This week is International Immunisation Week.
And vaccines have been all over the news.
I've seen so many stories about this massive measles outbreak.
And I'm just wondering, why now?
Haven't we been here before?
One thing that strikes me as interesting,
having looked at some of the numbers here,
is that I thought the narrative was actually good...
a positive narrative of improvement.
So I had a look at some stats from the World Health
Organisation.
So, if we look here we've got the measles vaccination rate.
And up here we've got the rate of cases per million people.
And all of these figures are global.
And in 1980, the numbers were up here.
So we had a lot of cases and a relatively low vaccination
rate.
But since then the numbers have trended consistently
towards this positive corner up to 2011
where cases are now way down.
And the vaccination rate has improved.
We've gone from about 800, a rate of 800 cases
here, down to a rate of about 10 cases here.
And vaccination rates have gone from about 15
per cent up to about 85 per cent.
So haven't we got rid of the measles question?
Absolutely.
And actually, let me pick up from 2011
because there's a really interesting database
on the World Health Organisation.
Now although it's a bit patchy it's very ambitious
because it has number of measles cases
for every country in the world, for every month, starting
from January 2011.
They did a 12-month rolling average
to have a look at the trend.
These are the global number of measles cases.
This is the trend, starting from 2011 to the last 12 months,
ending in February 2019.
And globally we have over 30,000 measles cases worldwide.
So, my question is, what's happening now?
Why is it that now people don't feel safe
vaccinating their kids?
Maybe we could employ good old-fashioned nuance
and actually look at the individual cases
in a number of countries and see what the underlying
trend is in each case.
Great idea.
Let's do it.
So I've got this really cool thing.
Awesome.
Let's map measles cases.
OK.
So we've got a pretty big outbreak in Ukraine.
Good lord, this cork is very hard...
one over here in New York City.
Italy.
There have been some cases in France, Madagascar.
This is Madagascar, right?
Yeah.
And even some in Israel.
OK, let's spin the globe and start from the UK.
The UK is arguably the birthplace
of the anti-vax movement, thanks to a Lancet article
published in 1998 by a man called Andrew Wakefield.
That's the study that's since been retracted, right?
It was since retracted.
And this is what happened when this infamous article was
published.
We're going to look at measles cases,
we're going to look at vaccination rates.
This is in England.
Number of measles cases, and then this
is the trend the vaccination rates took.
1998 is when the Wakefield article was published.
February 2010 is when The Lancet withdrew the article.
As you can see, babies are born here.
It's time to vaccinate them.
And measles cases rise as the coverage rate drops.
And then they go down again once the coverage rate recovers.
So there's clearly a correlation between the percentage...
the proportion of kids that are vaccinated and the measles
cases that go up.
So this is what's happened in the UK.
It was the medical establishment that published this article
- or I mean, The Lancet, not the whole establishment -
published this article.
And that led to the public...
parents not wanting to vaccinate their kids.
Even now, 21 years after the article came out,
there's still a long shadow in terms
of the effect of that article.
Exactly, because so we've ended this in 2014.
But the most recent figures show that measles cases
have increased again.
And Public Health England has said
that this is because this is happening amongst teenagers
and young adults.
And in fact...
you must've heard... you go to festivals, don't you,
as a young kid?
And the Rize Festival, which is the one that replaced the Beef
Festival in Essex, was cancelled because of a measles outbreak.
And this was happening, as I said, amongst 20-year-olds
or around that age.
And it's these kids that were born around this time that
are getting measles now.
So OK, let's move on maybe to Ukraine?
Yeah, so the really interesting thing in the Ukraine.
So again we're talking about a very recent outbreak.
This is an uptick in cases this year.
But there are some different dynamics going on here.
It's not necessarily about the anti-vaccination movement.
Now you had a look at the vaccine coverage rate
in the Ukraine.
And what did you find there?
Well, in the Ukraine it increased
from a staggeringly low 42 per cent
in 2016 to 86 per cent in 2017.
Yet, that hasn't prevented an outbreak,
even though it's a massive improvement.
Although, as we said before, the data is a bit patchy.
Still, that shows an improvement.
And the reason that hasn't had that much of an impact
is because the World Health Organisation says that there's
basically a threshold.
If under 93 per cent to 95 per cent of kids
don't get vaccinated, it doesn't matter whether you've improved.
The outbreak is going to happen.
Right.
And that's because of what we talk about as herd immunity, so
this idea that measles is such a contagious virus that it
can spread really rapidly even if the vaccination
rate drops just a tiny bit below 100 per cent.
So what happened exactly in Ukraine?
Is it because...
are they anti-vaxxers as well?
Good question.
And the interesting thing that's happening there
is that, although a small part of it
probably is to do with anti-vaccination movements,
the big factor there is just a fundamental shortage
of the vaccine.
