Measles eradication targets under threat amid epidemics

European efforts to wipe out measles by 2015 are in jeopardy as outbreaks continue to sweep across the continent.

A series of measles epidemics in Western Europe and a major polio outbreak in Central Asia served to focus minds as senior officials met in Brussels to launch European Immunization Week (EIW).

The WHO had hoped to eradicate poliomyelitis by next year and to do the same for measles and rubella by the middle of the decade but recent events are seen as a serious setback.

Launching the EIW, Zsuzsanna Jakab, Regional Director, WHO Europe, described the measles figures as “sombre” but committed to stepping up the fight in the face of waning immunisation rates.

“In 2010, we witnessed explosive measles outbreaks continuing in the western part of the region and the re-emergence of poliomyelitis at a time when we would have been preparing to celebrate 10 years of polio-free status in 2012,” she said.

Twenty four European countries have reported more than 4,000 cases in the first quarter of 2011, sparking concerns of a further surge in the wake of the Easter holiday.

Europe on a ‘slippery slope’

“It disheartens me to see our strong region facing this slippery slope of losing the significant gains, knowing what the consequences will be: increased illness, lifelong disability and deaths.

However, on the positive side, we have witnessed countries mount effective responses to many of these outbreaks, by applying lessons learned, conducting joint planning and ensuring strong collaboration between all countries in the region,” Ms Jakab said.

She said strong partnerships between countries are needed to prevent and control vaccine-preventable diseases.

“I want to assure everyone that we have effective tools, and we will continue to engage political leaders, public health experts, academia, institutes and the public to reach these goals. This is a marathon with the finish line now in sight – we need to urgently press on to meet the milestones we have set and to win. It can be done!”

Shared solutions to common threats

Fifty two countries are participating in European Immunisation Week, making it one of the most visible public health events in Europe. The theme of this year’s event is Shared solutions to common threats’.

Ms Laurette Onkelinx, Vice Prime Minister, Minister for Social Affairs and Public Health, Belgium, said the experience of handling the H1N1 pandemic had led national governments to become more willing to cooperate in areas such as common procurement mechanisms.

“Recent measles outbreaks in Europe require us to remain vigilant and also illustrate that immunisation remains our best weapon to stop the progress of an infectious disease, to reduce it and finally eradicate it,” she said.

The H1N1 pandemic has led to the very principle of vaccination being questioned, according to Ms Onkelinx whose government is defending a legal challenge against elements of its immunisation programme.

“We have just experienced this in Belgium where a tribunal is jeopardizing compulsory vaccination against polio. This is very worrying. If polio has disappeared, it’s because of vaccination.”

Questioning from the public is understandable, Ms Onkelinx said, but she appealed to the public to maintain their trust in science. “Reason must prevail over emotion,” she said.

Rebuilding public trust

Steve Allen, regional UNICEF Director for Central and Eastern Europe and the CIS, said the recent outbreaks of polio in Central Asia highlight the consequences of the failure of routine immunisation systems.

He pinned the blame primarily on declining public trust in vaccination, something which he said is a major concern, along with increased global travel. The surge in polio in Central Asia had originated in India, according to Mr Allen.

“Infectious diseases do not recognise borders. Outbreaks in one place can rapidly affect people in another due to increased mobility and migration,” he said.

Public health authorities must be more transparent and should be willing to communicate with the public, even when the information they are sharing is “difficult and embarrassing”. UNICEF is supporting initiatives designed to improve health communication in Europe in an effort to rebuild public trust, Mr Allen added.

Prof Johan Giesecke, ECDC Chief Scientist, said vaccination is the most successful medical intervention ever developed. “Nothing doctors or nurses do compares with vaccination. Not only does vaccination save lives, it prevents lifelong disability. Vaccines also protect those around you.”

He said EU member states have great childhood immunisation programmes, even though they differ from country to country – and sometimes even within individual countries. This creates problems for families moving from one country to another, he said.

Victim of own success

John Ryan, a senior official at the European Commission’s health and consumers’ directorate, said that despite the proven safety and efficacy of vaccines, too few children are protected against preventable diseases.

“Perhaps vaccines are a victim of their own success. Some parents lack information on vaccination while others are not familiar with the diseases they protect against,” he said.

Continuity of immunisation is a major difficulty for healthcare providers and the EU is looking at ways to better document vaccination status of children in Europe, according to Mr Ryan. He indicated that health ministers will adopt a series of measures in June which could help tackle these problems.

Reaching out to minorities and migrant populations will be particularly important, Mr Ryan said, and guidelines on how to do this can be developed at European level.

‘Good parental practice’

The guest of honour at the EIW launch was Her Royal Highness Princess Mathilde of Belgium, who also serves as WHO special representative for immunisation. She said cooperation and commitment is needed from all sides if infectious diseases are to be brought to heel and that vaccination is “good parental practice”.

“As a mother of four small children, I am fully committed to this on a personal level. Immunisation is one of the most cost-effective health investments that a society can make. It is one that protects not just the individual but also entire communities, countries and regions from diseases that can result in sickness, disability and even death. But, we should not forget that immunisation is at its most effective in preventing disease when everyone works together.”

She described recent outbreaks of measles and polio as “disturbing”, given the toll they have had on children and health services.

WHO Europe is aiming to eradicate measles and rubella by 2015 but cooperation will be needed if this is to be achieved, Princess Mathilde stressed.

Links:

European Immunization Week: official campaign site

World Health Organisation: EIW official launch page (includes text of speeches)

Al Jazeera: Measles bounces back in Europe

Gates Foundation: WHO Europe chief on immunisation

Vaccines Today: EU considers ‘vaccination passport’ for kids

Vaccines Today: Targeted campaign needed to stem measles surge

Vaccines Today: Is Europe on the verge of a measles epidemic?