title: [Consequences of opposition to vaccination in France and Europe. How to maintain effective vaccine coverage in 2010?].
abstract: Refusal of vaccination can result in inadequate vaccine coverage. The collective benefit of immunisation depends on a sufficient and sustained level of vaccine coverage. Low vaccine coverage can lead to the persistence of preventable diseases and, in some cases, to a dangerous shift in the age of pathogen encounter towards adulthood. This is the case of measles in Europe, where some countries, including France, have not reached the effective vaccine coverage rate of 95%. Outbreaks are occurring, leading to complications (encephalitis and pneumonia) in adolescents and adults, necessitating hospitalization in nearly one-third of cases. The French population is also under-vaccinated against hepatitis B, due to fears of a risk of demyelinating disorders: the coverage rate is currently only about 30% in infants and 10% in adolescents. These difficulties are due to negligence and to vaccine refusal by parents. Refusal of immunisation has a long history in Europe, and explains for example why pertussis remained endemic in many countries until 1995, and also the resurgence of diphtheria in the Russian federation during the 1990s. Sections of Western society are now questioning the need for some routine vaccines, overlooking the fact that they have eradicated some diseases (polio, diphtheria, etc.) and protect effectively against lesser-known pathogens such as hepatitis B virus and HPV. In France, it will be necessary to restructure healthcare professional training programs in vaccinology and to provide the public with more thorough information on the risk-benefit ratio of vaccination. The recent controversy surrounding pandemic H1N1 influenza vaccination demonstrates that the public and the media tend to focus more on the potential risks of vaccination than on its benefits. A vigorous ethical and political debate is needed to shape an effective and acceptable vaccine policy for the 21st century.
authors.affiliation: pbegue@wanadoo.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Bégué
mesh_terms: D003140:Communicable Disease Control; D005060:Europe; D005602:France; D006801:Humans; D016312:Treatment Refusal; D014611:Vaccination / Q000009:adverse effects