It was a damp Friday night in February, and the end of a long work week. Nicole Gommers finished tucking her happy, gurgling eight-month-old baby, Micha, into his crib, and then put his older brother to bed. Then her mobile phone rang.
“Nicole, I have bad news,” said a familiar voice. It was the manager of the daycare both boys attended around the corner from the family’s apartment in The Hague. An older girl who attended the daycare’s after-school program and wasn’t vaccinated against measles had come down with the disease. Now parents of children who may have been exposed were being called.
“It’s not Ben,” the day care manager said. “It’s Micha you have to watch out for.” Micha? But he was in the daycare’s baby section, off limits to older children because the infants were still too young to be vaccinated. It appeared the infected girl had brought the babies a toy. The measles virus can survive in the air or on surfaces for up to two hours.
The Netherlands was in the middle of a long measles outbreak that had begun the previous May in the country’s “Bible Belt,” communities of ultra-conservative Calvinist Protestants that stretch from Zeeland in the south to the province of Overijssel in the central northeast. Eventually, it would spread as far as British Columbia, 7,500 kilometres away, when a tourist exposed to the virus flew home. But surely, Nicole thought, surely Micha would be spared.
The fever started a few days later. Then he became lethargic and started vomiting, and finally, the telltale rash. Just like that, Micha became a statistic, one of 2,700 people who came down with the disease. For Nicole and her husband, Jörgen, an architect, the numbers didn’t—couldn’t—begin to tell their story of fear and fitful nights. Four and a half years later, the images and sounds still run through Nicole’s mind. Micha lying limp and unresponsive in a hospital bed, his little body covered in intravenous lines that carried fluids, supplements and antibiotics to fight the double pneumonia he’d developed; masked doctors and nurses moving in and out of the room; the slow beep beep beep of the monitor tracking his vital signs.
Even when Micha’s body responded to the antibiotics, the doctors bluntly explained there was still a risk he’d develop other conditions linked to measles. An ear infection that could leave him deaf, secondary encephalitis, in which his confused, immature immune system could mistakenly attack healthy cells in his brain, or—most scary of all—meningitis, where the membranes surrounding his spinal cord and brain could become inflamed. (Are you aware of the prescription drugs and supplements you should never mix?)
All this because one set of parents had decided that vaccinating their daughter wasn’t necessary?
What vaccines really do
Cholera. Bubonic plague. Typhoid. Influenza. Polio. Smallpox. Tuberculosis (TB). They may seem distant today, yet they’re but a few of the diseases that have caused terror throughout history, attacking silently and leaving millions upon millions of bodies behind. (These are some of the diseases that can be conquered by immunization.) Although the earliest western vaccines against disease came about in the 18th century, when British physician and scientist Edward Jenner pioneered one against smallpox, conditions really took a turn for the better in the middle of the 20th century, with the advent of antibiotics and an increased vaccination program against diseases such as tuberculosis and polio, as well as measles, mumps, and rubella, among others. No longer did people have to worry about the worst from the get-go—that their child’s cough was TB, or that a high fever and sore throat meant polio. Back then, they trusted that doctors knew best.
What leads some people to not vaccinate their children
In the past two decades, as the diseases have disappeared thanks to readily available vaccinations, both individuals and various groups—known as anti-vaxxers—have been part of a backlash against vaccines, trying to persuade the public that they have dire consequences. Some anti-vaxxers are against vaccines in general, believing that natural is always better or belonging to religious groups that proscribe putting a foreign substance in their bodies. And some believe the science is plain wrong, pointing to slickly packaged, scary individual anecdotes they find on the Internet that invoke faulty studies that have been disproven over and again to no avail.
Perhaps the most egregious of the studies was one led by now disgraced British gastroenterologist Andrew Wakefield, which caused a furor when it was published in 1998 in the respected medical journal, The Lancet. The study linked the MMR vaccine with the onset of gastrointestinal disease and autism. Retracting the paper 12 years later, The Lancet noted that the 12 children in Wakefield’s study had been carefully selected to support his theories and some of his research had been funded by lawyers acting for parents who were suing vaccine manufacturers. The British General Medical Council had found that Wakefield acted unethically and had shown “callous disregard for the children in his study upon whom invasive tests were performed.”
