In Austria, where elimination of measles is tantalizingly close, a creative and innovative campaign seeks to encourage vaccination among unimmunized adults.
On the evening of 10 January 2014, a group of young people were chatting at a popular hangout in a park near Vienna's Leopold Museum. They turned quiet as the museum lit up.
Austria's Federal Ministry of Health had arranged for projection on the museum’s walls of a red slogan surrounded by bright red spots. The slogan, Wir schielen schon auf dich, means "We're looking at you, too." The crowd started laughing.
The red spots were to remind people that measles was "looking" for them and they could soon be covered with a rash, like the museum's walls. But there was a double meaning: Many works by Egon Schiele, the renowned Austrian painter whose last name means "look" in German, are on display in the Leopold Museum – there to be looked at too.
Reaching unimmunized adults
Like other countries across the WHO European Region, Austria – despite its especially strong health system – has found it challenging to eliminate measles, which would mean no active spread of the disease for 12 months or more. Austria is a small country, with a population of less than 8.6 million, but in 2013 there were 75 cases of measles.
And so in 2014 the health ministry launched a playful but aggressive antimeasles campaign, using highly visible approaches like painting red spots on trams and coaches, public service announcements in movie theatres and ads in popular publications. The campaign targeted people of all ages, including parents, but it aimed especially at reaching unimmunized adults.
In Austria practically all babies - more than 95% - are immunized against measles. Not so for adults. “Many adults over the age of 45 are not immune to measles because they were never vaccinated and never had the infection. This makes them vulnerable to catching the disease if they are exposed. The result is “hotspot” outbreaks,” explains Dr Maria Paulke-Korinek, Head of the Vaccines Department at the Austrian Federal Ministry of Health. “More than a third of our measles cases last year were in people over the age of 15.”
Lost generation
Before the measles vaccine was discovered in the 1960s, the vast majority of European children caught the disease. People who had never been sick with the infection and were already past the typical age for measles immunization when the vaccine came into routine use fell through the cracks.
“In Austria, we have a sort of lost generation where measles is concerned. Young Austrian adults tend to think of measles as a childhood illness that is a thing of the past and do not realize it is quite dangerous and potentially lethal. They generally believe they were probably vaccinated – but don’t check to see if this is true,” says Dr Heidemarie Holzmann, Associate Professor in the Department of Virology at the Medical University of Vienna. “Anyone, no matter what their age, can get vaccinated against measles free of charge in Austria, but not enough people take advantage.”
Austria faces another challenge. “In many European countries, including Austria, we are encountering vaccine hesitancy – a prejudice against vaccination based on personal philosophy or groundless fears about side effects,” says Dr Mark Muscat, Technical Officer at the WHO European Regional Office. “Sadly, there are even quite a number of health workers who are anti-vaccine.”
Building awareness across Europe
WHO has been working closely with countries across the Region to help them educate people about the science behind immunization and make them aware of the seriousness of illnesses they prevent.
“The European Vaccine Action Plan calls for a new approach to promoting vaccination throughout life,” Dr Muscat says. “We know it takes creative thinking of the sort Austria has put into action, and some countries are following suit.” For example, Ireland set up vaccine clinics targeting adults on Saint Patrick’s Day (17 March), an important holiday where people are socially active.
It has already been shown that elimination of measles – and rubella - is possible. The WHO Region of the Americas – which includes many low-resource countries – has met this goal. “Elimination of measles and rubella is currently one of the top priorities for the WHO European Regional Office,” Dr Muscat says.
There were more than 16 000 cases of measles across the European Region in 2014. Although the number of cases has dropped to the lowest level since 2010, much remains to be done.