Avenging the measles outbreak requires local heroes not superheroes

Breaking News: ‘Avengers’ moviegoers in California may have been exposed to measles

So said the CNN headline scrolling at the foot of the TV screen in my Montreal hotel bedroom last week.

The warning was being given by public health officials to parents of budding young superheroes who may have attended the same showing as a woman with measles.

But this is no longer a case of ‘Houston, we have a problem
– or Fullerton, Organge County, California, in this case. The US is in fact having its biggest measles outbreak for 25 years. Cases are on the rise in the UK and other parts of Europe. The World Health Organisation (WHO)reported earlier this year that cases were at that time up by 300% worldwide in 2019.

So perhaps we can forgive the Health Secretary, Matt Hancock, for his characteristically Avenger-like delivery when he said this weekend that the Government were considering all options including compulsory immunisation to control the problem. Over the last few weeks he has also been thinking aloud about leaning heavily on social media companies to remove anti-vaccination content from their sites.

He is not alone. Other countries are thinking along the same lines. Germany is considering fines. Italy is already banning unvaccinated children from schools. The US is peppered with state laws and regulations – pre-existing and in response to current outbreaks – in an attempt to get things under control.

It is a worrying situation to put it mildly. But whatever measures the Health Secretary does decide to take it will be important to understand and be open about their limitations, to recognise that it will take more than the might of the law to turn things round. Rules and regulations have their place. But they tend to be a hammer to crack a nut and often an ill-directed one at that.

At the Montreal meeting I was attending – a global public involvement ‘summit’ to think about future challenges and opportunities in public involvement in both care and research – more than one speaker eloquently also reminded us of the general fact that many citizens and families rely on and trust informal networks of friends, neighbours and communities for information more than they do facts and evidence as presented by ‘officialdom.’

Two years ago the Academy of Medical Sciences similarly reported that ‘Only a third of the public trust the evidence from medical research, a survey for the Academy of Medical Sciences has found—half as many as trust what their friends and family tell them about medicines.

The presumption that this refers to people of a lower socio-economic status does not always seem to be borne out by evidence on low take-up of vaccination around the world which indicates similar phenomena at both ends of the social spectrum but for different reasons. For those who feel forgotten by or above the law, the threat of courts or fines hold no fear. It will perhaps hit hardest those who would respond better to other means in my view.

Nor will shouting at people louder and louder.

That means local, community based initiatives to me. This is a great piece in the Wall Street Journal from a few days ago about local initiatives in New York City to develop and spread information within Ultra-Orthodox Jewish communities about the importance of vaccination.

And this is another good article in the Economist (paywall) looking at the need for pro-vaccine voices to be more proactive and tell their story more effectively. It seemed telling to me that in the former example the local campaigners had to self-fund much of what they did.

To be fair there is a clear place for this sort of approach in Public Health England’s latest strategy published in January. I’m just not not clear what it means in practice and would be interested to know. In the meantime you might be interested in this NIHR 2016 study which looked at the costs of dealing with a measles outbreak and how this is 20 times more expensive than preventative measures. A sobering finding whatever your perspective surely?

Anyway, even Superheroes get vaccinated. Just ask Captain America,

(By the way this is an excellent and well-considered blog by Fiona Fox at the Science Media Centre on some of the evidence and background behind the issues in the UK. I am not sure we agree on every point but tend to concur with our respective conclusions)

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