And yet the MMR vaccine autism myth persists even today, with vaccination rates still lagging behind what they were before Wakefield, who was struck off the British medical register, did his damage. Along with the fear over the MMR vaccine, people’s questions range the gamut of myths and fraudulent claims, including that vaccines are made with aborted fetal tissue and that Gardasil, the vaccine that fights the cancer-causing human papillomavirus, is really a toxic killer cocktail. (It’s actually one of the four essential vaccines every woman needs to be healthy. )
The clear answer is no and no. All of these factors have led Europe and much of the rest of the western world to where it is today, grappling with dangerous outbreaks of diseases that were long thought to have been quelled, especially measles—and let’s not forget that measles can be deadly.
What happens when children don’t receive vaccinations
In a village of 1,000 people, all it takes is two children to be unvaccinated to cause an outbreak that can affect hundreds, and then thousands if it moves beyond the village confines. That’s why officers at the World Health Organization (WHO) maintain that in order to protect the population at large, 95 percent of a population should be vaccinated in order to gain what is known as “group immunity,” to protect the most vulnerable: infants, the aged and those with compromised immune systems. And in Europe, with trust in vaccine safety at its lowest level in two decades, vaccination coverage is below that 95 percent mark in 22 of 29 countries.
Dr. Heidi Larson, an anthropologist at the London School of Hygiene & Tropical Medicine, says there is genuine concern about vaccine safety, but the side effects, which are usually limited to a sore arm or a tummy ache that lasts overnight, do not outweigh the risk of not being vaccinated at all.
How the world views vaccines and why
Larson heads up the Vaccine Confidence Project, a massive undertaking that monitors and measures the faith people around the world have in immunization programs. It also provides analysis and guidance to in-country health authorities on how to engage the public before attitudes get out of hand. In 2016, the project’s survey of 65,819 people in 67 countries found that most believe vaccines are important, but their confidence in them is low, especially in Europe, where a startling 41 percent of respondents in France and 36 percent in Bosnia & Herzegovina contested their safety, compared to a global average of 12 percent.
Other countries with low confidence rates include Greece, at 26 percent of the populace, Italy at 21 percent, Slovenia at 22 percent and Romania at nearly 20 percent. At the other end of the scale is Portugal, which at 4.2 percent, has one of the highest confidence rates in the world.
“Every time you take a medicine, there’s a risk,” Larson continues, “but there’s something about getting jabbed with a needle in the context where there is no hard evidence of threats from disease.”
Anti-vaxxers suspect the science behind vaccines is bad, and believe that drug companies are in it only for the profits. A quick tour of the Internet brings up news stories and studies, including one titled “New Quality-Control Investigations on Vaccines: Micro- and Nanocontamination.” Written by two Italian scientists, Antonietta Gatti and Stefano Montanari, it’s published in the official-sounding “Journal of International Vaccines and Vaccination.” Yet click further into the site and you find that the journal is published by a group called MedCrave, which describes itself as “amazed by science and its wonderful forms and we now bring this beauty to you.” Ida Milne, an historian at Maynooth University in County Kildare, Ireland and the author of Stacking the Coffins, about war, revolution and the Spanish influenza epidemic of 1918-19, is echoed by others when she says such sites are little more than dangerous rabbit holes people can fall into.
The measles crisis
Over 41,000 children and adults in the WHO European Region have been infected with measles in the first six months of 2018. It’s 70 percent more than during the whole year of 2017. Monthly country reports also indicate that, as of August 2018, at least 37 people had died from measles that year.
Over the course of 2017, major outbreaks occurred in 15 of the 53 countries in the European region; the worst were in Romania with 5,562 cases, Italy at 5,006 cases and Ukraine with 4,767. Thirty people died. In France so far this year, a measles outbreak in the Nouvelle-Aquitaine region saw more than 500 new cases in February alone and the death of a 32-year-old woman in the town of Poitiers, where 22 people, including ten children, were hospitalized. In a news release, the regional health authority stated the death should remind people to verify if they have been vaccinated and if they haven’t, to have it done quickly because that is the only way to stop an epidemic.
