Luka Powell is a final year student of International Relations at King’s College London, her research focuses on the Middle East, Security and Foreign Policy. This article will be exploring the effects of the anti-vaccination movement on global health.
Last week, measles returned to Costa Rica after five years free from the disease. It is suspected that a 5-year old unvaccinated French boy reintroduced the disease when he visited the country with his family, highlighting the dangers of the “anti-vaccination movement” on global health security.
The World Health Organisation recently identified the top 10 threats to global health of 2019. “Vaccination Hesitancy” was a top contender. WHO defines this as “the reluctance or refusal to vaccinate despite the availability of vaccines”. The organization argues that this hesitancy could threaten to reverse progress made in tackling vaccine-preventable diseases, making it one of the biggest risks to global health security.
Immunizations currently prevent 2 – 3 million deaths annually, and if implemented further, an additional 1.5 million lives could be saved. Immunizations protect people from dying from whooping cough, measles, tetanus and diphtheria amongst others. They can also limit the spread of antibiotic resistance, a major public health concern, as they prevent humans and animals from getting infected and thus eliminate the need for antibiotics. Vaccinations are thus an incredibly important way to tackle antibiotic resistance and reduce preventable illness and deaths.
The Anti-vaccination movement
Like almost all medication, a small number of people can experience adverse reactions from vaccines, however the scientific consensus is that the risks are far outweighed by the benefits. Despite this, there is still a large movement of people refusing to vaccinate their children. The reasoning behind this is supposed links to autism and concern over the levels of aluminum and mercury.
While in existence for centuries before, the anti-vaccination movement was reborn with the publication of Andrew Wakefield’s paper in the Lancet in February 1998. The paper found a correlation between the measles, mumps and rubella vaccine (MMR) and autism and a new kind of inflammatory bowel disease, findings which no scientists or study have been able to replicate. The paper studied merely 12 children in a hospital in North London, where 8 out of the 12 families claimed their children had developed the first signs of autism 14 days following their MMR vaccine. Public outcry followed, and while Wakefield recommended the MMR vaccine should be replaced with individual shots, many chose to reject vaccinating their children altogether. Many critiqued the paper, highlighting the correlation was simply due to the fact that it is early children when early signs of autism begin to show.
In 2010, 12 years after its publication, the Lancet withdrew the paper and Wakefield was found guilty of serious professional misconduct and removed from the medical register. However, in those 12 years the anti-vaccination movement grew, and despite being debunked the movement still exists today. Wakefield moved to the United States, where he remains a figurehead of the popular movement. President Donald Trump has even expressed skepticism over vaccines, and Wakefield was an attendee of his inaugural ball. 
The threat to global health security
Social media has enabled a worldwide proliferation of the anti-vaccination message, with hundreds of Facebook groups, Instagram accounts and Pinterest boards advocating for anti-vaccinations and providing guidance for parents who do. The predominant message purported by these groups is that the drug industry cannot be trusted and vaccinations should be avoided. Despite being scientifically unfounded, the effects of this message and these groups are very serious.
For example, the childhood measles vaccination rate dropped to 80% in 2003, from 92% in 1996 in England. While measles had been nearly eradicated in the United Kingdom, the major drop in vaccination rates contributed to the resurgence to epidemic levels by 2013.  Similarly, in the USA in 2009, one quarter of parents believed that the vaccination of children was linked to autism, and as a result, despite being nearly eliminated, a number of diseases saw and outbreak including measles and pertussis. In France in 2017, only 80 per cent of the population had both doses of the measles vaccine. In some areas this figure is as low as 65 per cent. The WHO recommends that at least 95 per cent of every population needs to be immune, either through doses of vaccination or prior exposure to the virus, in order to ensure protection for everyone.
The anti-vaccination movement is being treated as a very serious threat and thus governments and the involved actors are responding accordingly. For example, in 2018 France made it compulsory for children to have 11 vaccinations, including MMR, where it was previously only 3. Numerous social media sites utilized by the movement are taking action to stifle the spread of disinformation. Pinterest, has now updated its site so that searches related to vaccinations will no longer show results, despite allowing vaccine-related content to be posted to pages. In a similar act, Youtube has demonetized anti-vaccination videos.
Vaccinations don’t just save lives, they save billions of dollars in treatment costs. Thus the anti-vaccination movement constitutes not only a health threat, but a financial one. In order to derail the movement and subsequently prevent epidemics from preventable diseases, and resultantly a potential financial crisis, a number of steps must take place. Firstly, assurances need to be made to the public of the safety of vaccinations, an increased public trust will slow down the momentum of the movement. Parents should be presented with more accessible and comprehensible information to improve their own understanding. Secondly, states must make vaccinations compulsory, to prevent those who are too young or too unwell to receive the vaccine from dying from preventable diseases. Finally, the involved actors across social media must work harder to monitor pages in support of the movement. While it could be argued that these suggestions would suppress free speech, the spread of misinformation is far more dangerous.
 Lusher, Adam. “Measles Returned to Costa Rica after Five Years by French Family Who Had Not Had Vaccinations.” The Independent. February 24, 2019. https://www.independent.co.uk/news/world/americas/measles-costa-rica-french-tourist-boy-anti-vax-vaccination-who-global-health-threat-infection-mmr-a8794256.html.
 “Ten Health Issues WHO Will Tackle This Year.” World Health Organization. https://www.who.int/emergencies/ten-threats-to-global-health-in-2019.
 “Addressing Vaccine Hesitancy.” World Health Organization. September 21, 2018. https://www.who.int/immunization/programmes_systems/vaccine_hesitancy/en/.
 Silverman, Rosa. “Whatever Happened to Andrew Wakefield? The Curious Rehabilitation of the Doctor behind MMR Scare.” The Telegraph. July 18, 2018. https://www.telegraph.co.uk/men/thinking-man/whatever-happened-andrew-wakefield-curious-rehabilitation-doctor
 Gu, Zhongyi, Patrick Badger, Jing Su, Edward Zhang, Xiguang Li, and Linqi Zhang. “A Vaccine Crisis in the Era of Social Media.” National Science Review5, no. 1 (2017): 8-10. doi:10.1093/nsr/nwx098.
 Reed, John. “Mistrust of Vaccinations Contributes to Global Measles Outbreaks.” Financial Times. February 18, 2019. https://www.ft.com/content/ab21b854-3056-11e9-ba00-0251022932c8.
 “Vaccination Greatly Reduces Disease, Disability, Death and Inequity Worldwide.” World Health Organization. March 04, 2011. https://www.who.int/bulletin/volumes/86/2/07-040089/en/.
 Gu, Zhongyi, Patrick Badger, Jing Su, Edward Zhang, Xiguang Li, and Linqi Zhang. “A Vaccine Crisis in the Era of Social Media.”