MYour son had his first vaccination a few hours after entering the world. In the London Borough where he was born eight years ago, tuberculosis rates were high. When a nurse appeared at my hospital carrying the BCG vaccine, I offered my baby red and roaring without hesitation for a moment.
Since then, he and his sister have received all the inoculations. I gladly and gratefully present them to each syringe and nasal spray, convinced that I am convinced by the scientific consensus that they are safe, effective and essential public health tools.
In the UK, the vast majority of parents do the same and vaccinate their children according to the NHS calendar, which recommends routine immunization at every stage of the child's development. It is therefore tempting to ignore the deniers and skeptics, to regard them as extremists peddling plots and unfounded theories. Except this strategy seems to fail – with potentially catastrophic consequences.
The virulent opposition to vaccines is as old as the vaccines themselves. In the 18th century, Edward Jenner's smallpox vaccine caught the wrath of religious groups, which inflamed their parents. Andrew Wakefield's discredited 1998 document linking the measles, mumps and rubella (MMR) vaccine to autism has caused widespread panic around the world. In 2016, his film Vaxxed: From concealment to disaster has increased again. The "anti-vaxxers" are now back on the scene, amplified by the far west of social media.
Yet this is not the group that is causing the most concern. Among the top 10 global health threats described this year by the World Health Organization (WHO) is "reluctance to vaccinate". This group – the undecided ones and the questions – is much more difficult to define. They are not loud on social media. In fact, many keep their concerns confidential for fear of censorship. But they have researchers and health professionals very worried.
Last month, the world's largest survey of attitudes towards immunization revealed a crisis of confidence in Europe. The Wellcome Global Monitor survey, based on data from 2018, found that in France, one in three people believe that vaccines are not safe. In Ukraine, only half of respondents trust their effectiveness. Both countries have recently experienced measles outbreaks.
In the UK, meanwhile, the proportion of children receiving both doses of MMR vaccine before their fifth birthday has fallen for a period of four consecutive years to reach 87.2%, which is significantly lower than the 95 % that are necessary for the protection of the population. In June, Public Health England (PHE) reported a fourfold increase in the number of measles cases compared to the previous year.
What has caused people to question a public health intervention described by PHE as the second goal, aside from drinking water, to save lives? Can listening to the growing number of "hesitant" parents explain how to counter this trend?
"I understand that there may be an increase in measles in the world. But weigh yourself against someone who tells you that his child has been deeply touched by the vaccines, "says Haru, a Londoner who works in the music industry. Her one-year-old daughter would normally have been vaccinated at 8 weeks, 12 weeks, 16 weeks and around her first birthday. They could have protected themselves against a list of diseases longer than his small arm: diphtheria, tetanus, whooping cough, polio, hemophilus influenzae type B, hepatitis B, meningococcus group B, rotavirus gastroenteritis, 13 infections. pneumococcus, meningitis, measles mumps and rubella.
However, Haru and her partner have decided not to vaccinate their daughter until now. "My parents are putting a lot of pressure and it's very difficult," he says. "But one thing that really helped me, is the brother of a friend who said," My child has undergone all the vaccines and has never been the same since – but much less alert. "You only need one experience of this type and you will ignore everything you've heard, because it's someone who has nothing to gain anyway." . "
Haru is far from being the only one to let himself be influenced by the anecdotes of his peer group. In 2017, WHO released a guide for public health spokespersons facing the daunting prospect of engaging "voice deniers" in the debate. "The more people read about the side effects of vaccines, the more their perception of the risk of side effects will be high, even if they know the baseline rate," the report says.
Meanwhile, the success of immunization programs means that most parents in developed countries hear little first-hand accounts of the horrors of the diseases they protect against, leaving vaccination in the hands. "I'm sure if people started to die in large numbers, I would be much more worried," Haru admits. "I am much more concerned about pollution."
