non-vaccination, said Larsson. “Because it’s so highly infectious.”
Larson fears that anti-vaxxers in positions of power will further aid these outbreaks by increasing uncertainty and anxiety among populations and feels that those in support of vaccines now need to be more vocal, like their opposition.
“We shouldn’t ignore it,” she said, adding that health professionals and public health officials should have conversations with people and not be dismissive of their concerns.
What’s being done
Health officials within Italian and Romanian departments of health as well as the WHO and European Centers for disease Control are working to control the current outbreaks.
In Romania, large-scale vaccination campaigns are underway to reach those who remain unvaccinated. “These are driving people towards immunization sites,” said Butler.
In Italy, national vaccination campaigns are not underway but there is national support to increase investment and communication of the importance of getting vaccinated to protect populations. “They need to reach underperforming regions,” said Butler.
While confident that the increased investment and campaigns in Romania are a step in the right direction to control that country’s outbreak, Butler admits controlling the epidemic in Italy is a “tough job.”
“We are in a very vulnerable place,” added Larsson, believing officials must not drop the ball on public confidence. “If we resist and say this is still fringe, we risk losing.”