Immunization and public health: the importance of good information
Immunization is one of the greatest achievements in favor of public health. However, the success of this tool that has helped to eradicate diseases and prevent others of high impact for the health, development and economy of the countries, could be affected by the action of pressure groups that oppose this type of procedures. In front of them, information of better quality, based on scientific evidence and coming from reliable sources, acquires importance at the time of taking a position on the subject
Immunization as the central theme of the 2030 Agenda
The importance and positive impact of immunization on global public health explains why several of the goals included in ODS No. 3 of the 2030 Agenda, focused on health and wellbeing, are dedicated to it.
Reduce death in newborns and children under 5 years old (3.2),
End epidemics such as tuberculosis, neglected tropical diseases, hepatitis and other communicable diseases (3.3),
Allow access to safe, effective, affordable and quality vaccines for all (http://www.un.org/sustainabledevelopment/en/health/) (3.8), and
Support research and vaccine development activities (3.9.b).
According to data from the World Health Organization (WHO), vaccination campaigns avoid between 2 to 3 million deaths per year worldwide, and are recognized internationally as one of the health interventions with greater efficiency and better results. Nevertheless, estimates indicate that in 2017 there were still 19.4 million unvaccinated or insufficiently vaccinated children in the world.
For this organization,
an effective immunization plan is one that reaches 95% or more of coverage of the target population within a country. In this context, levels of coverage have improved thanks to the greater affordability of vaccines by countries with fewer resources, as well as the important immunization campaigns that are carried out in the international and local framework. However, in recent years these advances have encountered an obstacle in the so-called anti-vaccine groups, which as such, call the population not to be immunized.
Anti-vaccine movements and the problem of disinformation
1998 Andrew Wakefield, together with other colleagues, published what would become a reference for these types of groups at present: a study of twelve young patients with inflammatory bowel disease and autism, who shared in common that they had been vaccinated against it. measles, mumps and rubella (MMR vaccine). This fact led the researchers to speculate about the direct association of said vaccine with both diseases.
The media impact that the publication caused was of such magnitude in the international society that it led to a substantial decrease in the percentages of vaccination in some countries. For example, in the United Kingdom between the years 1996 and 2004 decreased its percentage of MMR vaccination from 92% to 80%.
This, despite the fact that some time later it was found that the research suffered from important biases, as well as significant ethical and methodological failures. However, and the fact that The Lancet, the journal that originally published the article had to withdraw it, this study became a real recognition for anti-vaccine groups.
Although there is a common belief that this type of movement has a presence in developed countries, since it has been in them where they have manifested themselves most strongly (for example in Italy, France and England during the last decade), the truth is that in Latin America, you can also find advocacy groups for this cause. In fact, the issue has recently revived as a result of outbreaks of influenza in the United States and yellow fever in Brazil.
Undoubtedly, the emergence of the Internet and the development of Information and Communication Technologies have become powerful tools that have allowed these groups to disseminate and disseminate their ideas. One of the platforms in which this type of movement has been strengthened in greater form, in the last time, has been through the social networks in which platforms such as Twitter, Facebook, YouTube and Blogs are easily accessible, at the same time that allow contact with other groups with similar ideas through links or the suggestion of related content.
In the world, many anti-vaccine groups have their own web pages -with updated information and donation systems for their financing- in which they generate brochures and documents that can be downloaded or purchased by their members. Thus, for example, we can consign "The League for the Freedom of Vaccination" in Spain, or the Facebook group "Freedom of vaccination for a democratic Chile". Even, it is possible to find some that come out of the traditional canons of diffusion as "The Refusers", who present themselves as a music group with anti-vaccine protest songs.
A problem not minor, that has taken particular importance during this last time and that can get to affect the high indexes of coverage of immunization, says relation with the diffusion through the Network of false news (hoaxes) that are divulged with some end , in this case disinformation campaigns that spread in social networks as false viral reports and that contribute to create a general feeling of uncertainty and distrust.
In this last aspect, it is worth remembering what happened in 2009 with the drug Tamiflú, highly marketed as a defense against the H1N1 pandemic (Influenza A or swine flu) and in 2014, the Cochrane Collaboration, an organization that brings together groups of scientists and independent researchers around the world, found that their effects were considerably lower than estimated, which led even in 2017 to the WHO itself to lower its priority.
