Growing role of GHIT

Non-profit pairs

Japanese pharma with

global organisations

Page 2

FT Health

Communicable Diseases

FT SPECIAL REPORT

Tuesday August 27 2019 http://www.ft.com/reports | @ftreports

Inside

Struggle against

superbugs

There are glimmers of

light in the fight against

antimicrobial

resistance

Page 3

Responding to

epidemics

Investing in vaccines

makes strong economic

sense

Page 3

Focus on prevention

Primary care plays

crucial role in fighting

disease

Page 3

O

utside an Ebola treatment

centre in Beni in the Dem-

ocratic Republic of Congo,

medical staff in yellow

smocks, hair nets and blue

surgical gloves administer vaccines to

thefamiliesofhealthworkers.

“You won’t cry will you, Claudi,” a

mother says to her small son, as the

nurse plunges the life-saving vaccine

intohisleftarm.

The shot, developed by Merck, the US

pharmaceutical company, has been a

revelation. Though still unlicensed, the

vaccine has demonstrated an estimated

efficacy of 97.5 per cent in stopping

infection for the haemorrhagic fever

that was impossible to prevent as

recentlyas2014.

But it has not been enough. Despite

the vaccination of more than 180,

people, Ebola is still spreading more

than 12 months after the first cases in

thislatestoutbreakwereidentified.

This has stoked a heated debate over

the medical response, the ethics of vac-

cination trials and why a second experi-

mental vaccine developed by Johnson &

Johnson is still languishing in Dutch

warehouses.

Pharmacists first trialled the Merck

vaccine, rVSV-ZEBOV, on 16,000 volun-

teers during the 2014-2016 Ebola epi-

demic in west Africa that killed more

than 11,000 people. Despite dozens of

outbreaks since the virus was first iden-

tified in the forests of central Congo in

1976, progress to develop and test a

potential vaccine was slow.

When the current crisis started a year

ago, Congolese officials agreed to a more

expansive trial of the Merck product

under global “compassionate use” pro-

tocols, which allow for unlicensed treat-

ments to be administered when there is

nobetteralternative.

The trial has used a “ring vaccination”

strategy, where the circle of people with

whom an infected patient has come into

contact, in addition to the circle of peo-

ple around each contact, receive the

vaccine. Frontline health professionals

also received the shot. In the first eight

months of the outbreak, each ring aver-

Vaccine debate dogs Ebola response

Vaccination strategies

for curbing the latest

outbreak in DRC are

fiercely contested,

writesTom Wilson

aged just over 100 people, according to

theWHO.

The trial has been successful,

the WHO says, delivering immunity

in more than 97 per cent of cases — but

it has not stopped the outbreak.

Anne-Marie Pegg, a doctor with the

Continued on page 2

Family members of a deceased Ebola victim get to see the body before burial in Beni last month. Almost 2,000 have died in the current outbreak— John Wessels/FT

Public health experts in the US are try-

ing to beat “anti-vaxxers” at their own

game by using new tactics to stem the

spread of misinformation about vac-

cines, as the country suffers its largest

measlesoutbreakin27years.

So far this year, more than a thousand

Americans have contracted measles — a

childhoodinfectionthatcanleadtohos-

pitalisation and death — as unvacci-

nated travellers bring back the disease

once thought to have been eliminated

byvaccines.

Local authorities have tried to boost

vaccination rates by removing exemp-

tionsthatallowparentstoputtheirchil-

dren in school without having shots.

New York City introduced a $1,000 fine

for those who did not vaccinate in the

middleofanoutbreakinaJewishOrtho-

doxneighbourhoodinBrooklyn.

Butmostrealisethatrulesandregula-

tions cannot win in an information war.

Vaccination levels have slipped because

of concerted campaigns to spread

rumours on social media that they are

unsafe — fuelled by distrust of govern-

ment and scientific expertise. Instead,

public health authorities are trying to

hone how they communicate with anx-

ious parents, whose fears may have

beenignitedbydisinformationonline.

