Some states in the United States, including the Oregon and neighboring Washington, allow easy opt-outs for vaccines, allowing parents to skip immunization if they express a personal objection. Last year, research published in the journal Plos Medicine found "focal points" of "anti-vaccine activities" in the 17 states that allow exemptions based on personal belief – covering the cities of Seattle, Portland, Phoenix, Salt Lake City and Austin in particular.
"We identified about a dozen cities where there are a large number of children who do not receive vaccines because their parents excluded them from vaccination for non-medical reasons," says Baylor professor co-author Peter Hotez College of Medicine.
"The common denominator of most of these urban hotspots is that they are targeted by the anti-vaccine lobby, which is well organized and well funded, with 480 anti-virus websites, social media and books."  Living in a city means staying close to millions of people every day while you move into condominiums, offices or public transport. And while most of us have caught a cold at some point, we tend to not worry about taking something more serious like measles, especially if we have been inoculated during childhood. After all, the vaccines helped deliver the deadly explosions to the story. Yet in the last decade, diseases such as measles, mumps and whooping cough, once they disappeared, have given birth again to
this year, the World Health Organization has declared the anti-vaccination movement a of the 10 major health threats, after a 30% increase in measles cases worldwide – even in countries where the virus had been virtually eliminated.
vaccinations participate in the "March for medical freedom" outside the Legislative Palace of Olympia, the capital of the state of Washington. Photo: Lindsey Wasson / Reuters
You can take measles anywhere, but the opportunities for infection are often strong in high-population areas. Given that in 2050 about seven out of 10 people will live in cities globally, public health is a pressing concern.
"Viruses spread easily in urban environments," says Arthur Caplan, professor of bioethics at New York University. "Most cities are transportation hubs that provide truck, car, train and air routes for infected people to spread the disease worldwide.
" The most unvaccinated people are there, especially in cities, easier the spread of the disease. Anti vaxx put their communities and others at risk. Many people, children and babies cannot be vaccinated due to transplants, cancer treatments, immune diseases. You vaccinate to protect yourself, children and neighbors who cannot. "
Cities are also constantly on the move, offering greater opportunities for spreading disease." Cities often have more transient populations – with people coming and going and sometimes carrying infectious diseases that can spread among unvaccinated people " says Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. "Unvaccinated travelers can also contract infectious diseases from local populations and take them to other places."
Vaccine resistance movements are as old as the vaccines themselves, but misinformation was particularly fueled when, in 1998, a study that was now withdrawn and debunked by Dr. Andrew Wakefield mistakenly linked measles, mumps, and rubella with autism. years, the anti-vaccine sentiment coincided with the proliferation of "false news" and a general disregard for science.  Anti-vaxx can be in the minority, but it does not take much to undermine "the immunity of the community" – a form of protection from disease when a large percentage of the population has become immune to an infection, protecting those who are not & # 39;
About half of all parents with young children have been exposed to disinformation about social media vaccines, according to a recent report by the Royal Society for Public Health. "Cities generally have greater media saturation and more opportunities for spreading misinformation," says Larson.
Edward Jenner, pioneer of the smallpox vaccine, and two colleagues see out their anti-vaccination opponents, with the dead scattered at their feet. Colored etching by Isaac Cruikshank, 1808. Photography: Wellcome Library, London
Some groups are more likely to present anti-vaccine opinions, even if this is changing, says Dr. Saad Omer, director of the Yale Institute for Global Health.
"We know this at least a few years ago, although it has slowly changed, the rejection of the vaccine has often been grouped into very urbanized, educated and large families," he says. "But it is not exclusive to that group now. Like other social phenomena, it sometimes starts in some populations but spreads."
Very contagious, the measles virus can live in the air or on a surface where one infected person coughed or sneezed for up to two hours, infecting up to 14 others. And in crowded cities, children who are too young to be vaccinated are particularly at risk.
Catherine Cooper lived south of London when her eight-month-old son, Toby, contracted the virus. It was 2003, a time when measles vaccine consumption was decreasing after the Wakefield study.
The doctor identified the "child with the rash" and asked Cooper to skip the line. "He asked if he could call a new qualified doctor from the next consultation room to show them [Toby] since it was likely he had never seen a measles case," he says.
"He spent the week limp and unhappy, but recovered. He took me into the cradle of my local gym, so I presume from an unvaccinated child – the creche is also suitable for older children. "
Measles epidemics in the United States and Europe have been declared emergencies, but experts warn of the consequences of the anti-vaccination movement could be more acutely felt in low-income countries. Preventable diseases are more likely to kill in densely populated cities with poorer health infrastructures.
Access to reliable and factual information on vaccine safety is a priority for public health organizations. Photograph: Brian Snyder / Reuters
"It is reasonable to have concerns about cities, not only in the developed world, but also in the developing world," says Omer. "It is the perception that the rejection of the vaccine is a Western concept, but it is not. It was the rejection of the vaccine during the eradication of smallpox. There is the refusal of the polio vaccine and measles in various parts of the world. "
And anti-vaccine sentiment represents an additional risk when access to vaccines is still a problem in many cities, including London, where immunization rates for MMRs ( measles, mumps and rubella vaccine) are lower than those in the rest of the UK.
"This is due to a multitude of reasons: large mobile population that can frequently change general practitioners, pockets of serious disadvantage, people not registered with general practitioners" says Helen Bedford, UCL Professor of Child Health .
"The anti-vaccine movement can threaten people if they influence those who are undecided about vaccination, who perhaps have concerns about the safety of vaccines but do not have access to health workers who are important to appease fears and discuss concerns. "
For example, the 2017 measles epidemic in Minnesota – the largest in the state for 30 years – was largely attributed to specific anti-vaccination misinformation aimed fetishily at the Somali-American community in Minneapolis. Over 80% of cases in Minnesota involved unvaccinated American non-somatic children, showing exactly the impact that such messaging can have.
And with our cities continue to expand, improving vaccination coverage and access to reliable and concrete information on vaccine safety – it must be a priority for public health organizations.
"Science has repeatedly shown that vaccines are highly effective and very safe," says Bedford. "We need parents and celebrities, just as scientists are clearer on the value of vaccines. We can use social media and the stories of individuals damaged by disease can be very powerful. These are the tactics used by anti-vaccine groups – we should we also hire them. "
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