COMPULSORY VACCINATION AND HEALTH COMMUNICATION

Anti-vaccine movements, and how to prevent their nefarious influence, have been again in the limelight in the last weeks.   Recent measles outbreaks in the US and the EU have been directly related to vaccine skepticism, and vaccine objection has been considered within the wider political context of emerging “populist” movements. Yet, as Donald Trump’s presidency is not likely to affect in depth vaccine policies in the US, similarly it is arguable that Emmanuel Macron’s victory in France could improve vaccination coverage in the EU (and notably in France). Actually, it is misleading to use traditional political criteria to analyze the anti-vax polemics. The traditional  political polarity between conservatives and liberals is hardly tenable in this field, as it is witnessed also by the strict association between anti-vaccine and anti-GMO movements, which are usually considered part of the larger ecologist and  liberal camp.

The main difficulty with anti-vaccine people is that they are usually impermeable to scientific evidence. Countering antivaccination attitudes by providing scientific evidence is not only ineffective, but it even risks to be counterproductive. Anti-vaccine theories are conspiracy theories, and it is always very difficult, if not impossible, to change the mind of someone who believes in a conspiracy theory. Finally, conspiracy theories are delusive constructions and, as most delusions, they cannot be modified by rational arguments. People suffering from paranoiac beliefs tend to interpret evidence against their beliefs as a proof of cover-ups, consequently as a proof that they are right. This means that any direct attempt to debunk a conspiracy theory risks to reinforce it. Indeed, one of the most frequent communication mistake is to accept framing the anti-vax quarrel in terms of “debate” between different points of view. Such an approach implies two very negative consequences. First, it is totally ineffective with anti-vax activists, who are usually unaffected by rational arguments; second, it implicitly provides some scientific legitimacy to anti-vaccine theories, and risks to disseminate them in larger sections of the population.   Also,  showing that vaccine related harm is negligible in comparison to vaccine related benefits, is hardly a good strategy. It is well known that people tend to overestimate harm caused by their actions, and underestimate harm caused by omission, or doing nothing.  Most people will always consider “worse” the risk (no matter how small) entailed by vaccination in comparison with risk entailed by non-vaccination (omission).

Scholars and experts in health communication have thus suggested that  highlighting information about the dangers of infections might be more effective to convince people to vaccinate themselves and their infants, than explicitly “marketing” vaccines. A new class of risk of misinformation is finally emerging, it concerns “arbitrary and unfair behavior by scientific journals”.     

The increasing pressure towards the promotion of open access journals and  online publication of electronic papers, is facilitating the birth of a new generation of predatory publishers, which pay very little attention to scientific quality, dramatically lowering peer review standards. These open access journals have the tendency to accept papers, which have been rejected by more established journals.  They tend to realize very late the  poor quality of published papers, even worse, their subsequent reaction is often totally inadequate. It was the case, for instance, of the  Journal of Translational Science, which published in April 2017 a paper discussing a correlation between vaccination and autism in 666 children, concluding that there is a statistic evidence of such a correlation.  This paper was statistically inadequate and scientifically very weak. A decent publisher would have never accepted it. Indeed, after a couple of weeks, in early May, the publisher realized it, and the paper was retracted from the journal website, but with no explanation or explicit  notice. Such a move was still worse than the initial publication, because it is unavoidably destined to generate suspects and fuel conspiracy theories. Brief, a very poor paper, which should have never been published, not only was published, but it is probably destined to become a  “proof” of anti-vax conspiracy theories, because of its “mysterious” retraction.Peso el tacon del buso (the patch is worse than the hole) reads an old Venetian proverb.