Brad Hutton, the deputy commis-

sioner at New York state’s office of pub-

lic health — which co-ordinated the

response to a separate outbreak this

yearinRocklandCounty—saysthatone

misconception is that measles is not

serious. “People have forgotten that in

prior generations as many as one in four

childrenwithmeasleswashospitalised,”

hesays.

As anti-vaxxers stir up fears that vac-

cines can give children autism, public

health experts believe it is important to

counter with tragic tales of people who

sufferedfrompreventablediseases.

In Denmark and Ireland, for instance,

officials tackled concerns about giving

young girls the vaccine against HPV —

human papillomavirus — with social

media testimonials from people who

had lost wives or mothers to cervical

cancer.

The messenger and the style of deliv-

ery are just as important as the message

itself. Jennifer Nuzzo, senior scholar at

the Johns Hopkins Center for Health

Security, says it is important to segment

your audience and understand that not

everyone is “vaccine-hesitant” for the

same reasons. “You can’t treat this

group as a monolith, you really have to

understand the underlying motivation

andaddressit,”shesays.

In some cases, it can be as simple as

improving access to vaccines, or tack-

ling concerns about having too many at

once. Some might be worried that vac-

cines are not “natural” and believe they

can tackle diseases with a healthy life-

style, while others may resist because

theydonotlikebeingtoldwhattodo.

Many healthcare professionals are

adopting a “presumptive approach”,

where instead of asking parents if they

want vaccines, they presume they do.

Theytellparentsitisimportant,backed

by scientific evidence, and safe, giving

themlessroomtopullout.

But in Quebec, Canada, they are

experimenting with a very different

technique called “motivational inter-

viewing”, designed to help parents feel

their concerns are understood. Instead

of confronting misinformation head on

— and potentially causing ambushed

parents to dig their heels in — they ask

questions to encourage them to exam-

inetheirownuncertainties.

Thatprojectisalsotryingtomeetpar-

ents earlier. “We deploy education in

maternity wards across Quebec to

encourage parents to get vaccinated

when the babies are born,” says Dr

Theresa Tam, Canada’s chief public

health officer. “We borrow from behav-

ioural science to provide a technique

that allows the provider to communi-

cateinthemosteffectiveway.”

Another important technique is to

help people understand the tools anti-

vaxxers are using to manipulate them,

such as fake experts, Dr Tam says.

“Never underestimate the fact that peo-

pledowanttohavefacts,”sheadds.

Parents may want the facts — but

often the last place they go is to their

public health agency. Facebook and

Twitter are trying to change this, by

putting a link to each country’s author-

ity first in the rankings when people

searchforvaccinesontheirsites.

Sending messages from on high is one

thing, but getting people from the com-

munity to inform others can be more

effective. In Rockland County, New

York state worked with local religious

leaders and healthcare centres. In Can-

ada, the state is getting “parenting influ-

encers” — who already have large audi-

ences of young parents — to spread the

messageonline.

The London School of Hygiene and

Tropical Medicine’s Vaccine Confidence

Projectmonitorsmisinformationonline

in real time, operating a “triage”

approach where local health officials

around the world are alerted to emerg-

ingissues.

Professor Heidi Larson, who runs the

project, says social media sites have to

be wary of being perceived to be delet-

inginformation.“Itcouldleadtoaback-

lash as it absolutely pushes that button

that‘theyarecensoringus’,”shesays.

Pro-vaccine campaigners also need to

be wary of using language that alienates

their audience. She said some people

who were just asking responsible

parenting questions could feel “demon-

ised” by the language used by those in

favourofvaccinesonline.

So far, there is no perfect protocol for

publichealthofficialstocombatvaccine

misinformation. Ms Nuzzo says she

wouldlovetosee“moreintellectualfire-

power” — including from behavioural

economics — to inform the experiments

to boost vaccination rates. With hard

workandoutsideexpertise,shebelieves

society has shown it can change its atti-

tudes.“Itrulybelieveitisafixableprob-

lem,”shesays.

Officials give ‘anti-vaxxers’

taste of their own medicine

Measles

US public health authorities

use social media and

influencers to curb spread of

disinformation.Hannah

Kuchlerreports

New York nurse prepares a vaccine

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