Risks of ‘vaccine fatigue’ in Europe – studies show economic benefits of immunisation programmes

European immunisation programmes are among the great medical success stories.

But Europeans are increasingly reluctant about getting vaccinated – with the result that infectious diseases such as measles, thought to have been defeated, are once more increasingly present in Europe.

Speaking at the European Health Forum Gastein, MEP Karin Kadenbach called for joint European efforts “to remind people” about immunisation. World Bank expert Dr Armin Fidler emphasized the high cost-benefit ratio of public vaccination programmes.

Polio and smallpox were both successfully defeated in Europe thanks to comprehensive vaccination programmes. Smallpox is now considered extinct, and in 2012 – for the 10th time in a row – the WHO European Region certified Europe as polio-free. But Europe is still suffering from other serious infectious diseases. “At the moment, for example, measles and rubella are once again raging in Europe,” the Austrian MEP Karin Kadenbach told the European Health Forum Gastein (EHFG). “The World Health Organisation has as a result had to put back its goal of conquering these diseases by 2010 to 2015. The reason for this is a falling vaccination rate, leading to an increase in infections”. Measles viruses could only be prevented from circulating if 95 per cent of the population has been inoculated, she said. But the vaccination rate was nowhere near high enough in the 53 countries of the WHO European region to stamp out this extremely contagious disease. This had dangerous consequences, as had been shown by a recent study: between 2010 and 2011 the number of measles cases in the EU has risen by a factor of four.

„As a success story, the memory of Europe’s immunisation programmes is unfortunately fading,” said Karin Kadenbach. “Paradoxically because they have been such a success.” The importance of vaccination was being disregarded because certain diseases were no longer an issue. This misled many into thinking vaccinations were no longer necessary. Controversial discussions, particularly on the Internet, had resulted in vaccination suffering an image problem. Many parents were confused and did not have their children vaccinated against measles, rubella, and so on. „For example, nearly 650,000 children in the WHO Europe Region do not receive the first dose of measles vaccine to meet the conditions for basic immunisation,” said Kadenbach. This was very unfortunate, since measles, especially, was not a trivial illness, but could lead to serious neurological damage, or affect the body’s organs, and at worst could be fatal.

Costs discourage many from getting vaccinated, as the example of flu vaccinations showed, she said. Countries which spent the least on subsidizing seasonal flu vaccination also had the lowest coverage rates. Austria, along with the Czech Republic and Poland, had the lowest coverage in Europe. The task of informing groups which were especially as risk was often neglected. „In Austria only 37% of people over 65 are vaccinated against flu, against the recommended target rate of 75%,” said Kadenbach. “By comparison, 71% of the Spanish population has been vaccinated, in Britain 70% , in France 68 % – almost twice as many as in Austria.”

Apart from economic barriers, physical obstacles might also be to blame for too few people getting vaccinated. Low-key approaches to influenza vaccination at their places of work, or vaccination stands in shopping centres, had already been shown to be a success in many countries.

For Dr Armin Fidler, senior advisor to the World Bank on health policy issues, it also makes economic sense to give substantial financial support for certain vaccinations, and where possible for these to be cost-free: „There is clear evidence that immunisations are among the most cost-effective public health interventions.”

This was even the case where vaccines are expensive, something emphasized in the WHO’s State of the World’s Vaccines and Immunisation Report: „The positive cost-benefit ratio is clearly shown by the example of pneumococcal vaccines. A US study published in 2011 shows that if there is adequate vaccination coverage in those developing countries receiving support through the GAVI Alliance development aid organisation (Global Alliance for Vaccines and Immunisation), over the period 2010 – 2019 costs of between 986 million and 1.2 billion US dollars could be avoided at a cost of about 85% of the costs that would result from pneumonia – a disease that in 2008 alone killed more than 1.5 million children in the developing world,” said Dr Fidler.

„Not included in this calculation are the other diseases that pneumococcal vaccination would spare both children and health budgets. Pneumococcus in children under five years of age is the second leading cause of acute bacterial meningitis, which is often fatal or results in severe disabilities”.

The World Bank expert argued that the issue of whether or not to pay for such medical interventions did not only apply to developing countries. Immunisation could not just prevent much severe illness, invalidity, and indeed death; it also made economic sense, said Dr Fidler. „Even in many low-to-middle-income countries, those responsible for public budgets are not only prepared to waive contributions to immunisation: they literally pay people to take part in order to boost the vaccination rate. In countries like Brazil, Mexico, and Turkey, some social services such as school fees are linked to vaccinations. Given the cost-benefit analysis, Dr Fidler said, these “conditional cash transfers” paid off.

“People have to be reminded of the importance of vaccination”, the Euro-parliamentarian Karin Kadenbach said. “This calls for a joint European initiative that brings in health experts and decision-makers.” Vaccination programmes must continue to be fully supported politically. Otherwise the risk to the WHO region was that highly-contagious diseases would recur, bringing in their wake suffering, disabilities, and death, she said. This would put huge strains on health services and parents alike: “To increase participation in vaccination programmes we need doctors who recommend vaccination, and distribute more information about infectious diseases and ways of preventing them. Not least: there there has to be enough money to support such programmes and proper administration for them.”

The EHFG is the most important conference on health care policy in the European Union. In this its 15th year, the EHFG attracts more than 600 decision-makers from 45 countries to discuss major topics on the future of the European health care system from 3 to 6 October