Around the continent, individual stories about loss and suffering are at once heartbreaking and a call to action. In Romania, Ion Pravăţăt, the mayor of Valea Seacă, a village in the central eastern part of the country, revealed that a 10-month-old baby girl died of measles in February of 2018 when her parents refused in writing to vaccinate their children after seeing reports on television that vaccines kill. “After this tragedy, the community was shocked and the vaccination rate of children increased to 85 percent,” he says.
But how do you change people’s minds? Faced with this onslaught of unnecessary deaths, some governments have decided the situation, and the potential of an epidemic, if not a pandemic, is so dire, it’s not even worth trying to persuade people to vaccinate their children voluntarily. Instead, they have made 10 childhood vaccines mandatory, period.
What happens when vaccines are mandatory
In late 2017, Italy was the first to go this route, making the vaccines a prerequisite of children entering school, yet in the wake of a national election in March, the new populist government moved quickly to weaken the regulation, eliminating the requirement that parents provide a doctors’ note as proof their children have been protected. It’s a dangerous step back, say experts. “What surprises me as a doctor is that for a child to be enrolled in a swim class, a doctor must sign a certificate of good health, yet an unvaccinated child can now go to preschool with a simple declaration from the parents,” says Dr. Roberto Burioni, a professor of microbiology and virology at the Universit. Vita-Salute San Raffaele in Milan, and the author of Vaccines Are Not An Option. “The worst case scenario in a swim class is that the swimmer dies, says Dr, Burioni, “but an unvaccinated child can infect others, as we are seeing in the current measles epidemic here, where the highest incidence is occurring in children under the age of 12 months. They’re too young to be vaccinated and can only be protected through herd immunity.”
Romania is considering similar mandatory measures as the former Italian government and France has taken the hardest line of all. Announcing the decision before the French National Assembly, Prime Minister Edouard Philippe said: “Infants are dying from measles today in France, that is not acceptable.”
Reaction to the move has been mixed. Some parents’ groups welcome it on the grounds that their children’s health and safety trumps freedom of choice. Others, including medical advocates, worry that it will backfire because people don’t like being told what to do, especially by authorities they tend not to trust any longer. “I’m not a fan of mandates,” says Larson of the Vaccine Confidence Project. “I think people should do things because they want to and believe it is good for them.” For her, the issue is all about finding the most positive ways to engage the public. This includes health professionals devoting more time to listening to patients’ fears and answering in language that is easily understood, and immunization campaigns expanding to target kids themselves.
Most of all, it requires the telling of stories that remind people of what once was and what could be in the future, of epidemics and pandemics that wiped out millions at a time, even whole civilizations. “People forget,” says historian Ida Milne. “It’s why I do the work I do. We cannot forget.”
Back in the Hague, after more than a month of ups and downs, Nicole was dozing beside Micha’s crib when she heard a familiar giggle. Opening her eyes, she saw a tiny hand reach out to grab her curly hair and she knew her son would be okay. But she also knew she wanted to stop someone else from having to go through the same nightmare. After telling the story to a newspaper, she suddenly found herself a lightning rod for those on both sides of a bitter, emotional debate. Some people were supportive, but most were filled with vitriol.
“They said that it’s an individual’s choice to vaccinate or not,” she recalls. “But my child’s right to live is more important than that.”
Today, Micha is five years old, a boy who loves to cuddle and a soccer fan who believes that one day Barcelona star Lionel Messi will knock on the family’s door and ask him to come out and play.
Recently, when Nicole bought him an ice cream cone, he thoughtfully licked it, then said: “Mum, I have a beautiful life.” “You do,” Nicole replied, thinking of how he nearly didn’t. “Oh, Micha, you do.”
Infection Prevention and Control Canada (IPAC Canada) has launched a campaign to increase vaccination and push back against rampant misinformation online. IPAC Canada endorsed B.C.’s decision to require mandatory registration of vaccinations for all students starting in September. As well, IPAC has started a social media campaign – #StartWithVaccines – requesting all provinces work collaboratively to ensure school aged children have records of vaccination. Follow the hashtag for updates.
Next, check out the top autoimmune diseases affecting women in Canada.