Opposition to vaccination often appears in clusters, among people with a similar world view, which makes them resistant to advice from doctors or governments © Getty
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The richer countries are, the less their citizens believe that vaccines are safe. In the US and Canada, only 72 per cent believe vaccines are safe. In the northern European arc from Ireland and the UK through the Nordic countries, the figure is about 73 per cent.

In other parts of Europe, confidence in vaccines is even lower. In Germany, France, Austria, Switzerland and the Benelux countries, only 59 per cent on average believe vaccines are safe. In eastern Europe, the figure is 50 per cent.

These are the findings, published last week, of a Gallup survey for Wellcome, the UK-based foundation that funds science and health research.

By contrast, belief in vaccine safety is high in poorer regions. In South Asia, 95 per cent of people think vaccines are safe. In east Africa, the figure is 92 per cent. In Bangladesh, a determined vaccination campaign has contributed to a fall in childhood mortality. Rwanda has lifted its national immunisation rate from 30 per cent in 1995 to 95 per cent today.

That does not mean immunisation campaigns always go smoothly. In parts of Pakistan, health workers have been killed.

But the relatively low faith in immunisation in wealthy countries has also had its effect, particularly in the recent rise in measles. The most striking example is France, where an upsurge in measles cases has accompanied collapsing faith in vaccinations. One in three French people regard vaccines as unsafe — the highest level in the world.

The scepticism runs across French society. “It does not vary significantly by education, age, gender, urban or rural status, or whether people are parents,” the Wellcome report said.

What lies behind what the report calls “vaccine hesitancy” and why is it so much higher in some countries than others? The report says that the rise of social media has prompted what Unicef calls a “real infection of misinformation”.

This may explain why richer countries, more connected to the internet and social media, have higher levels of opposition to vaccination. But some of the most notorious spikes in anti-vaccination sentiment predate the rise of social media. The now-discredited article in The Lancet by a group of doctors led by Andrew Wakefield, linking the measles, mumps and rubella vaccine to autism, appeared in 1998. It led to a crisis of confidence among some parents in the MMR vaccine, an echo of which persists today.

Opposition to vaccination often appears in clusters, among people with similar beliefs and with a particular world view, which makes them resistant to advice from doctors or governments. In New York, there have been measles outbreaks among vaccine-opposing groups of strictly Orthodox Jews.

There are non-religious parents who persuade themselves and each other that the MMR vaccine is an unnaturally powerful cocktail, capable of overpowering a child’s immune system, and causing autism. They are unconvinced by large-scale studies in countries such as Denmark that have found no link between MMR and autism.

France represents a particular puzzle. This is an advanced society with, in world terms, a well-educated, prosperous population. How did its faith in vaccination fall so low?

Some French researchers point to the 2009 influenza pandemic during which many believed that the accompanying vaccination campaign was an overreaction driven by the pharmaceutical industry. Unfavourable attitudes to vaccination in the country rose from 9.6 per cent in 2005 to 38.2 per cent in 2010, after the influenza episode.

Governments are trying to tackle the issue. Some authorities have decided to exclude unvaccinated children from school. New York state this month ended the religious exemption for the vaccinations that are required for children to enrol at school.

In 2017, France’s parliament passed a law increasing the number of vaccinations for children born after the beginning of 2018. Instead of three mandatory vaccinations, children will have to have 11, including MMR, if they want to attend nurseries or schools.

Some support these moves because they protect children from diseases and because the unvaccinated are a threat to those too young or ill to be vaccinated themselves. But it doesn’t change minds or win the argument. That requires persistent persuasion and pointing to how dangerous these diseases can be, something people in poorer countries, living more perilous lives, appear to find easier to understand.

michael.skapinker@ft.com
Twitter: @Skapinker

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