Call to eliminate measles and rubella once and for all

Despite being vaccine-preventable, once-common childhood diseases are still endemic across the EU, reports Colin Mackay.

By Colin Mackay

20 Apr 2016

Sunday 24 April sees the start of European Immunisation Week (EIW). The goal of EIW is to increase vaccination coverage by raising awareness of the importance of immunisation.

This year, EIW will focus on addressing the challenges that Europe faces in its efforts to eliminate measles and rubella. At first glance, this may appear to be tackling diseases of the past, but, both of these highly infectious conditions have been on the rise once again in recent years.

In fact, eliminating measles and rubella is a core goal of the European Vaccine Action Plan 2015–2020. According to the WHO, in 2014, 32 countries in the European region interrupted transmission of endemic measles, with the same numbers for rubella. 


Despite this, eight EU member states are still considered as endemic for measles and nine for rubella. The unfortunate thing is that both diseases are vaccine-preventable conditions.

Dr Zsuzsanna Jakab, WHO Regional Director for Europe, is calling on these remaining endemic countries to catch up. 

She warns that, "complacency anywhere will result in a dangerous resurgence of these preventable diseases and the unnecessary suffering and loss of life that they cause." 

She believes that "Europe's policy-makers should join forces to eliminate measles and rubella once and for all."

However, the challenge to achieving this is attaining suitably high levels of population immunity. For measles and rubella, this can be achieved through sustained high coverage (95 per cent or above) with two doses of the relevant vaccine, combined with supplemental activities that target recognised susceptible individuals and groups in the population.

In addition, it requires a high-quality surveillance system capable of detecting and investigating every suspected case.

Despite this, it provides remarkable value. EEP MEP Cristian-Silviu Busoi points out that prevention - of which vaccination is a major component- is a highly cost-effective way of combatting the burden of disease.

However, Europe spends only a small proportion of its healthcare budget on prevention measures; according to the OECD, it averages three per cent of total healthcare spending. Vaccination represents only a fraction of this. Busoi also worries over changing attitudes to vaccination. 

He says; "There are many diseases that can be prevented through immunisation, however, we increasingly face reluctance amongst parents to have their children vaccinated. The main reason seems to be low awareness that communicable diseases including measles and rubella are re-emerging."

"In the Parliament's ENVI Committee, we regularly debate the necessity of prevention when discussing immunisation and chronic diseases."

However, he stressed the need to be aware that organising and delivering health services are member states competences, "it is essential that we encourage them to take action."

The Romanian deputy believes that Parliament needs to place two important instruments on the agenda in the coming months. Firstly, the Council conclusions from 2011 referring to childhood immunisation. 

He explains; "This is important given the increasing numbers of parents opting not to immunise their children against vaccine-preventable diseases."

The other instrument is last year's Council conclusions, which emphasised that an evidence-based, cost-effective, safe and efficient immunisation system should an integral part of a well-functioning health system.

Busoi is encouraging the Commission to identify and develop synergies between promoting immunisation and implementing relevant EU legislation and policies while developing awareness raising campaigns and supporting member states actions. "We must not forget," he says, "that health is also a European concern."

Andrea Rappagliosi, the President of Vaccines Europe, the Brussels-based manufacturers association sees EIW as an opportunity. "We can use this as a platform to increase awareness of vaccine-preventable diseases from a public health perspective," he said. 

"More activities at EU and national level during European Immunisation Week will help to draw attention to the importance of national vaccination programmes."

Rappagliosi believes vaccination to be a cornerstone of European public health programmes; "Vaccination constitutes one of the most cost-effective preventive measures existing today."

However, he has concerns over the increase in so-called 'vaccine hesitancy' as well as the rise in complacency over vaccine-preventable diseases. He believes that the success of vaccines in reducing the threat from so many diseases runs the risk of making people blasé, thus, "putting the proper implementation of national immunisation programmes at risk."

As a result, Europe has been experiencing a worrying surge in cases of vaccine-preventable diseases such as measles and rubella in recent years.

Rappagliosi believes that political commitment at all levels - and buy-in from the public - is a must-have if we want to achieve the shared goal of eliminating measles and rubella and effectively implemented national vaccination programmes.

He is also keen to point out that vaccination is not only about our children. With Europe's population ageing, it is important to keep all citizens in good health for as long as possible, and he believes there is a growing appreciation of the importance of senior immunisation through a life-course approach to vaccination.