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Global Health Security Begins At Home

02/06/2017 16:31

The current Ebola outbreak in the Democratic Republic of Congo is a sharp reminder of the ever-present global threat of infectious disease. Countries like Italy are playing their part by investing in health systems and vaccination in poor countries to try to prevent this and other kinds of deadly outbreak - like yellow fever in Brazil, and cholera in Yemen and Somalia. Such efforts are helping to make the world safer. But given that Italy is now experiencing its worst measles outbreak in years, with more than 2,300 cases since January alone, this is also a reminder that global health security begins at home.

In fact Italy is by no means alone. There are currently outbreaks of vaccine preventable disease in the USA, France and Germany and beyond. As G7 leaders met in Sicily last week under Italy's Presidency, it is fair to say that there is not a single G7 country that isn't currently experiencing some form of drop in vaccination rates amongst its people. So, why are countries that are making such a positive contribution to fight disease around the world, now facing such challenges at home?

The answer lies in the worrying rise in the kind of vaccine hesitancy that has come to typify a post-truth world, where facts are deemed fluid and where science and experts are no longer trusted, a trend that ultimately leaves people at home more vulnerable. A study published last week in the medical journal, the Annals of Internal Medicine, warns that millions of Americans are travelling overseas without measles vaccinations, running the risk of importing the disease, placing themselves and others back home at risk.

The fact that infectious disease knows no borders also means that this can work both ways. In 2009, the Lancet reported that cases of measles had been "exported" from Europe to poorer countries in Latin America, a region that had previously eliminated the disease and where higher levels of malnutrition and limited healthcare make the virus far more lethal.

In wealthy countries, there is a common misconception that measles is not dangerous. In fact, it carries a range of serious complications and currently kills more than 134,000 people a year, mostly children. It is also one of the most infectious diseases known to humanity; so much so that it is possible to catch it from someone just by entering a room, even hours after they have left. This is one reason why immunisation coverage for measles needs to be so high compared to other diseases; as soon as coverage drops below around 90% it is just a matter of time before an outbreak occurs.

And yet with two doses of an inexpensive measles-containing vaccine it can be easily prevented. It is this that has given the global health community hope of eradicating the disease, with the World Health Organization's initial goal to eliminate it from most parts of the world by 2020. Since 2006 Italy has been helping to control measles and other infectious diseases, through its long-term support and recent US$ 100 million, five-year commitment towards childhood immunisation in developing countries, through my organisation Gavi, the Vaccine Alliance. But this and other efforts are being undermined by vaccine hesitancy on the home-front in Europe and North America.

The Italian government recognises this and has taken this global fight closer to home by responding robustly to the threat; speaking plainly about vaccine safety and the risks of measles, and by announcing plans to reintroduce compulsory vaccination as a pre-requisite for kindergarten enrolment.

Let us hope it is successful. Public opinion has been heavily influenced by the promotion of now debunked and discredited claims of a link between vaccines and autism. Too often parents who remain worried by such claims believe they are erring on the side of caution by not vaccinating their child, believing that no harm can come from this. Yet by doing so they are inadvertently perpetuating the spread and the very existence of the disease, and through that human suffering. The fact is, a measles outbreak anywhere is a risk everywhere. Global health security means thinking globally and acting locally.

This article was first published by the Corriere della Sera on the 29th of May 2017.

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