Measles Outbreak and Malicious Actors in Europe: Public Health Watch

First, it was reported they came for our political system.

Now, apparently, they are after our health.

That’s right, according to a paper published on August 23 in the American Journal of Public Health (AJPH), Russian online “trolls” have taken to social media to sow doubt among the general public regarding the safety and efficacy of measles/mumps/rubella (MMR) vaccines. The result, they state, is a reduction in vaccine uptake and outbreaks of measles in multiple countries, most recently in Europe.

“The insufficient vaccine uptake is the crucial factor that is responsible for such outbreaks,” Guillaume Beraud, MD, PhD, Health of Populations and Best Practices in Health, University Hospital of Quebec/University of Laval Hospital, Sainte-Foy, Quebec City, and Interuniversity Institute for Biostatistics and University of Poitiers (France) Hospital Center, told Contagion®. “The worrying aspect is that this [measles] outbreak is composed of multiple outbreaks disseminated all over Europe, not a big one over a limited time. Therefore, I think there are still many cases to come from all over Europe.”

Dr. Beraud was not part of the AJPH research, and he questions the true impact of Russian trolling on the vaccine “debate” in Europe and, thus, in the ongoing outbreak. However, the numbers are stark. The World Health Organization (WHO) has reported that there have been more than 41,000 cases of measles in Europe since the beginning of 2018 (data tracks cases through June), nearly double the number (24,000) for all of 2017. In all, 7 countries across the continent—France, Georgia, Greece, Italy, Russia, Serbia, and Ukraine—have reported more than 1000 cases each among children. Ukraine has been the hardest hit, with more than 23,000 cases.

“We are seeing a dramatic increase in [measles] infections and extended outbreaks,” Zsuzsanna Jakab, PhD, WHO Regional Director for Europe, said in a statement.

Although Dr. Jakab emphasized that “good health for all starts with immunization,” not everyone in Europe—or in the United States, as Contagion® reported previously—is getting the message, and an online “disinformation” campaign may be at least partly to blame. The AJPH study compared Twitter bots’ (essentially automated accounts) to average users’ rates of vaccine-relevant messages collected on the social media platform from July 2014 through September 2017 and assessed numbers of “polarized and antivaccine tweets across user types.” Their content analysis of a Twitter hashtag associated with Russian activity revealed that “Russian trolls, sophisticated bots, and content polluters” tweeted about vaccination at higher rates than regular users. So-called content polluters posted more antivaccine content, while Russian trolls amplified arguments on both sides of the issue.

“It turns out that many antivaccine tweets come from accounts whose provenance is unclear,” study co-author David Broniatowski, PhD, assistant professor, Engineering and Applied Science, George Washington University told The Guardian. “Although it’s impossible to know exactly how many tweets were generated by bots and trolls, our findings suggest that a significant portion of the online discourse about vaccines may be generated by malicious actors with a range of hidden agendas.”

Dr. Broniatowski and his colleagues found that these “malicious actors” typically raised the issue of vaccination within the context of political and/or religious debates and would often include attacks on the credibility of US government agencies engaged in health care. Sample tweets cited by The Guardian include: “Did you know there was secret government database of #Vaccine-damaged child? #VaccinateUS.” As the example tweet highlights, though, the target of these Russian trolls, assuming they exist, seems to be the United States.

“Unfortunately, at least in France, we don't need Russia to have [heated] debates,” Dr. Beraud joked, adding, “In addition, as usual, Russia is the ideal culprit, which gives us the opportunity to not tackle our problems with the antivax community.”

Indeed, as the WHO notes in its statement regarding the European measles outbreak, national governments must work toward a target of “at least 95% immunization coverage with 2 doses of measles-containing vaccine” and initiate “efforts to reach children, adolescents, and adults who missed routine vaccination in the past.” Although WHO figures suggest that vaccine coverage across the continent exceeded 90% in 2017, there was a wide disparity between countries. Notably, despite the implementation of the European Vaccine Action Plan in 2015, countries such as France, Greece, Italy, Romania had vaccine uptake rates of less than 84% in 2016, according to the WHO.

Meanwhile, in Venezuela, where access to vaccine remains an issue, the Miami Herald reports that there have been more than 3500 confirmed measles cases, and 60 deaths related to the disease. As a result, the Pan-American Health Organization has placed the entire region on high alert, and recommended the aggressive implementation of vaccination programs, particularly for countries bordering Venezuela, where political unrest remains a serious issue.

“At this midterm juncture for the European Vaccine Action Plan, we must celebrate our achievements, while not losing sight of those who are still vulnerable and whose protection requires our urgent and ongoing attention,” the WHO’s Dr. Jakab said in a statement. “We can stop this deadly disease. But we will not succeed unless everyone plays their part: to immunize their children, themselves, their patients, their populations—and also to remind others that vaccination saves lives.”

While perhaps suggesting that they not take advice from strangers on Twitter as well.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care—related publications. He is the former editor of Infectious Disease Special Edition.