People’s confidence in the safety and efficacy of vaccines is greater in poor than rich countries, according to Wellcome’s recently published Global Monitor, a survey of 140,000 people from over 140 countries.
For instance, beliefs in vaccine safety are at 99 percent in Rwanda and 97 percent in Bangladesh but 72 percent in the U.S. and 47 percent in France. This is a problem because to stop the spread of a very contagious disease like measles, 90-95 percent of the population should be vaccinated — the concept of herd immunity.
Despite immunization being one of the most cost-effective public health interventions, there is an increasing population of anti-vaxxers who do not believe in it and do not vaccinate their children. As a direct result of people’s beliefs about vaccines in places like the U.S. and Europe, measles cases are spreading.
From Jan. 1 to June 20, 2019, 1077 cases of measles were confirmed in 28 U.S. states like Washington, New York, California, Florida, Pennsylvania and Texas, according to the United States Centers for Disease Control and Prevention (CDC). Measles outbreaks are raging across Europe. In the first two months of 2019, 34,300 measles cases and 37 deaths were reported in 42 countries of the World Health Organisation (WHO) European Region.
This rise in measles cases across Europe have been attributed to a decline or stagnation in overall routine immunization coverage. Most measles cases are occurring in unvaccinated or under-vaccinated individuals.
Ten European countries including France, Belgium, Bosnia and Herzegovina, Georgia, Germany, Italy, Romania, Russian Federation, Serbia and Ukraine remain endemic for measles, according to WHO European Region.
Of course, governments in the U.S. and Europe have attempted to stem the measles outbreaks. In New York City, the Mayor DeBlasio declared a state of public emergency and all unvaccinated children were banned from public spaces. In New York, California, Illinois, Oklahoma and Washington, eight individuals infected with measles cancelled travel plans when they were warned by health officials that they could be stopped from boarding their flights.
In Europe, Public Health England urged students about to enroll into European Universities to visit their doctor so they can be fully protected against measles before they travel.
But this is not enough. There are important lessons that governments in rich nations can learn from poorer ones to improve vaccination coverage. Indeed, wealthy nations can stem the spread of preventable diseases by looking to the African continent where vaccine-preventable diseases like polio have almost been eradicated.
First, governments need to convince all parents to vaccinate their children. In Democratic Republic of Congo, parents were also leery of giving their children vaccines, but leaders figured out creative ways to engage with them.
Likewise, in 2003, at the height of boycott of polio immunization, the Global Polio Eradication Initiative Partners engaged faith leaders in northern Nigeria by improving their knowledge about production of the polio vaccine. The aim was to show them the polio vaccine is safe and is not laced with any harmful substances.
Globally, the United States Agency for International Development (USAID) provides support to engage faith leaders and organizations to generate and sustain demand for vaccines, as well as mobilize communities for immunization sessions. Since many current anti-vaxxers base their convictions on religion, America must begin to engage religious leaders and ask them to share the benefits of immunization.
Second, achieving universal health coverage improves access to health care, including immunization. This is a lesson the U.S. can learn from Rwanda. In America, 13.7 percent of the population do not have health care. Rwanda has achieved universal health coverage with more than 90 percent of the population insured.
The major difference is that Rwanda has a publicly financed health insurance system with different co-payments and government pays for the poorest Rwandans. The Wellcome Global Monitor show that Rwanda has 99 percent belief in safety and efficacy of vaccines. It is not surprising that routine immunization coverage in Rwanda is 99 percent.
Third, costs must be altered. In America, the Measles-Mumps-Rubella (MMR) vaccine costs per dose are $21.22 and $75.04 in the public and private sectors respectively, according to the U.S. Centers for Disease Control. This can make it cost-prohibitive for some. One lesson that the U.S. can learn from South Africa in reducing the costs of drugs is by instituting bulk purchasing.
In South Africa, the government issues tenders for essential medicines and other commodities sold in all pharmacies in the public health-care system. Applying bulk purchasing of vaccines will drive down the price by engendering price competition. Bulk purchasing of vaccines will reduce vaccine costs and likely increase immunization coverage in the U.S.
To be sure, African countries may be better about addressing vaccine-preventable diseases because they have seen more recent outbreaks (aside from the very recent ones in the U.S. and Europe) and so they are more aware of the dangers and impacts on their economies. It is likely that more people in the U.S. and Europe have gotten over-confident that it won’t be a problem because there haven’t been big recent outbreaks until now.
To eradicate measles and other vaccine-preventable diseases, countries who have outbreaks must learn from those that do not. Communities should be constantly educated on vaccine safety to improve confidence. Then parents and caregivers can allow their children to be vaccinated.
Dr. Ifeanyi M. Nsofor M.B.B.S is the CEO of EpiAFRIC and director of policy and advocacy at Nigeria Health Watch. He is a current 2019 Atlantic Fellow for Health Equity at George Washington University and a 2018 New Voices Fellow at the Aspen Institute. He has written opinion pieces for Devex, African Arguments, AllAfrica and Vanguard Nigeria. Follow him on Twitter: @ekemma.