The dissemination of videos through which influential figures in politics, the show or even the scientific field are supporting causes that from the current scientific evidence lack support also collaborate with disinformation in the Network. For example, the current president of the United States, Donald Trump, during his campaign for the oval office met with Andrew Wakefield, author of the controversial study mentioned above, and alluded to his ideas in a speech prior to his election during the debate republican presidential
The media impact that the publication caused was of such magnitude in the international society that it led to a substantial decrease in the percentages of vaccination in some countries. For example, in the United Kingdom between the years 1996 and 2004 decreased its percentage of MMR vaccination from 92% to 80%.
This, despite the fact that some time later it was found that the research suffered from important biases, as well as significant ethical and methodological failures. However, and the fact that The Lancet, the journal that originally published the article had to withdraw it, this study became a real recognition for anti-vaccine groups.
Although there is a common belief that this type of movement has a presence in developed countries, since it has been in them where they have manifested themselves most strongly (for example in Italy, France and England during the last decade), the truth is that in Latin America, you can also find advocacy groups for this cause. In fact, the issue has recently revived as a result of outbreaks of influenza in the United States and yellow fever in Brazil.
Undoubtedly, the emergence of the Internet and the development of Information and Communication Technologies have become powerful tools that have allowed these groups to disseminate and disseminate their ideas. One of the platforms in which this type of movement has been strengthened in greater form, in the last time, has been through the social networks in which platforms such as Twitter, Facebook, YouTube and Blogs are easily accessible, at the same time that allow contact with other groups with similar ideas through links or the suggestion of related content.
In the world, many anti-vaccine groups have their own web pages -with updated information and donation systems for their financing- in which they generate brochures and documents that can be downloaded or purchased by their members. Thus, for example, we can consign "The League for the Freedom of Vaccination" in Spain, or the Facebook group "Freedom of vaccination for a democratic Chile". Even, it is possible to find some that come out of the traditional canons of diffusion as "The Refusers", who present themselves as a music group with anti-vaccine protest songs.
A problem not minor, that has taken particular importance during this last time and that can get to affect the high indexes of coverage of immunization, says relation with the diffusion through the Network of false news (hoaxes) that are divulged with some end , in this case disinformation campaigns that spread in social networks as false viral reports and that contribute to create a general feeling of uncertainty and distrust.
In this last aspect, it is worth remembering what happened in 2009 with the drug Tamiflú, highly marketed as a defense against the H1N1 pandemic (Influenza A or swine flu) and in 2014, the Cochrane Collaboration, an organization that brings together groups of scientists and independent researchers around the world, found that their effects were considerably lower than estimated, which led even in 2017 to the WHO itself to lower its priority.
The dissemination of videos through which influential figures in politics, the show or even the scientific field are supporting causes that from the current scientific evidence lack support also collaborate with disinformation in the Network. For example, the current president of the United States, Donald Trump, during his campaign for the oval office met with Andrew Wakefield, author of the controversial study mentioned above, and alluded to his ideas in a speech prior to his election during the debate republican presidential
The impact of these movements
The impact of these movements
Although declines in immunization rates can not be attributed exclusively to the lobby exercised by anti-vaccine movements, the impact these groups have or could have should not be underestimated.
In Italy, for example, the detractors of the vaccines managed to have the debate present in the last parliamentary elections, something that, together with United Nations sources, speak of a fall of 90% in 2013 and 85% in 2015 in the percentage of the population of children of two years vaccinated. Another similar case is the one that occurred in Spain, a country that during the year 2015 had a case of diphtheria, a disease that was believed eradicated since the late eighties, because the affected person was not vaccinated against said disease, and for the which were not prepared.
Chile is not immune to this debate. In fact, one of the founders of the collective Freedom of vaccination for a democratic Chile, was one of the first cases to be prosecuted, when she refused to vaccinate her daughter. The Health Service of Talcahuano filed an appeal for protection in favor of the girl, before which the Supreme Court confirmed that the child should be vaccinated.
