The World Health Organization (WHO) recently published their top 10 world public health threats in 2019. It includes all of the public health threats that you can imagine, plus what they call “vaccine hesitancy,” or what I call the anti-vaccine religion’s ignorance, misinformation, and lies.
Yes, the anti-vaccine fiction and deception are one of the greatest dangers to the world’s public health. Their tropes, memes, and falsehoods are convincing enough people to delay or avoid vaccinating their children that diseases we thought weren’t a threat anymore are coming back. Europe and the USA are experiencing an unprecedented measles outbreak because of slightly lower measles immunization rates.
I want to review the WHO public health threats list because it’s interesting to those of us who fight the good fight for science. Of course, I’m going to focus on the vaccine deniers because that’s what we do here.
WHO’s top 10 list of public health threats
- Air pollution and climate change – Over 90% of humans breathe polluted air, which is linked to numerous health conditions, including cancer. And, of course, air pollution is one of the causes of climate change. From a public health perspective, it’s not just rising seas or more violent weather, it’s also about diseases like malaria and dengue fever moving into more areas of the world, about malnutrition from crop failures due to drought, and heat stress. WHO estimates that climate change will lead to an additional 250,000 deaths per year. Climate change denial, which seems to be the political strategy of the privileged class, will kill people.
- Noncommunicable diseases – These diseases include diabetes, cancer, cardiovascular disease, and mental illnesses. They are responsible for over 70% of deaths worldwide, about 41 million people. Suicide is the second leading cause of death across the world among 15-19-year-olds. These diseases are driven by five major risk factors – smoking, sedentary lifestyle, alcohol abuse, unhealthy diets, and air pollution (you’ll notice that many of the public health threats are linked to each other).
- Global flu pandemic – Even though some people believe that the world will never again experience a flu pandemic like the one in 1919, which killed around 50-100 million people worldwide, because of modern medicine. In 2009, a global H1N1 flu pandemic which killed up to 150,000 people worldwide – influenza is not a trivial disease. Moreover, modern medicine will probably not be able to save lives in a serious pandemic, since healthcare facilities across the world will be overwhelmed by the response to the disease. Increasing the vaccination rate against the flu, along with developing more effective vaccines, will help mitigate a future pandemic.
- Fragile and vulnerable settings – According to the WHO, more than 1.6 billion people live in places with protracted crises such as drought, famine, war, and population displacement along with ineffective and weak healthcare services.
- Antimicrobial resistance – Along with vaccines, the development of antibiotics, antivirals, and other antimicrobials is one of the greatest successes of medicine. Sadly, the ability of bacteria, parasites, viruses, and fungi to resist these drugs may send us back to the era before the invention of these drugs, when infections like pneumonia, tuberculosis, gonorrhea, and salmonella were death sentences. And it’s more than the infection itself that is problematic – medical procedures like surgery and chemotherapy can be compromised by the inability to prevent and treat infections.
- High-threat pathogens – These are diseases like Ebola, Zika, and other pathogens that are highly infectious with a high mortality rate. Outbreaks of Ebola occurred in conflict zones and spread to densely populated cities. This makes it difficult for public health officials to identify and contain the pathogen. Moreover, as the transportation and tourism industry allow novel pathogens to easily move across the world, it makes this threat even more frightening.
- Weak primary health care – Primary health care, usually a family physician, is the first point of contact most people have with the healthcare system. It should be comprehensive, affordable, and continuous throughout one’s life. Primary healthcare is more than just diagnosing disease, it is the first step in preventative medicine that can reduce the burden on the overall healthcare system. A robust national healthcare plan, with appropriate levels of primary care physicians and healthcare workers, actually reduce the overall cost of healthcare to a nation (looking at you America).
- Dengue – Dengue is a mosquito-borne disease that is quite dangerous, killing up to 20% of those with the most severe cases. As I mentioned above, global warming means that the mosquitos that carry the dengue virus are moving into areas whose climate is more favorable, like the southern USA and Europe. At this time, there are no effective treatments for the disease, so prevention is the number one public health priority. For example, genetically modified mosquitos are being tested in the Florida Keys in an attempt to stop transmission of the disease.
- HIV – HIV/AIDS doesn’t make the news as it did 25 years ago because of the enormous gains that antiretroviral medications have made against the disease. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), where the antiretrovirals are given to individuals at risk of HIV infection. Despite this success, around 37 million people worldwide have an HIV infection, with about 25% in sub-Saharan Africa.
And the public health threats of vaccine denial
Since I focus a lot on vaccines, I wanted to focus on the vaccine denial, or what WHO calls “vaccine hesitancy.” Of the top 10 global public health threats that WHO describes, nine of them are generally outside of personal choice. They are political matters, often at a global scale, like climate change.
On the other hand, vaccine denial is almost exclusively a matter of “choice,” generally, parents using their ignorance to deny protecting their children from vaccine-preventable diseases. This is not an issue of availability of vaccines – it is simply that parents are not vaccinating their children.
For example, the WHO report states:
Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.
Many developed countries have seen a large increase in measles cases, a disease that many countries thought had been eliminated. Although measles vaccine uptake is over 90% in the USA, the problem is that vaccination rates tend to be lower in many areas of the country. In California, pockets of vaccine denial tend to be in wealthier, more liberal sections of the state.
These pockets of unvaccinated children (and adults, to be realistic) can be ground zero for a measles epidemic.
The reasons for this vaccine hesitancy are multifold:
- The ridiculous belief that vaccines cause autism. It doesn’t.
- The lost cultural memory of the epidemics that used to kill children. Some parents seem to think that these vaccine-preventable diseases are trivial matters, not unlike a common cold, because they grew up in a world without some of these epidemics.
- Scientific ignorance. Vaccine safety and effectiveness are settled science, not unlike the settled science of anthropogenic climate change.
- Chemical phobia.
- The appeal to nature fallacy. Getting a “natural” measles infection puts children at risk of serious complications like SSPE and death. Vaccines work by inducing the immune system to “remember” the pathogen without a living pathogen.
- Conspiracy theories. You know, Big Pharma along with Big Government put nanobots into the vaccines to control people.
As I mentioned, the overall immunization rate across the world remains very high. But if governments, like Italy and the USA (since Donald Trump is a vaccine denier), reduce their commitment to vaccines, massive epidemics of vaccine-preventable diseases can become a serious threat to global health.
I started writing about vaccines because I wanted to add pro-science information about vaccines to show up in Google searches. Many other individuals do the same, to make sure the pseudoscience pushed by the anti-vaccine religion is overwhelmed by real scientific facts.
However, the traction that the deniers are getting is troubling. The World Health Organization is right in calling out the anti-vaxxers one of the global public health threats. They are dangerous.