When he expressed his doubts to his peers and members of his family, he claimed that he was being felt as an extremist. "One of the things that worries me is that my child is being ostracized by other parents." But, it is telling: he has found countless online resources to feed his fears: videos of people claiming to be doctors and nurses who do not vaccinate their children. . On social media, of course, the strongest voices do not belong to public health organizations, nor to the majority of parents who quietly and happily vaccinate. A 2010 study, published in the peer-reviewed journal of health psychology, suggested that people only need to go to anti-vaccination websites for five to ten minutes to better understand risks and risks. avoid vaccination to decrease.
Dr. Stuart Blume, professor of anthropology at the University of Amsterdam and author of Vaccines: How vaccines have become controversial, says it is too convenient to blame reluctance vis-à-vis vaccines "to stupidity and the fight against vaccination. Because it saves the public health system from having to ask: are we doing something wrong? This avoids the need for self-reflection. "
According to Blume, there was a time when people trusted what they were told and that doctors could simply ask people to get vaccinated. "Since then, many things have undermined people's trust; some are in the vaccination system and others are wider and deeper. "
He underlines the simultaneous rise of populist politics. "We see the same disgruntled people as those behind Trump, Salvini and even Brexit. It's the systemic dissatisfaction, the loss of confidence and trust. Vaccines, manufactured by major pharmaceutical companies and regulated by governments, are a prime target for those who are wary of the people in power.
Annabel has two children, aged eight and four. Their works are hung on the walls of his living room, accompanied by a certificate that the elder has recently received at the school. He had some routine vaccinations. His sister, however, had less – and not the MMR.
Annabel is highly educated and works in the field of public health. She explains, "A little bit of me wants to trust the authority of public health and play a role in the public health program by supporting the immunization program." She adds, however: "The MMR did not feel 100%. "
These are his concerns: In the 1950s, a registered polio vaccine was found to be defective and resulted in the death of several children in the United States. "Although the methodology to make them has changed completely, this historical event, combined with knowledge about the harmful side effects of many drugs, fueled my reluctance," she says. "Combine all this with a fairly strong mistrust of the data. [in the late 90s] and the relatively low risk of immediate exposure to the disease and you have a very reluctant person. "
Annabel recalls the panic that spread after Wakefield's 1998 report. "I reached an age when she was really affecting me," she said. Despite many subsequent studies firmly discrediting any link between vaccination and autism, his suspicions persisted. "You'll think I'm angry, but I convinced myself, after my elder's MMR, that I had noticed some behavioral changes."
He is now a healthy and adorable boy, precociously funny, intelligent and sporty. Yet, with respect to her second child, first-hand experiences with health professionals tipped the scales. "A very austere nurse completely dismissed my worries, refused to talk and frowned." A private pediatrician "did not have the time or the inclination to discuss risks and spoke to me as if I were stupid to consider another option ".
She stalled for a moment, then "tried to get her MMR, but the nurse could not tell if the dose would be appropriate because my child was, at this point, older than the recommended age. I did not know what to do. In the end, his daughter was not vaccinated.
"Doctors and health practitioners do not have the easy task either," says Dr. Heidi Larson of the London School of Hygiene and Tropical Medicine. "Demographic and economic pressures mean that they have less time and more people. Mothers have said, "I feel we are only a number." I think we need to work on that, to build dialogues and conversations. "
Larson and I meet in her office where for the past 10 years she has been leading the Vaccine Confidence project. Here, she and her team developed an index that measures people's attitudes about the importance, safety, efficacy, and compatibility of vaccines with religious beliefs. the evolution of opinions.
Around the world, says Larson, the spectrum between those who say they "totally agree" with vaccines and those who say "totally disagree" is vast, including "from 70% to 80% who are questioning more and more ".
The extent of this spectrum varies widely across countries and regions. The recent Wellcome report, which used the Larson index, clearly showed that Europe was the most skeptical region in the world for vaccines, with France being the most skeptical. The reasons differ at the local level. Sometimes, says Larson, this comes from mistrust in the system. Sometimes it is suspected that freedom or dignity is not respected. Sometimes it is religious beliefs; For example, nearly three-quarters of measles cases reported in New York occurred in Orthodox Jewish communities.
