Catherine Conlon: Truth spreads like thick porridge, but disinformation travels like wildfire
The measles vaccine is highly effective. However, because measles is so infectious, very high vaccination coverage (95% or more) with two doses is necessary to block transmission. Picture: Getty
Following the announcement of another confirmed case of measles in Ireland last week, passengers who travelled on a recent flight from Abu Dhabi to Dublin were urged to come forward.
The HSE said the appeal particularly related to pregnant passengers, the immunocompromised, or those under the age of 12 months, as immediate treatment may be beneficial.
As cases continue to rise across Europe and the UK, and the HSE responds by rolling out a measles vaccination programme targeting around 300,000 people, why is there a threat of a measles epidemic?
It’s not just measles. The last century saw many diseases that had previously decimated society being contained and, in many cases, eliminated, but in a post-pandemic world, disinformation is causing humanity to slide backwards.
Life expectancy in Ireland in 1900 was 49 years. A century later it was 76 and by 2023 it had risen further to 83 years. Public health advancements, including vaccines, have played a major role in these gains.
Since 1990, World Health Organisation (WHO) data reports that immunisation has played a key role in the 60% fall in childhood mortality. The evidence confirms that immunisation is one of the most successful and cost-effective public health interventions, saving an estimated 2 -3m lives per year.
However, the huge gains in vaccine programmes have made us complacent. Parents no longer live in fear of measles, whooping cough, polio, diphtheria or tuberculosis. And neither parents or our public health teams were prepared for the power of the internet and social media to potentially scupper these century-won health gains.
A paper published in the Lancet in 1998 by Andrew Wakefield alleged a link between the MMR (measles, mumps, rubella) vaccine and autism. The findings were subsequently entirely debunked and the paper was retracted by the Lancet, but the misinformation led to a precipitous drop in MMR vaccination rates across the globe.
If the truth spreads like thick porridge, falsehoods spread like wildfire.
A study in the journal (2018) documented how lies spread faster than the truth. Where individual tweets of truth rarely reached more than 1,000 people, the top 1% of fake news reached up to 100,000 people.
Two months after a global covid-19 pandemic was declared by WHO in May 2020, researchers at Carnegie Mellon University, Pittsburgh, reported that much of the discussion on Twitter surrounding covid-19 was misinformation fuelled by bot accounts. An examination of 200m tweets discussing coronavirus since January 2020 found that of the top 50 influential retweeters, 82% were bots.
So, what is the truth about the measles vaccine? Since its introduction in 1963 globally deaths dropped from 2.6m a year annually to around 100,000.
According to the Global Burden of Disease Study (2019), vaccine-preventable deaths from diseases such as measles as well as pertussis, diphtheria, and meningitis declined by almost 80% to 90% between 2000 and 2019 in children under the age of five.
Prior to the introduction of the measles vaccine in Ireland in 1985, by the age of 25 years, almost everyone had suffered from measles infection and risked complications of pneumonia, deafness, encephalitis, and death.
In the 1950s, an average of 8,500 cases were reported each year. In the 1970s, an average of 7 children died in Ireland every year from measles. In 1985 there were almost 10,000 cases notified. By 1991, this had plummeted to 135.
That is how effective this vaccine is when uptake rates are high. But vaccines only work when they get into people’s arms.
Data from Unicef and WHO reports that the percentage of children who received three doses of the vaccine against diphtheria, tetanus, and pertussis fell five percentage points between 2019 and 2021 to 81%, the lowest level since 2008.
Unicef executive director Catherine Russell warned this was a ‘red alert’ for child health.
The European Centre for Disease Prevention and Control (ECDC) predicts that measles cases will continue to increase in Europe in the coming months because of sub-optimal vaccination coverage in a number of countries.
With peak travel occurring at Easter, in peak measles season, unvaccinated children and young adults are taking a risk, and it's a risk they spread to pregnant women, young babies or anyone who is immunocompromised, as the recent HSE alert highlighted.
The measles vaccine is highly effective. However, because measles is so infectious, very high vaccination coverage (95% or more) with two doses is necessary to block transmission. Measles is so contagious that one patient can infect an average of 12 to 18 people who lack immunity, much more contagious than covid or flu.
For people who have had measles, or have had two doses of a measles-containing vaccine, the risk is deemed to be low due to the high protection conferred by two doses of the vaccine or the lifelong protection from having had the disease.
Professor Peter J Hotez, co-director of the Texas Children's Centre for Vaccine Development and author of ‘The Deadly Rise of Anti-Science' (2023) suggested recently that people who decline to vaccinate their children against measles are taking large and unnecessary risks.
President of the US National Foundation for Infectious Diseases, Patricia Stinchfield, told NBC News that about a fifth (20%) of measles patients are hospitalised, often because they need intravenous fluids:
"These kids come in, slung over their parent’s shoulders, barely able to hold their head up. They’re like little rag dolls," she said.
Advice for parents is clear, unequivocal and unapologetic — make sure your children are up to date with their measles vaccines.
This third confirmed case of measles in Ireland was a red flag for air travel, leading to prolonged exposure in a contained space, to a highly transmissible and potentially serious disease.
Consider the Easter break as a red flag for measles being transported into Ireland from countries with outbreaks. The only way to protect your family is to make sure vaccinations are up to date. That means checking those vaccine records now.
- Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition at Safefood
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