Over the first two months of 2022 alone, reported cases of measles - a highly contagious but vaccine-preventable disease - jumped by 80 per cent worldwide.
Immunisation, along with anaesthesia, antisepsis, and antibiotics, - has been hailed as one of the four great advancements in medicine in the last 200 years. The race for COVID-19 vaccines was a powerful reminder of the benefits of vaccination, but also a booster of vaccine hesitancy.
The fear of contracting COVID-19 also led some families to put off vaccinating their children, and resources that would otherwise be dedicated to routine immunisation programmes were used to respond to the pandemic. As a result, over 25 million children missing at least one vaccination in 2021 alone, according to the World Health Organisation (WHO).
"This is a red alert for child health. We are witnessing the largest sustained drop in childhood immunisation in a generation. The consequences will be measured in lives,” Catherine Russell, UNICEF Executive Director, said in a statement.
This week, WHO announced “The Big Catch-up,” a global initiative to reverse this decline in collaboration with UNICEF, the Vaccine Alliance and the Bill & Melinda Gates Foundation, and other health partners.
A global vaccination decline, but how do European countries compare?
It’s estimated that four million deaths worldwide are averted each year thanks to childhood vaccinations, and more than 50 million deaths could be prevented between 2021 and 2030. Measles jabs alone could save nearly 19 million lives.
Worldwide, over the first two months of 2022, reported cases of measles jumped by 80 per cent, according to WHO. Rubella, meanwhile, is the leading cause of vaccine-preventable birth defects.
In 2021, a record high of nearly 40 million children globally missed a measles-containing vaccine dose. In France, for example, vaccination against the highly contagious disease dropped by 10 per cent.
Vaccination rates against measles in Europe have been on an upward trend since data first became available in 1982. Back then, only 69.4 per cent of children were vaccinated against the viral disease, compared with 94.2 per cent in 2020.
However, if we look more closely at the curve after 2018, before the coronavirus pandemic hit, a drop of almost one percentage point becomes evident. The vaccination rates went from 95.5 per cent in 2018 to 94.2 per cent in 2020. It may seem like a small drop, but at the time WHO warned it put 117 million children at risk of infection.
The graphic below shows the latest available data on vaccination rates for measles in European countries. Mumps and rubella are also included because a single combined shot protecting against all three viral diseases - the MMR vaccine - has been widely used since 1971.
Nine EU Countries (Bulgaria, Croatia, Czech Republic, France, Hungary, Italy, Latvia, Poland, Slovakia) have made vaccination against mumps-measles-rubella mandatory.
Interestingly, across the continent, the countries with near-perfect vaccination rates are not exactly the ones that have made the shot compulsory. Only in Portugal, Luxembourg and Hungary are 99 per cent of children vaccinated against all three diseases. They are closely followed by Andorra, Latvia and Spain.
The country with the worst vaccination rates in Europe is Montenegro. Only 24 per cent of children are vaccinated against measles, and 42 per cent against rubella and mumps. These rates are dramatically lower than in any other country on the continent.
This case is worth looking into. The country has the lowest vaccination rate overall in Europe, according to the WHO’s data. But this has not always been the case.
If we look at the evolution of vaccination rates for measles, for example, an odd picture emerges: the country was doing much better over a decade ago. In 2012, 90 per cent of children were vaccinated, compared to 24 per cent in 2020.
This dramatic decline in immunisation rates has public health experts bracing for an imminent measles outbreak in Montenegro and its Balkan neighbours, where vaccination uptake has also plummeted. In the Republic of North Macedonia, 75 per cent of children were vaccinated against measles, while in Serbia, 87 per cent have had the jab.
Experts say an uptake of at least 95 per cent of the two-dose jab is needed to avoid the spread of measles as it is highly contagious.
The virus can cause complications that include blindness, brain swelling and pneumonia, and unvaccinated children are at the highest risk of serious cases - and even death.
In Montenegro, doctors have called on the government to take the issue more seriously, saying that existing fines on parents who refuse vaccine mandates have done little to reverse the nation’s anti-vaccination shift.
"The MMR vaccine is currently not a condition for enrollment in schools and kindergartens," Milena Popovic Samardzic, an epidemiologist from Montenegro's Institute of Public Health, told AFP.
But it is not only about the MMR vaccination rate: Montenegro is also the big outlier when it comes to the number of infants vaccinated against hepatitis B, with only 52 per cent of them receiving the jab in 2020. Ten years ago, the picture was, again, very different, with a vaccination rate of 90 per cent.
Hepatitis B is an infection that causes liver inflammation and damage and can lead to serious, even life-threatening health issues like liver disease or liver cancer. The virus can be transmitted via blood, saliva or sexual contact and by the mother during pregnancy.
Eastern European countries lagging
When looking at these vaccination rates overall, it becomes evident that Eastern European countries tend to be in the bottom half of the list.
“What is wrong with Eastern Europe? In a word: disinformation,” Mitchell A. Orenstein and Kristen Ghodsee, both professors of Russian and East European Studies at the University of Pennsylvania, wrote in Project Syndicate.
"The region is awash in it, a legacy of the breakdown of public trust in governmental institutions after communism. Feverish conspiracy theories have gripped these countries like the coronavirus’s shadow”.
On the other side of the spectrum, Portugal has historically recorded high vaccination rates, and its population has traditionally been well-disposed toward vaccines. In 2021, the country even had the highest COVID-19 vaccination rate in the world.
If we look at infant vaccination rates for diphtheria, tetanus and polio - for which combined shots are widely available - Portugal also ranks at the top, alongside Monaco, Luxembourg, Latvia, Hungary, Greece, Andorra, and Albania. All eight countries have a 99 per cent vaccination rate against the three diseases. They are closely followed by Spain, Malta and Belgium, which have a vaccination rate of 97 per cent.
The countries with the lowest vaccination rates for tetanus, diphtheria and polio are Bosnia and Herzegovina, (73 per cent for the three diseases), Montenegro (84 per cent) and Austria (85 per cent).
'A cornerstone of public health'
“Vaccination is a cornerstone of public health,” the WHO said in a recent statement marking European Immunization Week. “Every dose in a country’s national immunisation schedule is timed to build or sustain protection from one or more diseases”.
The sudden post-pandemic decline in immunisation followed "almost a decade of stagnant progress," warned WHO vaccine manager Kate O'Brien.
The WHO’s “Big Catch-up” initiative now hopes to boost vaccination rates, strengthen national health systems and ultimately save lives.
The European Centre for Disease Prevention and Control (ECDC) is also urging policymakers to close the “vaccination gap” especially affecting refugees, immigrants and asylum seekers who are not closely monitored by health systems.