"Then there is the group that did not start as an anti-vaccine group, but is now part of this portfolio, anxious to raise their children in the most natural and natural way possible" said Larson, linking reluctance to vaccinate to segments of the population. Community of "natural parenthood". This movement encourages parents to question some forms of medical intervention even from pregnancy, with a focus on births without drugs.
Larson points out that the vast majority of these people continue to vaccinate, "but some people start with very sincere and responsible questions about safety. Then, when they do not get answers or feel dismissed, they feel alienated, hide something, and are much more open to some negative points of view. "
Addressing so many disparate concerns seems daunting. But, says Larson, "I do not think it's unreasonable that in this environment we take the time to try to help parents and guardians navigate this rather confusing space."
Parents often consult the general practitioner to ask him questions about what they saw online: "Difficult questions to anticipate and beyond the scope of standard training." In January, an investigation by the Royal Society Public health revealed that parents' quarters appreciated the advice of health visitors and midwives regarding immunization. Still, he noted: "A PHE report said that over time, far fewer parents said health visitors were discussing vaccination with them."
The following month, a journal published in the Journal of Advanced Nursing examined the influence of licensed practical nurses on the adoption of MMR. He noted that training and annual updates are essential to stay abreast of the evidence on which national immunization programs are based "and pointed out that in the past, nurses had found it difficult to keep up to date. This can change, however.
PHE and the Royal College of Nursing publish training standards and a curriculum for all health practitioners participating in immunization programs in the UK. The latest version, updated in February 2018, recognizes that doctors and nurses play a crucial role in the parents 'decision: "A follow-up survey of parents' attitudes conducted in England in 2016 revealed that 71% of parents had had a discussion with a health professional before the birth of their child. must be immune. For those who were undecided … 60% said they were more confident about immunizing their child after their discussion. "
The alternative, of course, is to make vaccinations mandatory. In May, Health Secretary Matt Hancock told the BBC's Today program: "I do not want to be forced to reach the mandatory vaccination point, but I'm not going to exclude anything. ". He added, "Not being vaccinated A good reason is wrong, people who campaign against vaccination are campaigning against science." Last month, the British Medical Journal posted an article on its blog stating that UK should consider "denying children to go to nursery or school until their vaccines have been updated."
This may seem like a good solution for those who have no doubts or, more convincingly, for parents of children whose compromised immunity means they can not be vaccinated and who therefore rely on so-called "herd immunity" provided when a critical mass of other people is immunized. But, as Jo, the mother of a seven-month-old child tells me, "For those who are predisposed to conspiracy theories, imposing vaccines does not look good."
As we speak, Jo bounces his baby on his lap. She is particularly concerned about vaccines: "I had a very severe eczema throughout my childhood. At each shower or bath I took, I screamed in pain because there were open sores on the arms and back of the legs. I had a beautiful childhood, but this pain is one of the lasting memories. My mother is absolutely categorical: it is because of the polio vaccine, that it happened right after I received it.
Jo, who is critical and questioning, says, "It's a thought I grew up with, so it's pretty hard to dislodge. This is the fear for me when it comes to my son.
She decided not to give him BCG and rotavirus injections, considering them as non-essential. Giving her the suggested routine vaccinations for babies at two, three and four months was "an extremely painful and difficult decision," she says. "I've been inundated with tears for days. I would have done anything to avoid making a decision that, in my opinion, might cause him disabling eczema for the rest of his life. "He had the stings and was still a healthy and happy baby, but Jo still worries that the vaccines may give him too much stimulation, immune system and allergies." I only have five months left before he returns for the MMR and I'm still on the fence, "she says." I plan to do only measles immunization and pay the price, although I have to do other research. "Some Private clinics import measles vaccines that are unique in the UK The NHS strongly defends them, describing them as noticeably safer, but wonders if this could mitigate the impact on his son's immune system.