Also, the inclusion in the National Immunization Program of the vaccine to combat human papillomavirus and prevent cervical cancer-disease that according to the Ministry of Health causes the death of around 600 women a year - has not been exempt either of conflicts, because several have been the resources of protection that in different cities of the country have interposed to avoid the vaccination of the minors, which however, have ended up being
Although declines in immunization rates can not be attributed exclusively to the lobby exercised by anti-vaccine movements, the impact these groups have or could have should not be underestimated.
In Italy, for example, the detractors of the vaccines managed to have the debate present in the last parliamentary elections, something that, together with United Nations sources, speak of a fall of 90% in 2013 and 85% in 2015 in the percentage of the population of children of two years vaccinated. Another similar case is the one that occurred in Spain, a country that during the year 2015 had a case of diphtheria, a disease that was believed eradicated since the late eighties, because the affected person was not vaccinated against said disease, and for the which were not prepared.
Chile is not immune to this debate. In fact, one of the founders of the collective Freedom of vaccination for a democratic Chile, was one of the first cases to be prosecuted, when she refused to vaccinate her daughter. The Health Service of Talcahuano filed an appeal for protection in favor of the girl, before which the Supreme Court confirmed that the child should be vaccinated.
Also, the inclusion in the National Immunization Program of the vaccine to combat human papillomavirus and prevent cervical cancer-disease that according to the Ministry of Health causes the death of around 600 women a year - has not been exempt either of conflicts, because several have been the resources of protection that in different cities of the country have interposed to avoid the vaccination of the minors, which however, have ended up being
Vaccination: voluntary or mandatory?
Faced with these movements and given the positive impact that immunization has shown on public health, some people wonder what will be the best measures to adopt to ensure that the greatest number of inhabitants are vaccinated.
Although the recommendations of organizations such as WHO / PAHO aim mainly to raise awareness among the population about the importance of timely vaccination, some countries have opted for different mechanisms to discourage anti-vaccine practices and promote greater immunization.
One case that should be highlighted is that of France, a country that according to a study by the London School of Hygiene & Tropical Medicine, is where vaccines generate the greatest distrust (in 41% of the population). Prime Minister Édouard Philippe, faced with the measles crisis that affects Europe, said that it was not acceptable that this type of situation should occur, which led the country to go from having only three compulsory vaccines (diphtheria, tetanus and polio), to eleven.
Another country with this type of measure is Italy, where the Prime Minister Paolo Gentiloni in 2017 decreed compulsory vaccination of all children, who if not vaccinated can not enter the public education system, and whose parents can even be subject to fines. The measure has had several detractors who prefer not to send their children to these types of institutions as long as these are not vaccinated.
Germany has also done its part in the matter, with fines of up to 2,500 euros to parents who do not inform themselves of the vaccination calendar before their children enter day care centers. On the other hand, in a context not only European, Australia during the year 2015 withdrew the social benefits of parents who did not vaccinate their children.
In the case of Chile, our country has had a successful National Immunization Program (PNI) since 1978, with its subsequent vaccination schedule. Open this document using the ReadSpeaker docReader.
In normative terms, and by virtue of the Sanitary Code, it is the Ministry of Health that is in charge in our country of the vaccination and who counts among its faculties with the competence to establish the obligatory nature of the same. Exceptionally, those who have a medical certificate that justifies it can be temporarily exempted from being vaccinated. However, those who can not be vaccinated for medical contraindications, are also protected by group immunity. Open this document using the ReadSpeaker docReader or commonly called herd, which is to protect a certain population through the presence of a high percentage of immune individuals in society.
Although, according to Law No. 20,584 on the rights and duties of patients, the national legislator recognizes personal autonomy in the field of actions related to health care, it is limited in those cases in which it is put in place. Public health risk. The rejection of vaccination poses a risk to the population, especially for groups at greater risk of exposure of the disease whose propagation is intended to be avoided through immunization.
What does the future hold for immunization?
