Fighting vaccine-preventable diseases through quality services and anti-vaccine myth-busting
- Author(s):
- Parliamentary Assembly
- Origin
- Assembly
debate on 24 June 2022 (25th sitting) (see Doc. 15542, report of the Committee on Social Affairs, Health and
Sustainable Development, rapporteur: Ms Carmen Leyte). Text adopted by the Assembly on
24 June 2022 (25th sitting).
1. While the world’s attention has
shifted away from combating the Covid-19 pandemic to dealing with
the consequences of the Russian Federation’s war of aggression in
Ukraine, serious outbreaks of vaccine-preventable illnesses are
on the rise, in Europe and across the world.
2. Measles cases alone increased globally by 79% in the first
two months of 2022, compared to the same period in 2021, with most
cases occurring in unvaccinated or under-vaccinated individuals.
Measles is a highly contagious viral disease. It remains a major
cause of death among young children, despite the availability of
a safe and effective vaccine. Other diseases that may attain epidemic
proportions despite the availability of safe and effective vaccines
include poliomyelitis, tuberculosis, diphtheria and chickenpox.
The Covid-19 pandemic continues to cause death, disability and chronic
disease on a large scale. In Europe this is mainly due to insufficient
vaccine uptake and the often premature relaxation of tried-and-tested
public health measures.
3. Vaccination remains the safest and most effective method of
protection against many infectious diseases. According to the World
Health Organization (WHO), it prevents 2 to 3 million deaths a year.
It is estimated that an improvement in the global coverage of vaccinations
could save a further 1.5 million lives. The current resurgence of
vaccine-preventable diseases is largely due to gaps in immunisation.
According to WHO, suboptimal vaccine uptake is currently one of
the most critical issues in public health.
4. The Parliamentary Assembly recalls its
Resolution 2338 (2020) “The impact
of the Covid-19 pandemic on human rights and the rule of law”, in
which it stated that “[t]he positive obligations under the European Convention
on Human Rights (ETS No. 5, “the Convention”) require States to
take measures to protect the life and health of their populations”
and the Convention on Human Rights and Biomedicine (ETS No. 164,
“the Oviedo Convention”), which requires that member States take
measures to provide equitable access to healthcare of appropriate
quality, taking into account health needs and available resources.
Furthermore, the Assembly notes the Council of Europe Committee
on Bioethics statement entitled “Covid-19 and vaccines: ensuring
equitable access to vaccination during the current and future pandemics”
and the committee’s work under the title “Ensuring equitable access
to vaccine, medicinal product and medical equipment in a context
of scarcity”, which provide valuable guidance and advice for Council
of Europe member States. The Assembly is convinced that addressing
suboptimal vaccination coverage is a matter of human rights protection
and should be a priority for Council of Europe member States.
5. The Assembly stresses the importance of ensuring quality standards
in vaccination and welcomes the work of the European Directorate
for the Quality of Medicines & HealthCare (EDQM) of the Council
of Europe, which co-ordinates the independent batch release testing
through the Official Control Authority Batch Release process, as
part of an activity co-funded by the European Commission and the
EDQM. The EDQM functions within the framework of the Convention
on the Elaboration of a European Pharmacopoeia (ETS No. 50), signed by
the European Union and by 39 countries, including all European Union
member States, which are committed to achieving harmonisation of
quality standards for safe medicines throughout the European continent.
6. To protect public health effectively, immunisation levels
need to be increased and sustained as a matter of priority. Vaccinations
largely prevent sickness and death associated with infectious diseases,
both for vaccinated individuals and for society as a whole, by developing
what is called “herd immunity”. Vaccinations also bring wider health,
social, political and economic benefits, including poverty reduction
and achieving greater gender equality, as well as savings in healthcare
costs, lost wages and lost productivity due to illness and death.
Vaccinations allow people to live longer, healthier lives and reduce
the long-term burden of disability. Expanding access to immunisation
is crucial to achieving the United Nations Sustainable Development
Goals.