Yet, even though Jo has a first-class mathematics degree, this research is proving difficult. "There is a lot of hyperbole about hazards, with no reference to supporting evidence. However, on the vaccination side or the NHS websites, there was no real mention of potential long-term risks. They mention short-term side effects: your baby may have an immediate fever. But I just do not think there can be any chance of long-term side effects. "
The Vaccine Knowledge Project website is designed to counter this mistrust of data. Managed by the University of Oxford and endorsed by the Vaccine Safety Network of the World Health Organization as an independent, authoritative and authoritative source of information, it answers questions frequently. asked by parents and doctors, and provides detailed lists of vaccine ingredients and their potential. -effects. "Nothing in life, including vaccination, can be totally risk-free," he says, "but so far everything indicates that vaccination is safer than non-vaccination." Nothing indicates that the vaccination weakens the immune system or triggers allergies, he adds.
In the case of MMR: "There are now a large number of studies that show no link between MMR vaccine and autism." It lists the side effects, including the fact that up to one in 10 will have a temperature rise, a loss of appetite and a rash resembling measles for two to three days. Temporary joint inflammation is rare in children, but more common in adult women, whereas about one in 50 children will experience symptoms resembling those of mumps.
One in 1,000 people at each dose may have epileptic seizures, while one in 24,000 causes "a rash of small bruise-like spots." The website points out that, as with any vaccine, drug or food, there is a very low risk of anaphylaxis (severe allergic reaction): "In the UK, between 1997 and 2003, 130 cases anaphylaxis in total have been reported. . Approximately 117 million doses of vaccine were administered in the United Kingdom during this period. This means that the overall rate of anaphylaxis is about one in 900,000.
Dr. Manish Sadarangani, director of the Vaccine Evaluation Center at the University of British Columbia in Canada, tells me that "there are no long-term side effects consistently associated with any of the commonly used vaccines." (The website of his organization emphasizes that he is "distinct from government and vaccine manufacturers and provides independent and expert evaluations of vaccines.")
Indeed, the long-term risks associated with the vaccines used today are, he says, "as close to zero as one can say," because of the rigor of testing and surveillance systems. to which they are subject. By the time vaccines passed the lab tests, animal tests and three phases of testing increasingly important to obtain a license for public use, "they were administered to thousands, even tens of thousands number of people, usually in several countries. countries.
All test data – good and bad – should be submitted to regulators, such as the US Food and Drug Administration, the Medicines and Health Products Regulatory Agency or the European Medicines Agency. It is these, says Sadarangani, who decide whether the drug will be allowed to be used, not the big drug companies that so many parents are reluctant to get vaccinated.
And in the case of routine childhood vaccinations in the UK, there is another controller: the Joint Committee on Vaccines and Immunization, which reviews data on the safety and efficacy of each vaccine when It is introduced in the calendar, not just isolation but in the context of other inoculations. Even when children start using them, "there is so-called phase four surveillance. Any undesirable event that occurs after the delivery of a vaccine is still to be reported … This information is collected and collected, "says Sadarangani.
I feel a sigh of relief. The worry is contagious, especially in children. Although my rational stance on the issue did not shake me, after a week of discussions with reluctant parents about the vaccine, I still found my nerves in crisis.
How could the wealth of information be better communicated? "Hesitation is a specter," says Sadarangani. "We put a lot of emphasis on the very small number of people, the leading anti-vaccine people who will never change their minds, anyway. But I would say that most of the others just have reasonable questions and they want answers. These are the people we have to talk to.
Shortly after my conversation with Sadarangani, an email arrives. This is from Annabel. She has just read "a story about the regret and devastation of parents who did not vaccinate and whose children then became ill. M & # 39; s intention to do them. General practitioners remind me today. "
A few hours later, she writes again: "This time, the nurse told me that there were guidelines for children who needed to catch up. She did not put me through a bad time, was very nice and made things easy. We are going there on Monday.
• Some names have been changed. The WHO Vaccine Safety Network is a global network of websites providing reliable information on vaccinations.
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