Demonstrators in Washington state protest against a bill to limit parents' ability to exempt children from the MMR vaccine © AP
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From Washington to France, the Philippines and Japan, measles is on the march.

Falling rates of immunisation for this and other diseases have led the World Health Organization to name “vaccine hesitancy” as one of 2019's top global health threats. 

The reason? “Populists have constructed a narrative of collusion between big pharma, government, and statistics,” one economist told the FT this week.

In the US, Facebook faced fierce criticism for allowing advertisers to target users who have shown interest in anti-vaccine information, the so-called “anti-vaxxers”. Pinterest, another social network, set a better example by stopping returns for searches regarding vaccinations, putting pressure on its bigger rival to follow suit. 

In the UK, a parliamentary inquiry into “fake news” — although primarily concerned with political interference and privacy issues — demanded action to curb the spread of disinformation. 

There is a danger of over generalising the impact of denialists, and even strengthening their hand by focusing on them. In countries including the UK, low vaccination rates have many other causes, including inadequate outreach to immigrant populations and the need to make the health service more flexible to respond to their needs and suspicions.

But health authorities are waking up to the danger. US regulators on Tuesday threatened to wrestle vaccine policies away from lax state governments. But researchers also need to up their game and take on the anti-vaxxer movement, especially on their home turf of social media.

In the words of the FT editorial board: public health urgently needs better defences; the common good needs better advocates.

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Three questions

Clive Cookson spoke to Margaret Hamburg, former commissioner of the US Food and Drug Administration and current chair of the American Association for the Advancement of Science, at the AAAS annual meeting in Washington DC.

How would you sum up the state of scientific research today?

You could say that we are in a golden age of discovery and the application of science in every part of our lives. At the same time, the environment in which scientists are working is changing around us in dramatic and concerning ways. High on the list of emerging social complexities is the onset of a post-truth era, complete with “alternative facts” and a disdain for — or outright rejection of — expertise. This is not a uniquely American phenomenon but the current administration in Washington has fanned the flames significantly.

How should the scientific community handle this new and sometimes damaging environment?

We must open our arms wide to consumers and the public. We have to press forward to ensure that science, evidence and data are part of decision-making at all levels of government. That means reaching deeper into institutions and making sure our expertise is embedded within bodies that interact most directly with citizens, thought leaders and policymakers. We do have to avoid being politically partisan because some denial of science has come from the left as well as the right.

The World Health Organization has just appointed you to co-chair a new expert committee on the controversial issue of human genome editing. What will you be doing?

We haven’t started work yet. Our first meeting will be in Geneva next month. But we expect to concentrate on governance and the ethical, social and legal challenges associated with human gene editing. We’ll co-ordinate closely with the national academies that have set up an international group looking more deeply at the scientific issues. Our committee will also be important for the WHO as it redefines its role; we hope this be an area where it can provide leadership.


Chartwatch

World health expenditure Spending on health — particularly in poorer countries — is growing faster than the rest of the world economy and now accounts for 10 per cent of global GDP. Governments on average account for around half of a country’s health spending while a third comes from out-of-pocket expenses, a situation that pushes 100m people each year into extreme poverty. The proportion from external aid is now less than 1 per cent of global spending. Half of this goes on just three diseases: HIV/Aids, TB, and malaria. (WHO)


News round-up

Venezuelan red alert As the political situation in Venezuela deteriorates, experts fear worsening epidemics could spread beyond its borders and cause a public health emergency of 'hemispheric concern'. Medical professionals are quitting the country, including many Cuban doctors. The crisis could accelerate the re-emergence of diseases such as malaria, Chagas disease, dengue, and Zika. (FT, Lancet, NPR, Irish Times) 

Pandemic bonds The World Bank's plan to use global bond markets to help developing countries fight disease and social ills has come under criticism from those who say direct donor funding is more effective. The first “pandemic bond” failed to help the Democratic Republic of Congo's battle with Ebola as the disease had not crossed a border and so was not technically “pandemic”. (FT)

No-deal nerves England's chief medical officer warned that a “no-deal” Brexit could mean the UK losing access to the EU-wide surveillance scheme tracking infectious diseases. It could also lead to an increase in fake drugs, but at least there will be a dedicated shipping route for products with “short lead times”. 