7. Strategies to comprehensively address inadequate immunisation
coverage should focus on the root causes of this problem. Reasons
for suboptimal vaccine uptake are context specific. They vary broadly
and include social, economic and cultural barriers, lack of access
and availability, inadequate quality of services and attitudes to
vaccination. Covid-19 pandemic-related disruptions further increased
inequality in access to vaccines, while the displacement of millions
of people as a result of conflicts and crises leads to disruptions
in vaccination services. According to WHO and the United Nations
Children’s Fund (UNICEF), in 2020, 23 million children missed out
on basic childhood vaccines through routine health services, the
highest number since 2009 and 3.7 million more than in 2019. Emergency
measures are required to address vaccination gaps resulting from
the Covid-19 pandemic.
8. The Assembly is convinced that promoting peace, tackling poverty
and building robust and sustainable public health services that
people can trust are essential preconditions for improving vaccination
coverage. As the Covid-19 pandemic demonstrated, such public health
services need to be supported across the globe, as outbreaks of
contagious diseases can spread quickly across countries and regions,
with potential for further mutations of pathogens. The Assembly
recognises that vaccines and vaccination are a global public good
and unequal access to vaccines anywhere in the world is a threat
to us all.
9. Healthcare workers, pharmacists and community outreach workers
play a crucial role in successful vaccination and are the most trusted
sources of information on this subject, across countries and different population
groups. They need to be at the centre of vaccination strategies
and must be involved in relevant decision-making processes.
10. The Assembly notes with concern that public debate on vaccines
has become highly polarised and politicised in recent years. Unfounded
concerns about Covid-19 vaccinations, which had to be swiftly developed
and were made mandatory in some cases, had a knock-on effect for
other types of vaccination (and “anti-vaxxer” activism prior to
the pandemic led to greater reluctance to be vaccinated against
Covid-19). The Assembly’s
Resolution
2361 (2021) “Covid-19 vaccines: ethical, legal and practical
considerations” and
Resolution 2383
(2021) “Covid passes or certificates: protection of fundamental
rights and legal implications” provide useful guidance on the human
rights-compliant deployment of vaccines against Covid-19.
11. It is important to acknowledge that trust in governments in
general and in public health systems specifically are important
factors when people make decisions about vaccination. In this context,
the Assembly notes with alarm that the European region has a higher-than-average
percentage of negative opinions on vaccine importance, safety and
effectiveness. In fact, 7 of the 10 countries with the highest levels
of scepticism about vaccine safety belong to our region. Furthermore,
reluctance to have a vaccination seems to be more present among
younger generations. Older generations tend to have more confidence
in vaccines, as they have witnessed the consequences of outbreaks
of contagious diseases and the way in which they have been combated
through vaccination.
12. The Assembly calls on Council of Europe member States to take
urgent action and to acknowledge public responsibility for lowering
barriers to vaccine uptake, in full respect of the principles of
human rights, democracy and the rule of law. It welcomes the Tailoring
Immunization Programmes approach developed by the WHO Regional Office
for Europe as a useful model that can be emulated in different national
and subnational contexts. This approach, grounded in scientific
evidence and country experience, aims to identify those populations
with suboptimal vaccination uptake, to systematically identify the
barriers to and drivers of vaccination in these population groups
and to design context-specific interventions to address these barriers and
capitalise on what drives vaccination – with the aim of increasing
the uptake of vaccinations. The rapid-response approach designed
to ascertain the qualitative contexts of a population’s perception
of vaccination uptake developed within the context of the Covid-19
pandemic allows for rapid, up-to-date and relevant data collection
and decision making.
