Let’s talk about protection ECDC and vaccine preventable diseases, especially measles Irina Dinca Public Health Capacity and Communication Unit (PHC), ECDC Sofia, 17 October 2014

Structure of the presentation -About ECDC -Measles situation in EU/EEA and WHO measles and rubella elimination targets by Let’s talk about protection -Conclusion

About ECDC

Expanded Europe – the five freedoms in the EU 1.Free movement of people * 2.Free movement of services * 3.Free movement of goods * 4.Free movement of monies * 5.Free movement of microbes Adapted from Summary of Legislation — Internal Market

In Stockholm, Sweden Budget 2014: EUR 59.8 million Staff: 350 from all EU MS Epidemiology, infectious diseases, microbiology, public health ECDC facts

Core functions of ECDC Every working day at 11:30 a.m., a roundtable meeting in ECDC’s Emergency Operations Centre assesses threats, official alerts and epidemic intelligence. Disease surveillance Epidemic intelligence Risk assessments Scientific advice and guidance Response support Preparedness Capacity support on prevention Training Photo: ECDC

Measles situation in EU/EEA and relevant policy documents

Europe got measles! Notified cases (per million), July 2013-July 2014 Source: ECDC Measles and rubella monitoring report, July 2014 Measles images courtesy of Hardin MD/University of Iowa and CDC

Age-specific notification rate of Measles (cases per million) EU/EEA countries, July 2013 – June 2014 Source: EUVAC.NET

Max, 18 year old December 2004 October 2012, victim of Subacute Sclerosing Pan-Encephalitis

Size is not all that matters The issue of geographical clustering and why disaggregating data is important. Susceptible Immune

Measles outbreaks (clusters) associated with Roma and Travellers Roma: Romania, Portugal, Spain, Italy, Bulgaria, Poland, Greece, Germany (n=8) Travellers: UK, Slovenia, Ireland, Norway (n=4) Source: VENICE II

The Vaccination Paradox vaccine safety vaccine safety disease incidence disease incidence Public trust Public trust Doctors’ trust Doctors’ trust vaccine coverage vaccine coverage

WHO goals – to ELIMINATE measles and rubella –by end 2015 to achieve regional measles and rubella elimination goals (WHO-EURO) –by end 2020 to achieve measles and rubella elimination in at least five regions Source: WHO Global measles and rubella strategic plan ; Strengthening National Surveillance Systems towards Measles and Rubella Elimination in the WHO European Region Meeting Report Germany (2011) Elimination is defined as the absence of endemic measles transmission in a defined geographic area (e.g. region) for ≥12 months in the presence of a well-performing surveillance system.

EU Council Conclusion on childhood immunisation Coordination of policies and programmes Network for epidemiological surveillance and control of CDs Invites MS and the Commission to act ECDC supports with epi surveillance, training, EWR mechanisms, foster exchange of good practices and experiences

Communication guide “Let’s talk about protection”

ECDC: measles action plan with five key- stone activities Evidence-based communication (behaviour change communication for MMR uptake)  communication toolkits and guidance  awareness-raising among policy makers and other key audiences about the threat to public health from continued measles transmission  advocacy for increased resources for achieving measles and rubella elimination in the EU.  audiovisual material for communicating both to general public and professionals (videoclips, Euronews on parent’s stories)  support to European immunization week

Cultural adaptation in pilot MS –in: Bulgaria, Czech Republic, Hungary, Romania –content and format adaptation of the guide and flip book –+ methodology of adaptation

Messages from parents and carers 1.Do what you recommend others to do. 2.Teach us about the risks of non-vaccination. 3.Tell stories as well as sharing scientific facts. 4.Take time to listen to our concerns and tell us about possible side effects and risks. 5.Don’t ignore those of us who get immunised – we need reassuring and valuing as champions. 6.Don’t be put off by our efforts to find out more. 7.Make vaccination easier to access and less stressful. 8.Redefine success (recognise that some may need more time than others to decide). 9. Help enhance our vaccination health literacy.

Messages from health promoters,social marketers and communicators 1.Focus on behaviour and it’s determinants - not just ‘messages’. 2.Develop accessible, friendly and adapted service settings. 3.Make the discussion about ‘being protected’ rather than about vaccine safety. 4.Make those who accept vaccination more visible – build on and reinforce vaccination as a social norm. 5.Show how refusing vaccination is socially unacceptable. 6.Ensure any decision to remain unprotected is an active decision. 7.Use all media to advocate for the need to be protected and to protect. 8.Actively counter misinformation.

Messages from experts 1.Keep your immunisation knowledge current. 2.Strengthen your communication skills. 3.Use the team and other settings to provide information and address concerns. 4.Maintain your skills to ensure safe vaccine administration. 5.Guide parents to reliable information sources.

Messages from underserved groups 1.Know more about us. 2.Reframe ‘hard-to-reach’ as ‘poorly-reached’ system failures. 3.View immunisation as one part of larger health challenges. 4.Integrate us into mainstream programmes. 5.Involve us in all stages of programmes aimed at enhancing our inclusion and health. 6.Adapt governance and health systems to be more inclusive. 7.Health Mediators and other community health workers are critically important resources – they need to be supported. 8.Be accessible and respectful. 9.Beware of incentives that could be viewed as bribes for compliance.

The multifaceted intervention pilot project in Bulgaria (1) -Raise awareness of healthcare professionals (HCP) and health mediators (HM) on MMR related aspects -Training sessions -Test the usefulness of “Let’s talk about protection” guide and associated materials among HCP and HM -Intervention activities -Develop and implement an evaluation component -Pre- and post-intervention research

The multifaceted intervention pilot project in Bulgaria (2)

The multifaceted intervention pilot project in Bulgaria (3)

The multifaceted intervention pilot project in Bulgaria (4)

Conclusion

Knowledge from research can and should be used in practice Equally, users and producers of research should propose research priorities that will increase usable knowledge The collaboration among various levels of the healthcare systems and especially PHC and PH has a lot of potential for improvement in the future Conclusion

THANK YOU! Helping Europe to save lives