- By Jamie Shea
Until recently, the World Health Organization’s (WHO) Regional Office for Europe believed that it was close to eliminating measles from the continent. In the last few years, however, this optimism has been replaced by deep concern. The prevalence of measles has increased markedly in the region: from 5,273 cases in 2016 to 82,596 in 2018 and about 90,000 in just the first six months of 2019. In August this year, the WHO announced measles had returned to four European countries where it had previously been eliminated – the UK, Greece, Czech Republic and Albania.
These setbacks in efforts to eliminate measles have coincided with the rise in support for right-wing populist parties and politicians. Key developments include the UK’s vote to leave the EU in 2016, Marine Le Pen coming second in the 2017 French Presidential elections, Alternative für Deutschland (AfD) winning seats in the Bundestag for the first time in the same year, and Movimento 5 Stelle and Lega forming a government after Italy’s 2018 general election. Although the connection between these phenomena is not obvious, the European measles outbreak and political crises are closely related.
Measles is a highly infectious virus that can have devastating and sometimes deadly complications. It can be prevented by the measles, mumps and rubella (MMR) vaccine. MMR works on an individual-level, conferring immunity on those who have been vaccinated. It also works on a community-level as so-called ‘herd immunity’ is achieved when coverage reaches 90-95%. Herd immunity protects individuals who cannot be vaccinated, including young children and children who have suppressed immune systems as a result of chemotherapy.
There is consensus among mainstream scientists that MMR and other childhood vaccines are effective and safe. Notwithstanding, a number of conspiracy theories argue otherwise. The most influential of these can be traced to Andrew Wakefield, who first suggested there is a link between MMR and autism in the late 1990s. There is no evidence to support this claim. A study of over 650,000 Danish children published in 2019 found no indication of a link. Wakefield’s research has been retracted by the Lancet and he was removed from the UK medical register for acting “dishonestly and irresponsibly”.
Concerns about vaccine safety are part of a broader breakdown of trust in elites and experts in European society
A significant minority of parents are, nevertheless, reluctant to vaccinate their children because of concerns about dangerous side-effects. A recent global survey of over 140,000 carried out by the Wellcome Trust showed that the highest levels of uncertainly about vaccine safety were in Europe, with only 40%, 59% and 73% agreeing that vaccines are safe in Eastern, Western and Northern Europe respectively. A Eurobarometer survey of over 27,000 people published earlier in the years reported that 48% of Europeans believe vaccines often cause serious side-effects.
Concerns about vaccine safety are part of a broader breakdown of trust in elites and experts in European society that has also resulted in increasing support for right-wing populists. An article published in the European Journal of Public Health earlier this year looked at the link between populist political parties and vaccine hesitancy at the national-level. It showed that countries such as Greece, Italy and France, in which the highest proportion of votes were cast for the populist parties in the 2014 European Parliament elections, also had the lowest percentage of the population that agreed that vaccines were effective, important and safe, according to data collected by the Vaccine Confidence Project. In contrast, Portugal and Denmark had the lowest levels of support for populists and the highest levels of vaccines confidence.
At the individual-level, it is clear that supporters of right-wing populist parties are more likely to believe that vaccines are unsafe. According to data analysed in The Guardian, UKIP party supporters (33%) are three times more likely to believe that vaccines are unsafe than Conservative (11%) and Labour (10%) supporters. 44% of those who voted for Marine Le Pen expressed concerns about vaccines compared with 12% of Emmanuel Macron voters. Similarly, supporters of Movimento 5 Stelle and Alternative für Deutschland were more likely to believe that vaccines had dangerous side-effects than the general population.
Populism is characterised by anti-establishment sentiment. In politics, it manifests as distrust and hostility towards centre-left and centre-right political parties that have dominated west-European democracies in recent decades. In public health, populist sentiment presents itself as distrust and hostility towards public health authorities, scientists and doctors who promote vaccines.
If vaccination coverage falls below 90-95%, then some of the most vulnerable people in society no longer benefit from herd immunity
At first sight, such ideas might appear ignorant, irrational and counterproductive. It should not be forgotten, however, that many people who hold populist views do so because they feel left behind by modern society, economically marginalised by globalisation, and disenfranchised by mainstream political parties.
In several European countries, the state has responded to the rising prevalence of measles and other vaccine-preventable diseases by passing legislation making childhood vaccinations mandatory. In 2017 the Italian government announced that unvaccinated children would not be allowed to attend school, France increased the number of mandatory vaccines from 3 to 11 in 2018, and the German government recently passed a law making the measles vaccination compulsory. Right-wing populists have been among the biggest critics of such laws, arguing that it is unjustified intervention by the state into the family life.
Invoking liberal ideas to justify not vaccinating one’s child is problematic as it overlooks John Stuart Mill’s ‘Harm Principle’, i.e. people should be free to do whatever they want, so long as they do not harm others. Parents’ ill-informed decision not only puts the unvaccinated child at risk of avoidable harm. If vaccination coverage falls below 90-95%, then some of the most vulnerable people in society no longer benefit from herd immunity. If we hope to create a more resilient society, disinformation must be fought in all its forms, be it right-wing populism or anti-vaccine conspiracies.
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