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Confidence problems – Lancet Infectious Diseases



In November 2017, we published an editorial on vaccination against measles, which requires strong interventions to limit preventive diseases. 18 months later, how have things changed? As reported in a news release in this issue, 229,000 cases of measles were reported in 2018, and 98 countries reported an increase in cases compared to 2017. Spokesman is a global health crisis and it is getting worse. Although the causes vary from country to country, distrust and misplaced aversion to vaccination are largely related to unfounded fear of security, important contributing factors from the Philippines to France, from Ukraine to the United States. The WHO has mentioned the vaccine hesitation as one of the ten biggest threats to global health in 201
9. Lack of confidence is also central to one of the world's largest health risks: The outbreak of Ebola virus in DR Congo. The epidemic is focused in the north-east of the country, where conflict, political tensions, and social complaints have caused fear and suspicion to a large part of the local population. 40% of the new cases so far this year have been in people who died in society (ie they had not been in a treatment center), and a large part of the cases, especially in Katwa and Butembo, cannot be linked to any other patients , suggesting that unknown transmission chains exist. If patients are cautious about seeking proper care and if contact detection cannot be made, the outbreak will not be stopped.

Mistrust has also manifested itself with more direct and violent consequences in DR Congo. Médecins Sans Frontières (MSF) has reported dozens of attacks on its workers in the region. In February, two treatment centers were attacked and burned down, forcing MSF to suspend its activities in Katwa and Butembo. Joanne Liu, MSF's president, has been quoted as describing the atmosphere to the answer as "toxic".

The importance of community efforts to build trust was recognized in the wake of the West African Ebola epidemic, but the difficulties of DR Congo outbreaks have led to the use of coercion against patients and their contacts, and an addiction to the police and the UN & # 39 ; peacekeeping citizens for security have further alienated locals. MSF has criticized the use of coercion in DR Congo, and in an interview with STAT Liu said that "using police to force people to comply with health measures is not only unethical, it is completely counterproductive ". WHO takes another thanks: on March 9, it announced that it had sought additional support from the UN and local police forces to protect treatment centers, despite acknowledging the importance of "maintaining the neutrality of the response".
Concerning trust In measles vaccination, a Danish study of more than 650,000 children once again confirms that vaccination against measles, kisses and rubella (MMR) is not associated with autism. But while the results are welcome, the paper will not change the belief in anti-vaccination advocates. The safety of MMR was already well established before this study. A lack of reliable scientific evidence is not the problem. And in countries like the US, the dangers of not vaccinating have been repeatedly shown, most recently in an outbreak of measles among primarily unvaccinated children in Washington and Oregon, as reported in our March issue. Rather, it is the abundance of misinformation and distrust of authority to be solved. Social media companies like YouTube and Facebook have made changes that are beginning to dampen the tide of misleading demands, but the impact of these initiatives remains to be seen.
For example, an anti-wax in California, USA is very different from any potentially exposed to Ebola in rural DR Congo. But there are similarities in their mistrust. A belief that vaccines cause autism or Ebola is a government struggle is likely to have as much to do with broader complaints and distrust of authority as with the specifications of scientific evidence and education. Part of the problem is that lack of faith in the government, health care and pharmaceutical companies is not always irrational. In DR Congo, the postponement of elections in the regions affected by Ebola has been considered more motivated by politics than by public health (the region is a stronghold of opposition to the ruling party). Poverty and conflict in the region have long been neglected. In the United States, the country is plagued by prescription opioid addiction driven by aggressive drug marketing, flint people MI have been without safe drinking water for 3 years, and the most basic drugs are often prohibitive due to profit-driven health care. No wonder some individuals question the authorities' desire to prioritize their well-being. It is impossible to build trust and at the same time abuse it.
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