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In February of this year, holidays in paradise turned into a nightmare for a French family. Shortly after arriving in Costa Rica, their unvaccinated five-year-old son contracted measles, the first case in the country since 2014. Parents, also unvaccinated, have also been tested positive for the virus. It was thought to have brought from France.
The family was quickly quarantined and the Costa Rican authorities contacted people in danger. A few weeks later, two American children – again unvaccinated – also contracted measles in the country. Once again, the authorities had to act quickly to contain it.
Measles is more contagious than Ebola, tuberculosis or influenza. It is devoid of specific treatment and can be detected in the air or on surfaces until two hours after the passage of an infected person. Because it is so contagious, health experts see it as a warning sign of vaccine coverage problems.
"Measles is like a canary in the mine," said Heidi Larson, director of the Vaccine Confidence Project and professor of anthropology at the London School of Hygiene & Tropical Medicine. To protect a population from measles, she said, at least 95 percent of people need to be vaccinated – a higher threshold than most other infections. This means that if vaccination rates begin to drop, "it will be the first to show its ugly head".
At the last measurement in 2017, Costa Rica had a 96% vaccination rate for the disease – a clear sign that its people should not have been in danger for each other. In the same year, the coverage of measles in France was only 90%.
This is not surprising given the widespread concern over childhood vaccines in France. One in three think vaccines are unsafe – the highest rate in the world – and nearly one in five believe they are not effective – just behind Liberia. According to new data from the Wellcome Global Monitor, a global survey of more than 140,000 people in 144 countries.
France may be at the end, but it is part of a global trend that worries many health experts.
Confidence in immunization programs is essential to maintain high immunity rates. But throughout the European Union, people delay or even refuse vaccines, which contributes to the increase in epidemics.
Between 2010 and 2017, more than half a million French children did not receive the first dose of measles vaccine. Last year, France was among the ten countries with the highest annual increase in measles, with confirmed cases rising from just over 500 in 2017 to nearly 3,000 in 2018.
According to the World Health Organization, reluctance or refusal to vaccinate is now one of the top ten threats to global health. One manifestation of this is that even people in high-income countries with good health systems are dying of easily preventable diseases. More than 70 people died of measles in Europe in 2018, including three in France.
"It is a tragedy for Europe that a child or adult has died as a result of preventable disease," said Patrick O'Connor, Chief of the Vaccination and Immunization Program developed by WHO in Europe. "We owe them to protect them."
A critical mass of unvaccinated people produces a forest fire effect, O'Connor added. "Next year, this could be diphtheria or a variety of things."
"The good news is that many skeptics, who do not think vaccines are safe, continue to vaccinate their children," said Hania Farhan, senior director of methodology at Gallup, who conducted the Wellcome Global Monitor survey.
This is true for France, where vaccination coverage rates exceed confidence levels. But the measles outbreak shows that for some diseases, coverage needs to be further improved.
"It's all about money for pharmaceutical companies," said Priscille, a young mother living in Paris. Like many French parents, she is not sure whether to vaccinate her child. The 25-year-old woman doubts the effectiveness of the injections and fears to damage her baby's immune system, even though there is no evidence to support these fears.
"I think that the immune system is built and that if it is broken somewhere, it becomes complicated," she said, holding her daughter Madeleine in the family's apartment. "The basic idea of a vaccine is perhaps very good. But the vaccines we have today are not good enough. "
This lack of confidence in vaccines, despite overwhelming evidence of their safety and efficacy, can be attributed at least in part to the French government's mismanagement of a series of medical scares.
A scandal for blood transfusion shook the country in the 1990s. In the previous decade, thousands of people infected with HIV had received blood – most of them before the blood-HIV connection. and AIDS is not fully understood. Many who received tainted blood died.
World headlines shouted Transfusion of death and Ministers of the blood scandal walk free that the world's media have been following for almost a decade.
Edmond Hervé, former Minister of Health, was convicted of playing blood contaminated with HIV to two people, but did not serve his sentence. It would have been delayed by the introduction of a blood screening test developed by a US company until a competing French product is ready to be marketed.
After this scandal, health professionals claimed to have developed multiple sclerosis after receiving the vaccine against hepatitis B. Although the WHO investigated and concluded that there was no evidence of a link, the government suspended its vaccination program in schools and promised to conduct an investigation to calm the outcry.
"But suspending it has also raised suspicions," said Heidi Larson.
Then, in 2009, the controversy surrounding vaccination against the H1N1 flu pandemic resulted in an "absolute and total loss of confidence," Larson said.