When rates drop as low as 42 per cent as they were in 2016,
that's not just because of a mass movement
against vaccination.
They simply didn't have enough of the vaccine to go around.
So that's another factor which certainly in other countries,
like less developed parts of the world,
is often the reason that it takes a long time
to get that initial vaccine coverage rate up.
So another one that I think serves
as an interesting illustration is this outbreak just a couple
of months ago, a couple of weeks ago, in fact, in New York.
Another factor that can come up is religious exceptions
to having the vaccine.
So in certain parts of New York, particularly
among Orthodox Jewish communities,
there has been a sort of community-wide rejection
of the vaccine, a refusal to have children vaccinated.
And so in certain religious schools,
the vaccination rate is as low as 60 per cent.
So even though across New York State
as a whole, the vaccination rate, the average is 92 and 1/2
per cent, in some schools it's as low as 60 per cent.
And, of course, in a community like that,
people are moving around, interacting with one
another in close quarters.
So when you get one outbreak, it spreads rapidly.
And that's why we are now seeing hundreds of cases
simply because of a religious reason to exempt children
from the vaccine.
More broadly, in the US the anti-vax movement
has also been endorsed by a number
of high-profile celebrities.
Jenny McCarthy comes to mind.
She gave a really famous interview with Larry King.
Even Donald Trump has tweeted a couple of times
about the link between vaccine and autism.
And this endorsement by celebrities
and high-profile people is something that's
happened in Italy as well.
And that brings me to, oh, world's
gone mad, because with the rise of populism
we've seen a couple of politicians,
and some members of the Five Star Movement come to mind,
which have talked about this link, this conspiracy theory
about vaccinations and autism.
Whilst researching this article, we
had a chat with a couple colleagues.
And they all came up with their own interpretation
of what's going on.
Some people have talked about the rise of social media
and fake news websites.
Or there was an interesting theory
about the rise of wellness and a backlash against medicalisation
or excessive medicalisation rather?
So, to me, this is really more an epidemic of irrationality.
But I don't want to believe that the world has gone mad.
So, I was thinking that maybe we could
have a chat to somebody that has really looked into this.
And maybe he can convince us that people are still
in their right minds.
Great idea.
Who are we going to call?
So the person that I have in mind is Bobby Duffy.
He is the head of policy at King's College.
And previously he worked at Ipsos MORI.
And he led this annual survey that Ipsos MORI did
called the Perceptions Index.
And they focused on the gap between facts
and how people perceive things and how sometimes
flooding people with facts and with information
isn't actually effective at all.
So we did a huge study when I was
at Ipsos MORI across over 30 countries,
asking people whether they thought
there was a link between vaccines and autism
in healthy children.
And very depressingly, about 20 per cent of people
thought that there was a link despite that being disproved.
On top of that 20 per cent, there's
40 per cent of people who are not sure one way or the other.
And it's a very longstanding and consistent view.
And there's a number of reasons for that.
First of all, this is a very emotional issue,
particularly when you're talking about the health of your kids.
When we're in that emotional state,
we're less good at thinking about rational facts.
It worries us, so we think it's a bigger issue than it really
is.
And this is about probabilities.
There are absolutely minuscule probabilities
that if you have an underlying existing condition,
that these vaccines can exacerbate it
and that can present as autism.
But it's not really a factor that
should be taken into account.
But as soon as you raise that as an issue people
are drawn to those vivid anecdotes
and don't think about the probabilities, really.
It's not just about how we think, though.
It's both how we think and then what we're told
reflects a little bit this trend that we
have towards balanced reporting, where
you would give two sides of an argument
even though one side is discredited.
So a typical example is 99 per cent
of scientists believe this.
But there is 1 per cent of scientists
who believe something else.
And the problem with that is we still
hear and focus on the 1 per cent more than we should.
And then finally, you've also got people who are actively
trying to mislead people, things like the National Vaccine
Information Centre, which is actually
just a front for campaigning groups.
When these things interact, they become very sticky.
This is not an issue that's going to go away very quickly.
Is one solution for us in the media that we really
think about the use of emotions and emotional narratives
when we're trying to inform people
about things like vaccinations?
Give people a story that they can hold on to,
a narrative that they can follow,
are much more effective than just throwing facts at people.
There's a clear disconnect between fact and perceptions.
And a lot of that comes down to ineffective communication.
We both work with statistics.
We throw facts and stats around all day.
But emotions, our narratives, are
crucial to effectively communicating about vaccines.
So it's not enough just to say, vaccine rates
are x and measles rates are y.
You've got to talk to people about the pain
of what it's like to actually have your child contract
measles and how this can be a pretty traumatic experience
that you should want to avoid at all costs.
And people are much more moved by that than just
by reading a factsheet.
And hopefully, if we manage to achieve that, then we'll
be able, to some extent, prevent tragedies like this one.