The largest current measles outbreak in Europe is taking place in Romania with 24 deaths (as of 30 April 2017). The majority of cases are concentrated in areas where immunization coverage is extraordinarily low, Romania being a country with a growing anti-vaxxer movement in the past years. I talked to Dr. Vytenis Andriukaitis, the EU Commissioner for Health and Food Safety, about this issue.

His answers were remarkably strong for such a high European Union official. I would say this is fortunate, because vaccination is not a topic for diplomacy.

As you know there is a massive measles outbreak in Romania mainly due to low immunization coverage. As a medical doctor, what is your first thought when you hear news about deaths caused by measles in EU in 2017?

Vytenis Andriukaitis: We are all deeply sorry for this loss and our condolences to the families. I know the figures and they show Romania facing big problems with low levels of vaccination. In the last year, Romania reported 4800 cases of measles and this is a very very worrying information. Very painful figures. The coverage of vaccination in Romania is really a challenging issue. I am very concerned about this situation and we follow it closely through ECDC and through the health security committee. We once again ask Romania to present their view and what can we do to support Romania. At the moment there are 15 countries which reports outbreaks, but the highest figures are in Romania. We work together to help Romania raise awareness on the importance of vaccination and about the possible consequences of failing to vaccinate.

I know that in Romania you have a strong anti-vaxxer movement and vaccination hesitancy is quite high. I will send a very clear signal to those who have misleading perceptions or information: vaccination is a scientifically-based instrument. Vaccines help to save lives. It is a fact, it is not a matter of discussion. It is a fact! Those who do not believe it, please look how it was 45 years ago when we had every year 2.5 million child deaths due to low coverage of vaccination. It is crystal clear that vaccines are beneficial. I am so unhappy about the anti-vaccination movement. I would be more than open to explain anti-vaxxers why their understanding about vaccination is misleading.

Some parents don’t trust that the authorities are taking enough measures to ensure vaccine safety. Can you explain the approval procedures for vaccines in Europe?

Vytenis Andriukaitis: All vaccines are under strict control of European rules and requirements. All vaccines are under the strict control of European Medicines Agency. It is absolutely impossible to have vaccines which would not go through a thorough quality control and assessment. If something does happen, all those vaccines are immediately removed from the market because the European Union has a very strong control mechanism and we also have control at national levels. In Europe only a few manufacturers are producing vaccines because of technological sensitivities. EU-based manufacturers contribute with 80% to the global vaccine production and a significant part of the vaccines produced in EU are exported worldwide. Can you imagine what would happen if we would not follow strict vaccine safety requirements? We are controlling these producers. Of course a vaccine has some side effects because it is a very specific medicine, but all the side effects are strictly monitored by healthcare workers. There is no ground to say that European Union manufacturers supplies are dangerous. As you know, years ago different technologies were used and some problems with additional ingredients arised but they were immediately assessed, immediately controlled and removed from the market. No one can provide vaccines in the European Union without a pan-european control; it is not controlled only by the member states.

A draft of the vaccination law is right now in public debate in Romania. The controversy is whether to have mandatory vaccination or conditional immunization for children entering schools or no conditional rules at all. What is your stance on this topic?

Vytenis Andriukaitis: It is up to the member states to decide but we have a general picture: there are 17 member EU states where we have mandatory vaccination for child diseases. All countries have their own vaccination programmes with some vaccines mandatory, some not. My personal stand is to support mandatory vaccination especially in those areas where we have absolutely safe and effective vaccines. It is our obligation to fulfill the Convention on the rights of the child. This Convention encourages all member states to guarantee the highest level of child health protection. This is not only the parents’ obligation, it is also the states and governments’ obligation.

We had in Romania several famous evening talk-shows where anti-vaxxers where invited and given the opportunity to disseminate their opinions without any medical doctor or scientist present in the same TV show. Do you have a message for these talk-show hosts?

Vytenis Andriukaitis: Yes. We all are responsible, the whole society, all producers of media shows are responsible to disseminate true and scientific-based information and explanations. Today it is very easy to read scientific arguments on the WHO or ECDC websites, not to follow misleading information or lies. I want to say it very open: every child death in Europe from measles is the responsibility of those who disseminate such lies in the media, while those who do this without scientific and evidence-based arguments are equally responsible. Shame on anti-vaxxers! It is a shame to create in the 21st century this kind of mistrust. Please think about those parents who are now suffering because of what is a totally avoidable loss: their child’s death. Can you imagine their pain?

Today people feel safe because we all have collective immunity, we are surrounded by the herd immunity and those who are not vaccinated themselved live in a very safe environment due to herd immunity. Today Brasil is measles free, while Romania is not. Romania is a highly-developed country, member of the European Union, but it is not measles free. Brasil is measles free and in Brasil people asked us for help with vaccines against yellow fever because they saw how much suffering was spread around by some diseases. Anti-vaxxers should say „Thank you” to those around them who are vaccinated because they are safe thanks to everybody who got vaccinated. I am vaccinated myself because I save not only myself, but I save also other people around me.

Some people in the anti-vaccination movement will probably argue that you are serving the pharmaceutical companies’ interests. Why should parents trust you?

Vytenis Andriukaitis: I am a cardiac surgeon. When I am doing surgery I am using devices which are produced by the industry. So if I’m using during surgery a device produced by, let’s say, Siemens, does this mean that I am defending Siemens’ interests? This kind of logic is absolutely absurd. May I ask the anti-vaxxers why they are not blaming the auto industry when they are using cars, for example? This kind of logic is absolutely populism.

Romania is also going through a shortage of vaccines, in the last couple of months there has been a shortage of MMR vaccines. The causes are mixed but the Romanian authorities found out the MMR vaccines were parallel traded from Romania to other EU countries right in the middle of this measles outbreak. How do you comment?

Vytenis Andriukaitis: We want to help Romania address vaccine shortages. There are different causes for these shortages. There are only a few manufacturers of vaccines producing not only for Europe but all around the world. It is very difficult to guarantee sustainability of vaccine production without financial mechanisms to allow the sustainable production of vaccines. Today we have a big group of countries which decided to buy vaccines together and to guarantee stability of financial resources to vaccine providers. We are moving towards this direction very fast. We see good chances to address those shortages using joint procurement mechanisms. I can ask EU member states to cooperate more in this area and to discuss collaborative access to strengthen vaccine procurement and supply systems. I want to discuss how can we help Romania or other countries that face vaccine shortages, how can we facilitate that other member states show solidarity to immediately support Romania solve these shortages. I hope that EU health ministers will have more answers together.

The Romanian Government asked for the Commission support to ban the parallel trade of vaccines.

Vytenis Andriukaitis: Parallel trade of vaccines needs to be assessed. It is not so easy to discuss this without real figures because parallel trade is enshrined in the EU law and member states have the right to ban it only with sufficient grounds. If Romania has enough evidence, they can ask us to agree with such a ban, but we need a discussion based on very concrete figures. A phone conversation is not enough.

You can read this conversation, in Romanian, on the news website www.hotnews.ro.