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When Populism Can Kill

LONDON – Unfounded skepticism about vaccines in some communities, in developing and developed countries alike, has emerged in recent years as one of the most serious impediments to global progress in public health. Indeed, it is one of the primary reasons why eradicable infectious diseases persist today.

For example, the effort to eradicate polio worldwide has been disrupted in Afghanistan, Pakistan, and Nigeria, where rule by Islamist militants has led to increased resistance against vaccination campaigns. And many high-income countries have experienced measles outbreaks in recent years, owing to fears about vaccinations that began with the publication of a fraudulent paper in the British medical journal The Lancet in 1998.

More recently, skepticism about vaccine safety and efficacy has been on the rise in Southern Europe. According to a 2016 study, Greece is now among the top ten countries worldwide with the lowest confidence in vaccine safety. And, as Greek Minister of Health Andreas Xanthos has noted, health-care professionals are increasingly encountering parents who have fears about vaccinating their children.

Similarly, in Italy, Minister of Health Beatrice Lorenzin recently warned of a “fake news” campaign, backed by the opposition Five Star Movement, to dissuade parents from vaccinating their children. Already, the share of Italian two-year-olds who have been inoculated against measles is under 80%, well below the World Health Organization’s recommended threshold of 95%. So it should come as no surprise that Italy had five times more measles cases in April of this year than it did in April 2016.

In May, Greece and Italy each enacted very different policies to respond to vaccine skepticism. In Greece, despite the fact that child vaccination has been mandatory since 1999 (unless a child has a certified medical condition), Xanthos has advocated an opt-out option for parents who do not want to vaccinate their children.

By contrast, Italy’s center-left Democratic Party government has made vaccinations against 12 preventable diseases compulsory for all children. Under a new law, unvaccinated children are not permitted to attend school, and parents of unvaccinated children can be fined for their children’s non-attendance. According to Lorenzin, the law is meant to send “a very strong message to the public” about the importance of inoculation.

In other words, two left-wing governments have responded to the same public health problem in very different ways. Whereas Greece moved from paternalism to laissez faire, Italy moved in the opposite direction.

The decision by Greece’s Syriza-led government is surely the stranger of the two, given that Syriza tends to favor robust state intervention in most other policy areas. In Italy, the government is responding to the populist Five Star Movement’s anti-vaccination agenda, which has become a part of its broader campaign against the state, established political parties, and the “experts” responsible for the 2008 financial crisis and the eurozone’s prolonged economic malaise.

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But, putting politics aside, there are compelling reasons for why governments should mandate vaccinations for all children, rather than leaving it up to parents to decide. Ultimately, the state has a responsibility to protect vulnerable individuals – in this case young children – from foreseeable harm.

In 1990, Greece signed the United Nations Convention on the Rights of the Child, in which it recognized all children’s right to “the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health.” But by allowing misinformed parents to forego vaccinations, Greece is exposing children to preventable infectious diseases and openly violating its pledge to ensure “that no child is deprived of his or her right of access to such health-care services.”

Moreover, governments have a responsibility to establish public goods through legislation, and “herd immunity” is one such good. Herd immunity describes a level of vaccination coverage that is high enough to prevent a disease from spreading through the population. Achieving herd immunity is one of the only ways to protect vulnerable members of a community who cannot be vaccinated because they are immunocompromised, or simply too old.

In addition, vaccination is a crucial instrument in the fight against one of the twenty-first century’s biggest health challenges: antimicrobial resistance. By preventing infections, vaccines also prevent overuse of antibiotics, thereby slowing down the development of drug resistance. More generally, it is widely known that high vaccination coverage results in a healthier population, and that healthier people can contribute more, both economically and socially, to their communities.

No medical or technical obstacles are blocking us from eradicating preventable infectious diseases such as measles and polio. Rather, the biggest hurdle has been popular resistance to vaccination. By allowing parents to make uninformed decisions about the health of not just their own children, but their entire community, the Syriza government is only adding to the problem. Governments should be educating the public to improve overall coverage, not validating unfounded fears about vaccine safety.

No country can achieve herd immunity – and eventually eradicate preventable infectious diseases – if it allows parents to opt out of vaccinating their children, as in Greece. But it also will not do simply to sanction noncompliant parents, as in Italy. Ultimately, to defeat infectious diseases, we will have to restore faith in expertise, and rebuild trust with communities that have grown increasingly suspicious of authority in recent years.

Domna Michailidou works for the Economics Department of the OECD and teaches at the Center for Development Studies at the University of Cambridge and the UCL School of Public Policy. Jonathan Kennedy teaches at the UCL School of Public Policy and is a research associate in the Department of Sociology at the University of Cambridge.

By Domna Michaildou and Jonathan Kennedy

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