In such a discouraging scenario, a positive note is, however, coming from Italy and Germany. In these very days, both countries are enacting legislations, which are making several child vaccination compulsory. Parents, who refuse to vaccinate their children, risk to be fined and children to be prevented to attend the school. Many criticisms have been raised against mandatory vaccination, and it is difficult to escape the unpleasant impression that coercion is  the last, rude, resource of those who are not able to convince.  Such an impression is, however, misleading. It would be naïve to interpret legislations mandating child vaccination  only, or chiefly, in terms of coercion. Although legal coercion can play a (minor) role in reducing parental reluctance to vaccinate, no one could really imagine that in  democratic, pluralistic, societies, it could be ever possible to enforce such a legislation by using the police force, without evoking very strong negative social reactions. Making some vaccinations compulsory is rather a way to emphasize their significance. We are all used to consider something compulsory more important than anything which is only recommended on voluntary basis. In our culture, legal compulsion is often the hallmark of social importance.  Making some child vaccination compulsory is then one of the most effective, and simplest, means to communicate unambiguously that we consider vaccinations effective and valuable.    

RISK COMMUNICATION OR COMMUNICATION RISKS?

Innovate UK has recently awarded a team led by Dr Michael Jarvis at the University of Plymouth UK with a £408,000 grant to develop a new vaccine against zoonosis.

About 75% of newly emerging diseases and 60% of all known human infectious diseases are likely to be zoonosis.  The main idea of this new project is to develop a self-disseminating vaccine vector, called Zoonosis Barrier Vaccine (ZBV), targeting pathogens in the animal species from which they are emerging. By exploiting CRISPR/Cas9 technology, the team will aim to construct engineered viruses, which express target antigens from relevant Emerging Infectious Disease (EID) pathogens. Recombinant viruses will be then inoculated in few animals. They will spread through the whole host populations, producing EID-specific immunity in the targeted populations.

For now, the team will develop a ‘proof-of-concept’ vaccine vector, designed to halt the spread of Rift Valley Fever Virus (RVFV) and Q Fever (QF) among ruminant populations (i.e., sheep, goats and cattle).  The vaccine will prevent zoonotic transmission by using an attenuated bovine herpesvirus. The recombinant herpesvirus – which will replicate only for a short period of time for safety reasons - will infect domestic and wild animals, stimulating also immunity against RVFV and QF.  

The Zoonoses Barrier Vaccine strategy presents several advantages.  Self-disseminating vaccines allow addressing both domestic and wild animals. The transmission of infectious diseases between wild and domestic animals is particularly relevant to EIDs, as most EIDs originate from wildlife. The vicious circle of infections and re-infections between domestic and wild animals is likely to play a pivotal role in EID epidemiological cycles. Moreover, many emerging zoonotic pathogens are poorly adapted to the human hosts in their initial phases, this offers the opportunity to halt the zoonotic transmission by targeting the animal populations, and decreasing the “probability of complete adaption to the human host with global significance”. Finally, the approval requirementsfor animal vaccines are lower than those for human  vaccines, so reducing time to commercial availability. 

The Zoonoses Barrier Vaccine project presents, however, some Significant communicational challenges. Infecting wild and domestic animals with recombinant viruses is the typical project, expected to fuel conspiracy theories. People might also fear a sorcerer's apprentice phenomenon, with recombinant viruses that escape from human control and become dangerous for humans and animals.  Negative reactions can be also related to ecological considerations connected to the spread of engineered virus vectors in the natural environment. Finally, one should not underestimate the risk that some people may feel outrageous that livestock products for human consumption (including meat, milk, and eggs) could be theoretically “contaminated” by recombinant viruses. 

Researchers should carefully consider these communicational aspects. They should develop effective communication plans, to explain the rationale of their project and the way in which they intend to mitigate potential risks (even the most unlikely ones).  It is extremely important that full information on the Zoonosis Barrier Vaccine project is publicly available, in a format understandable to the public. Social media should be carefully monitored; worries, fears, myths, concerning the project should be immediately identified and addressed with appropriate counter-campaigns. Reasons of worry should be proactively addressed as they emerge. Finally, it is paramount that economic interests are completely and fully disclosed, without any ambiguity. People trust in scientists more than one usually imagine, but they do not  put up with researchers who are perceived not to be fully transparent. Suspects (even remote) of conflict of interest could have devastating effects on future research in this field.