RESEARCH PAPER ON MEASLES VACCINATION IN

EUROPE

Get your shots:According to the World Health Organization, measles infections hit a record high
in Europe, with more than 82,500 people having contracted the disease in 2018.
Considering the increasing number of unvaccinated people, what measures should the EU take so
as to prevent epidemics and strengthen routine immunization among its citizens?

1.Context and background

“On the darkest day of 2018, the winter solstice, we at the Center for Vaccine Research at the
University of Pittsburgh tweeted, with despair, a report in the Guardian that measles cases in Europe
reached the highest number in 20 years.”

Measles is a disease caused by a virus which is normally passed through direct contact and through
air. The virus infects the respiratory tract, then spreads throughout the body. Signs of measles typically
include fever, dry cough, inflamed eyes, sore throat, white spots inside of the mouth and skin rash. But in
severe cases complications it can lead to blindness, pneumonia or death .Measles is not known to occur in
animals, and so humans are the only natural host.

Before vaccination-era, most people would be infected during childhood as measles was endemic in
Europe. Outbreaks were regular, occurring in 2-5 year intervals, meaning few people beyond 20 years of
age would remain susceptible .In the 1960’s immunization against measles started and has dramatically
modified the disease’s epidemiology. Measles is no longer endemic in most European countries but it is
common to outbreak from imported cases in countries where subgroups of the population have low levels
of immunity. Despite availability of safe and cost-effective vaccines for measles, more than 100,000
people die globally from the illness each year, the majority being children younger than five years old in
developing countries. While in the developed world it almost disappeared, it has recently returned as a
retribution thanks to rising vaccine hesitancy.

According to the World Health Organization (WHO), more than 82,500 people contracted measles in
2018, despite the fact that more European children than ever before were being vaccinated against the
highly-contagious infectious disease .As a result, two thirds of people were hospitalized and 72 people
died. 45% of measles cases with known age were aged 15 years or older – highlighting gaps in cohorts of
individuals that missed-out vaccination. The total number of infections last year is 15 times higher than
the record low just two years ago, and three times higher than the total reported in 2017. The distribution
in the European space of WHO was not even, more than 90 per cent of measles cases were concentrated
in just 10 of the 47 countries that record infections .Leading the list by far was Ukraine, with 53,218
reported cases in 2018.It has been shown a correlation between low vaccine confidence and high rates of
measles outbreaks. While over 80 per cent of people in the UE think the measles vaccine is important and
safe, attitudes vary dramatically across the region.
 2.Key Conflicts
In the first place, I would like to state the fact that even though vaccines proved to be efficient in
preventing outbreaks of measles by high coverage, there are still some potential risks when talking about
administrating the MMR vaccine. A highly effective method of making high coverage a reality is by
making vaccination mandatory. A problem that might be involved in this measure is ethical in nature.
Even though the method proved to be highly efficient in eliminating epidemics of measles (in the US for
example measles have been eradicated for years), a debate is taking place on whether is it morally right to
enforce parents to make their children take medicines that could potentially put them at risk of different
nature (like autism, even though there has not been found enough scientific evidence to link it with the
MMR vaccine, there are still some doubts on the safeness of it).

To be more specific, the conflict is between the parents that fear vaccines due to mass-media
propaganda against it, and authority, that has the responsibility to protect it’s citizens. When a parent
chooses to not vaccinate their children due to personal belief, they put at risks those who are unprotected
from the disease because of age or compromised immune systems, cannot receive vaccines. On one side,
people feel like in democracy there is the freedom of choice which cannot be constrained by any means,
but on the other hand, society works by sharing responsibility. Those with no protection rely on the herd
immunity, which is provided only if a critical portion of a population is vaccinated against a contagious
disease. The question is whether one should play vaccine roulette with their child’s life, not being free to
make informed, voluntary decisions about which pharmaceutical products they are willing to risk their
lives for, denying freedom of the individual, or allow people to choose, but with the absolute certainty
that more and more children will suffer and occasionally die from vaccine preventable diseases.

