Juncker’s vaccination legacy needs a booster shot

The outgoing Commission president got countries to discuss dwindling vaccine coverage. But will they act?

Jean-Claude Juncker’s tenure as European Commission president will end with an unchecked resurgence of measles — despite his unusual intervention on a health-related matter.

On Thursday, Juncker blamed “stupid mistrust” of vaccines, in part, for deaths from preventable diseases in Europe. People who decline immunizations are “playing with fire,” he warned.

As that fire spreads across Europe, Juncker’s ambition to boost vaccine coverage is running up against the same restrictions on the EU’s role in health that have stymied so many other efforts by the bloc.

Two years after he called it “unacceptable” that children in Europe are still dying of diseases that should have been eradicated, the spread of measles shows few signs of letting up. Last month, three EU countries — Greece, the U.K. and the Czech Republic — lost their measles-free status, while only one, Austria, attained it.

Meanwhile, epidemics are still raging in France, Poland, Italy and Romania, and the numbers are grim. As of June, the EU28 already racked up 10,056 reported measles cases in 2019, according to figures from the European Centre for Disease Prevention and Control (ECDC). That puts it on a similar trajectory to 2018, when there were 12,586 total cases (there are usually fewer cases in the second half of the year).

Despite those numbers, public health experts give Juncker credit for forcing capitals to discuss a topic they’d long resisted, drawing on a keen sense of timing. This may be only baby steps at best, but Juncker may have laid the groundwork for Europe’s global leadership in the fight against vaccine hesitancy, say some health experts.

Juncker deserves credit for his “passion” about the issue, according to World Health Organization Director General Tedros Adhanom Ghebreyesus. He and Junker held a late fall powwow in 2018 when they decided to hold a high-level vaccines summit in Brussels this year.

“He was so worried because the headline of our meeting at that time was: Children are dying in Europe because of preventable diseases,” Tedros said.

On Thursday, Juncker spoke at that global gathering, which included Tedros, the U.S. surgeon general and a global cast of experts and policymakers. “Given the huge challenge ahead of us, no single country and no single organization can achieve success,” Juncker told the audience.

Surprise priority

Health-sector lobbyists in Brussels were shocked when they heard Juncker mention vaccines in his 2017 State of the EU address. This was, after all, a man who just six months earlier had floated the possibility of doing even less on health as part of post-Brexit EU reform.

But in that speech, he cast the issue as a matter of equality, arguing there “can be no second-class citizens.”

“Children in Romania or Italy must have the same access to measles vaccines as children in other European countries,” he added. “No ifs, no buts.”

The timing was key. Initially, first reports of outbreaks came from Romania — a country with a notoriously poor health system dealing with a mixture of shortages and vaccine hesitancy. But suddenly, they were starting to make headlines around the bloc, as they spread to Italy and elsewhere. In April 2017, an unvaccinated Portuguese teenager died of measles. And over that summer, health ministers’ plans to impose  requirements that kids receive 10 or more vaccines fired up political debates in France and Italy.

In his 2017 address, Juncker pledged that the Commission was “working with all member states to support national vaccination efforts.”

That hadn’t really been the case up to that point. The Commission participated in discussions on matters such as cross-border health threats, but countries shut down any discussion on proposals like aligning vaccine schedules or building comparable registries.

Experts increasingly call for such changes. An ECDC survey cited in a 2018 report found that out of 16 countries, only 10 had immunization information systems that could be used to record why people were declining vaccines. Without this information, fighting hesitancy is shooting in the dark.

But Juncker soon found he couldn’t push EU countries much further. National governments ultimately watered down already modest Commission proposals for moving toward a common vaccine schedule or creating an EU vaccine ID card to list people’s record of jabs.

Those results were “really disappointing,” said Fiona Godfrey, secretary-general of the European Public Health Alliance. “With the lack of support from member states, there’s not a lot more [the Commission] can do.”

More recently, however, the year-old European Joint Action on Vaccination, run by the Commission and the French government, is seeing some room for compromise. Countries are working on developing a standard protocol for responding to an outbreak alert from another country, said coordinator Geneviève Chêne of France’s National Institute of Health and Medical Research.

States are also inching toward working together on developing vaccine schedule. In echoes of the debate over EU-level health technology assessment, it seems capitals would be open to working together on considering the science of vaccine timing, as long as they can still make their own decisions about when shots should actually be administered.

Soft power player

This week’s summit was exuberant by the standards of a Commission “stakeholders” gathering. U.S. Surgeon General Jerome Adams made a selfie-video of the auditorium affirming the hashtag “vaccines work.” Yvonne Chaka Chaka, a South African music icon, belted out a melodic moral gut-check. And 18-year-old American activist Ethan Lindenberger played out the ultimate teenage rebellion, decrying his mother’s anti-vax views on the world stage.

The WHO and the Commission plan to make the summit a regular affair.

The showy summits with broad focus leave the effort vulnerable to charges that it’s all talk and no action. But at this stage, the talk is important, said Ber Oomen, executive director of the European Specialist Nurses Association (ESNO).

“It will be very important to see this kind of overall solidarity … so there’s not one organization that says, ‘I represent 5 zillion health care organizations, and I will be the one who solved this problem,’” Oomen said.

Given that the Commission’s latest vaccines effort leans heavily on health professionals to restore trust, it’s helping groups like ESNO get an audience with national authorities. The big question remains whether they’ll pay attention.

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“Now it’s for the member states to continue this exercise,” said Magdalena de Azero, executive director of the pharma-backed coalition Vaccines Europe. “This is the only way to move the needle.”

Jillian Deutsch and Carmen Paun contributed reporting.

CORRECTION: This article was corrected to clarify that the trajectory of measles cases in 2019 is similar to 2018.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.