France had ordered 94 million doses of H1N1 vaccine at a cost of nearly 1 billion euros. It was enough to inoculate two doses to about 80% of the population. But by the time most of the vaccines had been delivered, it was realized that only one dose was needed and that, in any case, the pandemic was less dangerous than it was. thought initially. By the end of the vaccination campaign in January 2010, less than 10% of the population had come forward and the government was trying to cancel or sell its surpluses.
"The public was unhappy with the WHO for what it thought was a risk overrun, of the government having bought so much vaccine," Larson said.
The percentage of people in favor of vaccinations fell from 91% in 2000 to 61% in 2010, according to the National Health Agency Public Health France. In 2016, it had recovered somewhat, but only at 75%.
Until the late 1980s, French media rarely covered scandals related to health. Journalists have focused on the great achievements of medicine and have used almost exclusively high-level professors at major universities, said Jeremy Ward, researcher on vaccine hesitancy at the VITROME laboratory in Marseille.
"The HIV epidemic and the blood transfusion scandal have changed everything," Ward said. Newspapers have invested more in their health coverage, researched issues and controversies, and reported on patients' experiences.
More recently, as in many other countries, social media has allowed the rapid spread of alarming stories and misinformation about vaccines. The Facebook Info Vaccines France group, for example, has a series of testimonials from parents stating that their children have died or become seriously ill as a result of routine inoculations.
Part of the problem lies in the fact that if a person in millions only has an adverse reaction to a vaccine, his story will spread and fly off on social media, without a broader context, said a doctor based in Paris.
Some of these online people are campaigning for freedom to choose whether to vaccinate or not. Others seek to counter what they say is a conspiracy of silence around the harmful effects of vaccines.
Some are even doctors themselves. Henri Joyeux, former surgeon and honorary professor of oncology at the University of Montpellier, has been a leading campaigner against injections containing aluminum. It is used in some vaccines to strengthen the immune response and make a vaccine more effective and sustainable.
Merry, who was almost stricken from the medical profession for his ideas against vaccination, launched a campaign against Infanrix Hexa – the six in one for children – in 2016. He has since collected more than a million signatures.
Vaccines against certain diseases – such as polio, diphtheria and tetanus – are important, he said. But his complaint against Infanrix Hexa is that it contains aluminum and formaldehyde, "dangerous substances for humans and especially infants, likely to cause a serious disease, macrophagic myofasciitis". Infanrix Hexa, he said, also contains "the vaccine against hepatitis B suspected to be linked to multiple sclerosis".
Campaign materials continue: "In addition, vaccinating children against six serious diseases at once is a risky medical procedure that can trigger an uncontrolled immune response. [anaphylactic shock] and increase the risk of long-term autoimmune disease. "
The scientific consensus – within the European Medicines Agency, the Vaccine Knowledge Project, the British NHS and others – is that Infanrix Hexa is safe.
"There are many rather negative, discouraging and sometimes scary enough documents about vaccination on websites," said Larson, while "aluminum" is France's appalling big bogeyman ".
O'Connor at WHO sadly sad to see that health professionals are fighting around the world. "Fervent or militant resisters are very strong on social media and other forums," O'Connor said. "People take that into account and then they have a lot of questions."
In response, French health organizations disseminated information on social media platforms, including Twitter, Facebook and LinkedIn. They financed YouTube videos as No bullshit about vaccines, which has received more than 350,000 visits in 18 months and sometimes engages directly in online discussions.
Following a recent outbreak of measles, a representative of Public Health France presented to mothers discussing Doctissimo, a website created by two doctors to disseminate reliable information on health. He reminded mothers of vaccine rules and answered their questions and concerns.
"It's a lot of work," said Sylvie Quelet, director of health promotion and prevention at Public Health France.
"It is very important that communication about immunization continues and is always there in the face of misinformation," she said. "The battle is not won."
"All my patients are concerned about vaccines," said Véronique Dufour, pediatrician and vaccine expert. "The vaccines are intrusive, so it's normal for them to ask questions."
Dufour is the deputy chief physician of the maternal and child health center in Paris. There are similar centers throughout France offering medical education and support for children, mothers and pregnant women.
She said her work had become much easier since the government had increased the number of compulsory vaccinations from three to eleven in January 2018.
Previously, the three mandatory vaccines – diphtheria, tetanus and poliomyelitis – had good vaccination rates of 95% or more. But eight other vaccines, including measles, meningococcus C and hepatitis B, were only recommended – and there was less coverage. Now, unless there is a medical exemption, children must have received these 11 vaccines in order to attend a public school.
"People are asking fewer questions," said Dufour. "Very very few are not vaccinated."
