Some Western countries have lower vaccination rates than poor parts of Africa. Anti-vaxxers are not the main culprits

ERADICATING a disease is the sort of aim that rich countries come up with, and poor ones struggle to reach. But for some diseases, the pattern is reversed. These are the ailments for which vaccinations exist. Many poor countries run highly effective vaccination programmes. But as memories of the toll from infectious diseases fades across the rich world, in some places they are making a comeback.

The trend is most evident for measles, which is highly contagious. At least 95% of people must be vaccinated to stop its spread (a threshold known as “herd immunity”). Although usually mild, it can lead to pneumonia and cause brain damage or blindness. The countries with the lowest vaccination rates are all very poor, but many developing countries run excellent programmes (see chart). Eritrea, Rwanda and Sri Lanka manage to vaccinate nearly everyone. By contrast several rich countries, including America, Britain, France and Italy, are below herd immunity.

Last year Europe missed the deadline it had set itself in 2010 to eradicate measles, and had almost 4,000 cases. America was declared measles-free in 2000; in 2014 it had hundreds of cases across 27 states and last year saw its first death from the disease in more than a decade. The trends for other vaccine-preventable diseases, such as rubella, which can cause congenital disabilities if a pregnant woman catches it, are alarming, too.

This sorry state of affairs is often blamed on hardline “anti-vaxxers”, parents who refuse all vaccines for their children. They are a motley lot. The Amish in America spurn modern medicine, along with almost everything else invented since the 17th century. Some vegans object to the use of animal-derived products in vaccines'manufacture. The Protestant Dutch Reformed Church thinks vaccines thwart divine will. Anthroposophy, founded in the 19th century by Rudolf Steiner, an Austrian mystic-cum-philosopher, preaches that diseases strengthen children’s physical and mental development.

In most countries such refuseniks are only 2-3% of parents. But because they tend to live in clusters, they can be the source of outbreaks. A bigger problem, though, is the growing number of parents who delay vaccination, or pick and choose jabs. Studies from America, Australia and Europe suggest that about a quarter of parents fall into this group, generally because they think that the standard vaccination schedule, which protects against around a dozen diseases, “overloads” children’s immune systems, or that particular vaccines are unsafe. Some believe vaccines interfere with “natural immunity”. Many were shaken by a claim, later debunked, that there was a link between autism and the MMR vaccine, which protects against measles, mumps and rubella.

In America, some poor children miss out on vaccines despite a federal programme to provide the jabs free, since they have no regular relationship with a family doctor. Some outbreaks in eastern Europe have started in communities of Roma (gypsies). Members of this poor and ostracised minority are shunned by health workers and often go unvaccinated.