Measles would be gone if we wanted it to be. We’ve had a highly effective, safe vaccine for it for 60 years. But because of rising anti-vaccine sentiments, measles is back, with recent cases in Philadelphia, New Jersey and Virginia. Unless we tackle the misinformation that is at the root of vaccine hesitancy, more children will get sick from this and other nasty, preventable diseases in 2024.
The U.S. is not the only high-income country seeing measles outbreaks. Europe saw a thirty-fold increase in cases last year. In England, the West Midlands is currently experiencing its highest rates since the 1990s, with health leaders urging a national call to action on measles. Officials in Sydney, Australia have recently issued a measles alert as cases are being identified there. The problem is even worse in low-and-middle countries, with measles still common in many countries in Africa, the Middle East, and Asia. Globally, there were an estimated 9 million cases and 136,000 deaths in 2022 alone.
Measles is one of the world’s most contagious diseases, infecting about 90% of unvaccinated people who come into close contact with an infected person. Because it spreads so quickly, measles is a good litmus test for how vaccinated a population is , highlighting gaps in countries’ immunization coverage and warning of possible future infectious-disease outbreaks. The good news is that measles is highly preventable: even one dose out of the recommended two is 93% effective. Unfortunately, about 1 in 5 children globally haven’t received a single measles shot.
Vaccine hesitancy is on the rise
Global vaccination programs have stalled over the past few years due to the pandemic and other factors like conflict and displacement. However, one of the other major reasons we are seeing a measles resurgence is vaccine hesitancy. Even before COVID-19, vaccine hesitancy was identified by the WHO as one of the biggest threats to human health. It’s gotten worse since then. Ironically, at the same time the world has witnessed one of the biggest vaccine successes of the past half century—the rapid development and use of COVID-19 vaccines—global confidence in vaccines has plummeted.
Unfortunately, that’s no coincidence. ‘Spillover hesitancy” is where concerns over one vaccine can be generalized to other or all vaccines, and one recent U.S. study showed that distrust of the COVID-19 vaccine has caused some people to avoid the one for measles. In the U.S., only 79% of people now think that childrens’ vaccines are important, a decrease of more than 10% since 2020. (For a population to have herd immunity , at least 95% of people need two doses of the measles vaccine.)
This appears to be a global phenomenon. A report last year by UNICEF found that vaccine confidence dropped in 52 out of 55 countries for which data were available. Most worryingly, younger adults ages 35 and under are much more likely to be hesitant about children’s vaccines than older adults. Unless we tackle measles misinformation, vaccine hesitancy is only likely to get worse.
Misinformation’s long shadow
The infamous Andrew Wakefield paper claiming a link between the MMR (measles, mumps, and rubella) vaccine and autism is now more than 25 years old. His completely unscientific and debunked theory (the paper was later retracted by the scientific journal The Lancet) still casts a long shadow, and even though Wakefield has been struck off the U.K.’s medical register, he’s become a darling of the anti-vaxx movement. The myth that vaccines can cause autism still leads to vaccine hesitancy the world over, from Somali immigrants in Norway to parents in Kyrgyzstan. It is even the reason why some people are not getting their dogs vaccinated.
Another problem is that misinformation-and-conspiracy-driven vaccine hesitancy affects some groups more than others. In particular, those from lower-income and some racial and ethnic minority communities tend to be more vulnerable to conspiracy theories—a phenomenon which needs to be understood in relation to a long history of mistrust in medical and political authorities and experiences of discrimination and disadvantage. This partly explains lower vaccination rates amongst children in lower-income neighborhoods and some racial and ethnic minority communities.
Dual threats: measles and misinformation
Measles is a horrible disease. It can cause disability and even death in unvaccinated young children. It can also cause something called “immune amnesia,” when the immune system temporarily “forgets” how to fight other illnesses.
In countries like the U.S., only the older generations will remember what measles was like, before vaccines started vanquishing it starting in the mid-1960s. We are already starting to see a bit of “social amnesia” creep in with COVID-19, which, when combined with vaccine misinformation, is part of the reason why so few people have gotten the latest updated shot. If we as a society continue to forget how dangerous measles, COVID-19, and other infectious diseases have been in the past, this will have serious implications for public health in the future.
The globalization of misinformation is a priority for more than just measles and vaccines. In a World Economic Forum report, 1,700 world leaders and experts cited misinformation as the greatest risk to society over the next two years, ranked above threats including interstate armed conflict, societal polarization, and pollution. Misinformation is so dangerous because it can catalyze all of these threats at once, and obstruct solutions to them.
Anti-misinformation scientist Dr. Peter Hotez has argued for “vaccine diplomacy” in the fight against measles. That means ensuring that all countries globally have sufficient access to necessary vaccines and accurate information about them. Vaccinations are more divisive and political than ever. In the U.S., there is now a big gulf in support for MMR vaccines between Republicans and Democrats. Presidential candidates Donald Trump and Robert F. Kennedy Jr. have amplified vaccine misinformation and have been embraced or endorsed by anti-vax movements. Research has shown how being exposed to anti-vax messages by such political leaders on social media can intensify some followers’ vaccine hesitancy. Vaccine diplomacy therefore also requires navigating and combating the growing misinformation and politicization surrounding vaccines.
Our children’s lives—and our lives—depend on it.
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Contributor: Simon Williams