Although Latin America in the field of immunization, shows high levels of coverage and has been a pioneer in the eradication of diseases such as polio, measles, or rubella has among its main challenges to address the health crisis that exists in Venezuela, where there has been a significant decrease in child vaccination coverage. This, together with the increase in the migration of its citizens, especially neighboring countries such as Colombia, has determined the appearance of diseases already controlled in them, such as measles, an issue that must be taken care of to avoid an eventual health emergency.
On the other hand, and in order to face the movements that oppose vaccination, it is necessary to combat misinformation with knowledge and educate the population adequately and thoroughly on the benefits of a timely vaccination. As advocated by WHO, it is necessary to generate awareness that this is not a matter of personal interest only, but concerns society as a whole, since inoculation against contagious diseases and whose spread is preventable through vaccination, is a matter of public health .
As David Geelan, Vice Dean of the School of Education and Professional Studies of the University of Griffith, Australia, says in an interview with the University of Chile, "anti-vaccine movements are a failure of scientific education" and the State should be actively involved in making that lack of education diminish as much as possible.
Although the recommendations of organizations such as WHO / PAHO aim mainly to raise awareness among the population about the importance of timely vaccination, some countries have opted for different mechanisms to discourage anti-vaccine practices and promote greater immunization.
One case that should be highlighted is that of France, a country that according to a study by the London School of Hygiene & Tropical Medicine, is where vaccines generate the greatest distrust (in 41% of the population). Prime Minister Édouard Philippe, faced with the measles crisis that affects Europe, said that it was not acceptable that this type of situation should occur, which led the country to go from having only three compulsory vaccines (diphtheria, tetanus and polio), to eleven.
Another country with this type of measure is Italy, where the Prime Minister Paolo Gentiloni in 2017 decreed compulsory vaccination of all children, who if not vaccinated can not enter the public education system, and whose parents can even be subject to fines. The measure has had several detractors who prefer not to send their children to these types of institutions as long as these are not vaccinated.
Germany has also done its part in the matter, with fines of up to 2,500 euros to parents who do not inform themselves of the vaccination calendar before their children enter day care centers. On the other hand, in a context not only European, Australia during the year 2015 withdrew the social benefits of parents who did not vaccinate their children.
In the case of Chile, our country has had a successful National Immunization Program (PNI) since 1978, with its subsequent vaccination schedule. Open this document using the ReadSpeaker docReader.
In normative terms, and by virtue of the Sanitary Code, it is the Ministry of Health that is in charge in our country of the vaccination and who counts among its faculties with the competence to establish the obligatory nature of the same. Exceptionally, those who have a medical certificate that justifies it can be temporarily exempted from being vaccinated. However, those who can not be vaccinated for medical contraindications, are also protected by group immunity. Open this document using the ReadSpeaker docReader or commonly called herd, which is to protect a certain population through the presence of a high percentage of immune individuals in society.
Although, according to Law No. 20,584 on the rights and duties of patients, the national legislator recognizes personal autonomy in the field of actions related to health care, it is limited in those cases in which it is put in place. Public health risk. The rejection of vaccination poses a risk to the population, especially for groups at greater risk of exposure of the disease whose propagation is intended to be avoided through immunization.
What does the future hold for immunization?
Although Latin America in the field of immunization, shows high levels of coverage and has been a pioneer in the eradication of diseases such as polio, measles, or rubella has among its main challenges to address the health crisis that exists in Venezuela, where there has been a significant decrease in child vaccination coverage. This, together with the increase in the migration of its citizens, especially neighboring countries such as Colombia, has determined the appearance of diseases already controlled in them, such as measles, an issue that must be taken care of to avoid an eventual health emergency.
On the other hand, and in order to face the movements that oppose vaccination, it is necessary to combat misinformation with knowledge and educate the population adequately and thoroughly on the benefits of a timely vaccination. As advocated by WHO, it is necessary to generate awareness that this is not a matter of personal interest only, but concerns society as a whole, since inoculation against contagious diseases and whose spread is preventable through vaccination, is a matter of public health .
As David Geelan, Vice Dean of the School of Education and Professional Studies of the University of Griffith, Australia, says in an interview with the University of Chile, "anti-vaccine movements are a failure of scientific education" and the State should be actively involved in making that lack of education diminish as much as possible.
Immunization and public health: the importance of good information
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May 21, 2019
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