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In the first six months of this year there have been 41,000 cases of measles recorded across the European health region¹.

To put this into some perspective over the whole of last year there were 24,000 cases and in 2016 there were 5,273 cases ¹.

With stories such as this, I do try not to leap to assuming an outbreak is due to vaccine hesitancy issues (my own personal area of research). For instant, in my post from last Friday I talked about the introduction of the pregnancy vaccine for pertussis as a response to a resurgence of the disease. It would have been easy to jump to assume vaccine refusal as a root cause, but this case was a lot more complicated, involving waning immunity in an adolescent population and their subsequent infecting of infant siblings.

Sadly, the epidemiology of measles is a fair amount simpler than the epidemiology of pertussis. Measles has two aspects that makes it a horrifying disease and two aspect that makes it basically harmless to our modern society.

• Horrifying 1: Measles is highly infectious. The disease has a reproduction number (also known as R⁰) of around 14-18. This means that in a completely naïve community (i.e. a community that has no immunity to measles) each person with measles will go on to infect, on average, 14-18 other people. This is exaptational growth on a terrifying scale. If you know the story of rice on the chessboard (see @flyyingkiwi's post if you don’t) then you know how quickly a situation like this can get out of hand. Think wildfire, in disease form.

• Horrifying 2: Measles is deadly. Measles reliably kills around 1 out of every 1000 individuals it infects. At 37 deaths from measles this year this is in the margins of error for this statistic. That said deaths are not the only thing we care about when it comes to diseases. Measles can also cause as encephalitis (swelling of the brain) which can lead to long term intellectual disability and also lets not forget, measles is a whole lot of shit even if it doesn’t cause permanent damage.

• Harmless 1: It is very easy to prevent measles. We have a spectacularly effective vaccine (MMR) that offers lifelong immunity at a price that is easily affordable for all health systems across the European health region. While side-effects from the vaccine do exist, these tend to be mild and the chances of complications are extremely low in comparison to measles. See below for a comparison of risk between the MMR vaccine and measles ².

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• Harmless 2: Most people are immune to measles thanks to vaccination. 85% of all the children in the world has received at least one dose of a measles vaccine ³(side note: between 2000-2016 its predicted that this achievement is responsible for saving approximately 20.4 million deaths a year). Those that aren’t vaccinated are often protected by community immunity

Reasons for the current outbreak across the European region

The horrifying aspects of measles are terrifying, and the things that make it harmless work well and are readily available. So why is measles returning to Europe?

Eastern Europe

Most of the cases this year have been in the Ukraine (23,000), so this is likely a good place to start. We’ve been concerned about ex-soviet countries for a while now. Earlier in the year Romania was a concern and with today’s news it seems that Serbia has also been particularly hard hit by this continuing outbreak¹. It is possible that this has its roots, historically, with The Soviet Unions zeal to vaccinate their population:

Vaccination campaigns were used to show that if a good was truly important the state would do it, indeed, the state must do it.⁴

Campaigns, compulsory in nature, may have laid the seeds of later mistrust when independence was granted.

France and Italy

Hesitancy and vaccine refusal is high across Europe, however France and Italy are particularly sceptical about vaccination. In 2016 our group conducted a survey into perceptions towards vaccination across 67 different countries. Around 1000 people were interviewed in each country and asked how much they agreed or disagreed with a number of statements. The map below shows the response to the statement “Overall, I think vaccines are safe” the darker the red the more people either disagree or strongly disagreed with the statement ⁴.

^{Image credit and licence If you would like to explore this data for in more detail we have it in a easily accessibly form on our website here: The vaccine confidence project}

In Italy the Five Star Movement is making vaccines a political topic in a similar way to how the right wing of the American republican party has politicised climate change ⁵. France however has always had a tricky relationship with government intervention, combine that with a love of alternative medicine and the ground is fertile for vaccine refusal.

These attitudes painted a picture here that is sadly becoming the new normal for Europe. A while back I wrote a post on vaccines being a victim of their own success. It would seem that this is the outcome of that psychology on a grander scale. My worry at this point in time is that governments may panic in reaction to these statistics and put into place some terrible draconian intervention that make this issue worse.

About me

My name is Richard, I blog under the name of @nonzerosum. I’m a PhD student at the London School of Hygiene and Tropical Medicine. I write mostly on Global Health, Effective Altruism and The Psychology of Vaccine Hesitancy. If you’d like to read more on these topics in the future follow me here on steemit or on twitter @RichClarkePsy.

References

Btw, the two papers I mention in the post are both open access. Take a look and share them with your friends, they’re cracking reads!

[1]The World Health Organisation: [Measles cases hit record high in the European Region](http://www.euro.who.int/en/media-centre/sections/press-releases/2018/measles-cases-hit-record-high-in-the-european-region]
[2] Pluviano, S., Watt, C., & Della Sala, S. (2017). Misinformation lingers in memory: failure of three pro-vaccination strategies. PloS one, 12(7), e0181640.
[3] The World Health Organisation: Key facts about measles
[4] Larson, H. J., de Figueiredo, A., Xiahong, Z., Schulz, W. S., Verger, P., Johnston, I. G., ... & Jones, N. S. (2016). The state of vaccine confidence 2016: global insights through a 67-country survey. EBioMedicine, 12, 295-301.
[5] The Guardian: Italy's Five Star Movement blamed for surge in measles cases