3.Stakeholders
As expected, a lot of institutions have an impact on the process of vaccination with the targeted goal
of 95% of the population being vaccinated with MMR. The World’s Health Organisation (WHO) aims to
highlight the collective action needed to ensure that every person is protected from vaccine-preventable
diseases. It encourages people at every level – from donors to the general public – to go further in their
efforts to increase immunization coverage. Also, European Regional Verification Commission for
Measles and Rubella Elimination (RVC) verifies on a local level the implementations that regional
executives have done in order to stop the measles infection from spreading.But foremostly, it is the state’s
responsibility to protect the basic conditions for public health and societal life. National governments are
responsible for promoting and securing equal acces to basic health care, which may also include certain
vaccinations. Vaccinations are the state’s moral-political responsibility, and guide decisions-making
about the content and character of immunistion programmes.

4.Measures in place
In order to prevents outbreaks of the measles virus we need at least 95% immunization coverage with
2 doses of measles-containing vaccine. Although it increased throughout the years, large disparities at
local level persist, some meet the need, others fall below 70%. One more thing to consider it the need to
reach children, adolescents and adults who missed routine vaccination in the past, as these represent a
threat for a new outbreak in the future.
 To face this issue, some countries enforce mandatory vaccinations,and other consider this option in
the future. Various governments try to persuade citizens to undergo vaccinations and they do so through
imposing fines or placing conditions on social benefits or school admission based on vaccination status.
Slovenia is considered to have the strictest vaccine laws, and refusing vaccinations goes against the
Infectious Disease Law, the Inspection Act, and the Administrative Procedure Act with noncompliance
fines ranging from €41 for refusing to vaccinate to €500 for noncompliance in the case of an order.
However, the country allows for a medical exemption and provides compensation in cases of damage
caused by mandatory vaccinations. This strategy is clearly working, as the national coverage amounts to
95%. Additionally, unvaccinated children are not allowed in nurseries, preschools, or kindergartens (if
such a child is accepted, the kindergarten might pay a fine of up to €18 500) . Slovakia imposes fines up
to €330 per parent and no objection to vaccination is possible (including the objection to abortion cell
cultures in MMR vaccine despite 70% citizens’ declaration of being Catholic) . In Poland, vaccination
hesitancy is treated with a fine, which, even if paid, does not relieve parents of a vaccination obligation
and no compensation is offered in case of adverse events. In France, parents who refuse to vaccinate their
children might face criminal charges (with up to 6 months in prison for child neglect/abuse) and might be
fined €3750 .

5.Possible outcomes
I think that in the European Union, the issue does not stand in the inefficiency of the health systems,
or on government failure of implementing vaccine routine, but in the mistrust of the citizens concerning
the benefits of vaccine that follow outweights by far the risks of it. To counteract the fears and
misperceptions associated with vaccine campaigns, the research community and ministries of health/
federal office of public health need to be proactive with regard to continued vaccine education, guiding
public perception with rigorous scientific research on vaccine safety and emphasizing the importance of
vaccination in preventing unwanted and potentially lethal infectious diseases. In conclusion, parents who
hesitate to vaccinate their children against measles, mumps and rubella have distinct opinions and
attitudes while emphasizing healthy living. Health professionals should be aware of these perceptions in
order to positively influence these parents to vaccinate their children and to tailor vaccination messages
accordingly . Special emphasis needs to be given to those parents who are planning to vaccinate their
children but are not following the national guidelines . This group may fall behind schedule or forget to
vaccinate their children and thus create a threat for other children in case of a measles outbreak. There
might be a need to shift thinking towards a more flexible approach on the vaccine schedule following up
those parents more closely.

My final thoughts are summed up in the following quotation: “Informed refusal must remain an
acceptable choice in a free democracy, and the culture of informed consent, with both religious and
philosophical exemption, must be maintained. The difficult balancing act will be in determining the right
of the state to control an infectious disease and the right of the individual to chose.”

References
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