Do urban anti-vaccine "hot spots" put children at risk? | towns

JA 30-minute drive from Portland, Oregon, is Clark County, Washington, home to one of the largest measles outbreaks in the United States. Of the more than 70 confirmed cases, the majority are children under 10 who have not been vaccinated.

In a country that had already eliminated measles in 2000, hundreds of children were out of school to avoid exposure to the disease. It's so contagious that if a child is diagnosed, all are considered to be at risk.

The outbreak, declared a public health emergency at the beginning of the year, began when an infected person from another country visited the area. It was enough for this "zero patient" to come into contact with children who had not been vaccinated. Then, when these children visited health facilities, schools, churches and a furniture store, the disease began to spread.

But why has the epidemic occurred here rather than elsewhere in the country?

Some US states, including Oregon and Washington, neighboring countries, allow the unsubscription of vaccines, allowing parents to not be vaccinated if they express a personal objection. Last year, a study published in the journal Plos Medicine revealed "hot spots" of anti-vaccine activity in 17 states allowing derogations for reasons of personal conviction, affecting the cities of Seattle, Portland , Phoenix, Salt Lake City and Austin. in particular.

"We have identified a dozen cities where many children do not get their vaccines because their parents decided not to vaccinate them for non-medical reasons," says co-author Peter Hotez. professor at Baylor College of Medicine.

"The common denominator of most of these urban areas in crisis is that they are targeted by the anti-vaccine lobby, which is well organized and well funded, with 480 websites, social networks and anti-vax books."

Living in a city means being close to millions of people every day, whether in buildings, offices or public transport. And although most of us have caught a cold at some point, we tend not to worry about catching something more serious, like measles, especially if we were vaccinated in childhood. After all, vaccines have helped keep history in the past deadly epidemics. Yet, over the last decade, diseases such as measles, mumps and whooping cough, once disappeared, have made an upsurge.

This year, the World Health Organization has declared the anti-vaccination movement among the top 10 health threats, after a 30% increase in measles cases worldwide, including in countries where the virus had been virtually eliminated.

You can catch measles anywhere, but the risks of infection are often high in areas with high population. And since it is estimated that seven out of ten people will live in cities around the world by 2050, public health is an urgent concern.

"Viruses spread easily in urban settings," says Arthur Caplan, professor of bioethics at New York University. "In addition, cities are transportation hubs that provide infected people with truck, car, train and plane routes to spread the disease around the world.

"The more unvaccinated people, especially in the cities, the easier it is to spread the disease. Anti-vaxxers put their communities and others in danger. Many people, children and newborns can not be vaccinated because of transplants, cancer treatments or immune diseases. You vaccinate to protect yourself and to protect children and neighbors who can not.

Cities are also constantly moving, offering more opportunities for spreading diseases. "Cities often have more transient populations – with people coming and going and sometimes bringing infectious diseases that can spread among unvaccinated people," says Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene. and Tropical Medicine. "Unvaccinated travelers can also contract infectious diseases among local people and transport them to other places."

Vaccine resistance movements are as old as the vaccines themselves, but the misinformation was particularly stoked when, in 1998, Dr. Andrew Wakefield, a study now retracted and debunked, mistakenly badociated measles, mumps and rubella with autism. In recent years, the anti-vaccine sentiment has coincided with the proliferation of "false news" and general disregard for science.

Anti-vaxxers may be a minority, but it does not take much to undermine "community immunity" – a form of protection against disease when a significant percentage of the population is immunized against an infection, protecting those who are not.

A recent report from the Royal Society of Public Health found that nearly half of parents of young children had been exposed to misinformation about vaccines. "Cities are generally more saturated with the media and more disinformation," says Larson.

Dr. Saad Omer, director of the Yale World Health Institute, explains Dr. Saad Omer.

"We know that at least a few years ago, although this has slowly evolved, the refusal of the vaccine has often been grouped into very urban, educated and numerous families," he said. "But it's not exclusive to this group now. Like other social phenomena, it sometimes starts in some populations, but it spreads.

Highly contagious, the measles virus can live in the air or on a surface where an infected person coughs or sneezes for up to two hours, infecting up to 14 other people. And in overcrowded cities, children too young to be vaccinated are particularly vulnerable.

Catherine Cooper lived in South London when her eight-month-old son Toby contracted the virus. We were in 2003, at a time when the use of the measles vaccine was falling as a result of the Wakefield study.

The doctor spotted the "baby with rash" and asked Cooper to queue. She asked if she could call a newly qualified doctor from the next consultation room [Toby] for her because it was likely that she had never seen any cases of measles, "she says.

"He spent the week floppy and unhappy but recovered. He caught her in the nursery of my local gym, so I guess an unvaccinated child – the crib also for older kids. "

Measles outbreaks in the United States and Europe have been declared urgent, but experts warn that the consequences of the anti-vaccination movement could be felt most cruelly in low-income countries. Preventable diseases are more likely to kill in densely populated cities with poorer health facilities.

"It's reasonable to worry about cities, not only in developed countries, but also in developing countries," Omer said. "There is a perception that the refusal of vaccination is a Western concept, but it is not. There was a refusal of vaccination during the eradication of smallpox. There is a refusal of vaccination against poliomyelitis and measles in many parts of the world. "

And anti-vaccine sentiment poses an additional risk when access to vaccines is still a problem in many cities, including London, where vaccination rates for MMR (measles, mumps and rubella to those of the rest of the United Kingdom.

"This is due to a multitude of reasons: a large mobile population that can change frequently from GPs, pockets of significant disadvantage, unregistered people," says Helen Bedford, a professor of child health at the University of Ottawa. ; UCL.

"The anti-vaccine movement can threaten people if it influences those who are undecided about vaccination, who may be concerned about the safety of vaccines but who do not have access to health professionals. that are important to allay their fears and discuss their concerns. "

For example, the 2017 measles outbreak in Minnesota – the largest in the state for 30 years – was largely attributable to faulty anti-vaccination information specifically targeting the US-Somali community of Minneapolis. In Minnesota, more than 80% of cases involved American children of unvaccinated Somali origin, which shows exactly the impact that these messages may have.

And as our cities continue to expand, improving vaccine coverage – and access to reliable factual information about vaccine safety – must be a priority for public health organizations.

"Science has shown time and time again that vaccines are very effective and very safe," Bedford said. "We need parents and celebrities, as well as scientists who talk more about the value of vaccines. We can use social media and stories of individuals damaged by diseases can be very powerful. These are the tactics used by the anti-vaccine groups – we should also use them. "

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