Doctors say the law change made it clear to the public that all vaccines are important.
The first signs are that trust in vaccines is increasing since the change in the law. A small study conducted last February on parents of young children found that 91% of respondents believe that vaccination is important for the health of their children and 87% in the protection of the general population. Both figures show a 5% increase over a similar study conducted in June 2018.
Vaccination rates have also increased. The percentage of babies receiving the first dose of meningococcal C vaccine has increased from 39% in 2017 to 76% in 2018. During the same period, vaccination rates against hepatitis B, human papillomavirus and measles also increased slightly. France aims to achieve 95% coverage for all vaccine preventable diseases, with the exception of influenza, where the goal is 75%.
The new law was born from an extensive consultation aimed at determining how to restore confidence in vaccines and improve immunization rates. The government launched the consultation in 2016, which involved both citizens and health professionals.
"There was confusion between mandatory and recommended vaccines," said Magid Herida, a senior vaccine expert with the Ministry of Health. "People understood that if it was recommended, it was not so important."
The consultation also suggested creating a public website containing information on vaccines – vaccination-info-service.com – which now has about 250,000 unique visitors per month. A more comprehensive website has been created for health professionals.
The Ministry of Health is also studying ways to simplify the vaccination process. In most cases, parents must get a prescription from their doctor, buy the vaccines at a pharmacy and store them in their refrigerator, and then make another appointment with a doctor to receive the injection.
Compulsory vaccination is one of the most effective ways to increase immunization rates, according to WHO. Indeed, France is not the only member of the EU to impose a large number of vaccines for children. The others include Italy, Hungary, Bulgaria, Croatia, the Czech Republic, Latvia, Poland, Slovakia and Slovenia.
The WHO cautioned, however, that this approach may also lead to a reluctance to vaccines – "not necessarily for safety or other reasons, but for reasons of resistance to the concept of forced vaccination ".
"Removing the freedom of choice can easily seem authoritarian," said Jeremy Ward at VITROME. In the highly politicized environment of France, he said, this could spur a minority that previously hesitated to become a creeping anti-vaccine.
There could also be an increase in the number of children benefiting from medical exemptions, he added, who are expected to apply if a child is allergic to eggs or if his immune system is too weak. "There are doctors in France – as in all other countries – who provide false medical exemptions," he said. "When you talk to people who work in private schools, many tell you that many children are not vaccinated and that school principals do not check." For some parents, this makes private schools more attractive.
Parents like Priscille plan to keep their children away from public crèches and send them to alternative schools outside the public education system.
"I'm lucky because I do not work, so I do not need to put them in the nursery, so I have a choice between vaccines," she said. declared.
The laws are relatively quick to change. Attitudes and behaviors may take longer.
Sydney pediatrician Sebban, sitting in a cafe near Notre Dame Cathedral, in the aftermath of the fire that ravaged her, said doctors needed to take the time to restore trust with parents.
He begins to do this when they bring their baby for the first time at the age of 15 days and he asks them about immunizations, in addition to diet and sleep. It's about listening to their questions, taking time and providing them with quality information, he said.
"I tell them there is no zero risk product," he said. "There is no such thing. People need to think about the side effects of ibuprofen or antibiotics. And I asked them, "How did you feel when you were vaccinated?"
It encourages parents to talk to their parents and grandparents about diseases that have been forgotten since the start of the large-scale vaccination.
"You can wait, but not too much because the main goal of immunization is to protect the child before he is at risk," he said. "If you approach the exhibition, it's too late."
According to the European Center for Disease Prevention and Control, diseases such as measles will continue to spread in Europe unless vaccination rates are durably increased.
"The most devastating consequence of hesitation with respect to the vaccine, or an improper adoption of the vaccine, would be a resurgence of life-threatening or life-altering vaccine-preventable diseases, currently well controlled or whose disposal is targeted, "said Mike Catchpole, the center's scientific manager. .
Overall, most experts believe that the public must be reminded that vaccines protect lives against deadly diseases that few people in Western countries have ever experienced.
"Vaccines are one of the best public health interventions we have and they work," O'Connor said. "We just have to make sure people understand that."
Among officials, doctors and academics, there is cautious optimism about the continued rise in vaccination rates in France.
"France can bring down skepticism with extraordinary efforts," Larson said. "But I think it will never completely disappear."
Alex Whiting is a freelance journalist who writes about food security, climate change, health issues around the world and everything Italian. She wrote for the New York Times, Reuters, New Strait Times, Sydney Morning Herald and many other publications around the world. She lives in Rome with her husband and dreams of growing organic vegetables.
This article first appeared on Mosaic.
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