Ireland said it had enough supplies for people not to stockpile, even if Britain — one of its main suppliers — crashed out of the EU. Here's a guide to pharma industry contingency plans. (Pharmaceutical Journal, Guardian, Reuters)

Youth health A study comparing UK 10- to 24-year-olds with their counterparts overseas showed high levels of asthma and obesity and a high rate of young people living with a long-term condition. (Nuffield Trust).

Cooking up problems Simple tasks such as making toast or cooking on unventilated stoves can be as unhealthy as breathing air on a heavily polluted street. Yet unlike the air outside and in workplaces, domestic air pollution is unmonitored and unregulated. The WHO estimates that 4m people a year are killed by fine airborne particles and combustion gases from stoves. (FT, WHO graphic)

Gene genius A British woman became the first in the world to experience gene therapy to treat the underlying cause of age-related macular degeneration or AMD, a common form of blindness in the west. (BBC)

The health insurance hustle A new investigation unveils how US health insurers give cash and gifts to the independent brokers who advise employers on health benefits. This “classic conflict of interest” drives up costs. This new interactive graphic calculates direct and indirect health costs for US households. (ProPublica, Kaiser)

Sperm secrets The sperm supply business has historically promised anonymity for donors to prevent any relationship with offspring unless the donors wanted. But the mass availability of consumer genetic tests is making it difficult to stop children trying to find their genetic fathers. “Donor anonymity will suffer the same fate as the cassette tape,” says a legal specialist. (NYT)

It's different for girls Doctors are much more likely to dismiss pain symptoms of young women, who are seen as more emotional and thus less credible, than those of men, who are seen as more stoic. (NYT)

The meaning of death Does death occur when the heart stops beating or when the brain ceases to function? A cardiologist argues that “death is not a binary state or a simple biological fact but a complex social choice”. British doctors are debating whether “assisted dying” is compatible with the Hippocratic Oath. (NYT, BMJ)

Vampire remedies The US Food and Drug Administration warned that infusions of young blood had no proven benefits against ageing. Advocates claim it helps with memory loss, dementia, heart disease and multiple sclerosis. (Stat, CNN) 


Best from the journals

Tackling typhoid Cases of typhoid and paratyphoid have fallen sharply from 26m in 1990 to 14m in 2017. It remains a major cause of disability and death but better water supply and sanitation, improved food handling, and more access to antibiotics are all having a positive effect. (The Lancet)

Cervical cancer HPV vaccines and screening could prevent up to 13m cases of cervical cancer over the next 50 years and in richer countries the disease could be wiped out within 25 to 40 years. The disease is the fourth most common cancer in women, with an estimated 570,000 new cases worldwide in 2018, of which 85 per cent are in less developed regions. (The Lancet)

Stigma struggle Stigma still plays an important role in diseases such as HIV, TB, mental health, cancer, substance abuse and leprosy. The burden of stigma may even exceed the burden of the disease itself. (BMC Medicine collection)

Not so sweet As 'Fizz-free February' draws to a close, a new study shows a higher intake of artificially sweetened beverages is associated with an increased risk of stroke and heart disease. (Stroke)


Podcast of the week

Safeguarding LGBT+ youth A discussion on what doctors can do to support LGBT+ adolescents who are at risk from increased rates of self-harm, suicide, and family rejection or abuse. (BMJ Talk Medicine, 28 min)


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Final thought

Health at work One of the biggest trials so far of a four-day working week yielded no fall in output but did reduce stress and increased engagement among staff. Is this the key to improve work-life balance? (Guardian)

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