13. The Assembly calls on Council of Europe member States to give
high priority to the prevention of the resurgence of contagious
diseases. It recommends that member States develop comprehensive,
forward-looking, proactive and human rights-compliant vaccination
strategies, by ensuring that:
13.1 with
respect to access, availability and quality of services:
13.1.1 investment in building robust and sustainable immunisation
systems and national immunisation schedules is adequate and takes
into account the lessons learned from past epidemics and pandemics
and emerging challenges;
13.1.2 quality vaccination services are available and accessible
to all people within the State’s jurisdiction and that this includes
provision of adequate vaccine supplies, free vaccination for all and
better follow-up from the healthcare system; when supply is inadequate,
the principle of equitable access to vaccines should be ensured;
13.1.3 the rights of individuals are respected, the risk of harm
is minimised and positive outcomes for persons concerned are ensured;
effective systems for monitoring potential adverse effects of vaccines
and independent compensation programmes are in place;
13.1.4 mandatory vaccination is only considered as a last resort,
when this is necessary in order to fulfil a legitimate aim, is provided
for by law and is proportionate; the introduction of any compulsory
vaccination is subject to public debate, parliamentary scrutiny
and judicial oversight, and less constraining measures are given
preference when feasible;
13.1.5 the principle of the best interests of the child is respected
in all matters concerning children and vaccination; relevant legislation
is reviewed to allow children to be vaccinated in their best interests
in situations where one or both parents are against such vaccination,
including by ensuring that the right of children to be heard on
matters concerning their own health is duly taken into account,
in accordance with their age and maturity;
13.1.6 the work of development agencies is supported, with a
view to extending the benefits of vaccination to people in countries
that experience shortages; vaccination is promoted as global public
good and the sharing of know-how is facilitated, including by lifting
restrictions arising from patents and intellectual property rights
when appropriate;
13.2 with respect to public attitudes to vaccination:
13.2.1 barriers to and drivers of vaccination are analysed on
a regular basis and the needs of specific population groups are
duly researched and understood; targeted evidence-based interventions
are designed and implemented; subnational entities and local communities
are engaged in developing and implementing tailored strategies to
support vaccine uptake; co‑operation with non-governmental organisations
and with other local efforts is supported to reach out to marginalised
groups and overcome social and cultural barriers to vaccine uptake;
13.2.2 reliable and transparent information on vaccination, including
contraindications, is available and accessible, and is up to date;
13.2.3 dissemination of misinformation is addressed through relevant
policies, regulations and other measures, including through good
use of information and communication technologies; digital behaviour
is monitored, researched and considered in public policy making
and communication strategies on vaccination;
13.2.4 open and transparent dialogue and communication on the
safety and quality control of vaccines and on the benefits of vaccination
are supported; resilience and health literacy are improved, in co-operation
with the education sector and the media, including social media platforms;
user-friendly awareness-raising materials are developed for various
target audiences and that any such materials address the barriers
and drivers related to a particular group and use language that
is accessible and appropriate;
13.2.5 anti-vaccination attitudes are tackled through systematic,
targeted counter-narratives that are context-specific, based on
science, address doubts and concerns raised and highlight individual
and collective responsibility for one’s own health and one’s children’s
health, as well as other people’s health, including that of vulnerable
groups who cannot get vaccinated for health reasons but who benefit
from “herd immunity” when a sufficient proportion of the population
is vaccinated;
13.2.6 media codes of ethics are strengthened with emphasis on
social responsibility for countering disinformation on vaccination
and for enabling maximum visibility for quality information on vaccination
from trustworthy sources; internet intermediaries are encouraged
to support anti-vaccine myth-busting and to raise awareness of the
potential risks to public health protection of false information;
13.2.7 all healthcare workers benefit from workplace training
on safety, characteristics and technical components of vaccines
and are equipped with communication tools and materials for promoting
vaccine awareness; dedicated staff and space for communication on
vaccination are envisaged, to allow for flexibility and ease of
access to relevant information;
13.2.8 healthcare workers have sufficient time to spend with
parents and other patients, to discuss with them any concerns that
they might have with respect to vaccination; this implies that their
working conditions, including working time, workload and remuneration,
are adequate;
13.2.9 politicisation of vaccine policies is avoided and non-partisan
continuity in public health policies is promoted, based on the advice
and guidance from WHO, other relevant international and national
scientific bodies, public health authorities and institutes;
13.2.10 the World/European Immunization Week celebrated in the
last week of April is supported to highlight the collective action
needed and to promote the use of vaccines to protect people of all
ages against disease;
13.2.11 full use is made of WHO toolkits and the resources developed
by the European Centre for Disease Prevention and Control.
14. The Assembly expresses its support for the work of the European
Commission and European Parliament to promote a joint European approach
on vaccination and encourages stronger co-operation with European countries
which are not members of the European Union, in particular with
the support of Council of Europe structures, such as the EDQM and
the Steering Committee for Human Rights in the fields of Biomedicine
and Health (CDBIO).
15. The Assembly welcomes WHO’s strategy and vision for the European
Immunization Agenda 2030, which aims to extend the benefits of vaccines
to everyone, everywhere, and undertakes to support its implementation
through parliamentary co-operation.
