A Crisis of Confidence: Vaccine Preventable Diseases Surge Amid Skepticism

Mdjaff, Freepik

By: Maida Salkanović

In recent months, countries in Southeast Europe have faced epidemics of vaccine-preventable childhood diseases such as measles and pertussis. Amidst a crisis of trust, citizens have turned to social media for answers and support, only to find groupthink and disinformation.

In February, the Serbian public was shaken by the news that in just a few months five infants had died from the consequences of whooping cough. The deaths of five children from a disease whose symptoms can be significantly mitigated by vaccination represent a tragic loss, especially for a relatively small country like Serbia. These infants were too young to have built immunity—some were too young to be vaccinated—and should have been protected by herd immunity. Which no longer exists in Serbia.

Despite this tragic loss, anti-vaccine advocates continue their mission against vaccination.

Vaccines have been a contentious topic in the region for years. The Covid-19 pandemic exacerbated the situation and thrust the issue into the public spotlight. Despite the rise in vaccine-preventable diseases—some of which have proven fatal—considerable skepticism about vaccines persists. Countries such as Croatia, Bosnia-Herzegovina, Serbia, North Macedonia, and Montenegro have all reported increases in vaccine-preventable childhood diseases and declines in vaccination rates to varying extents.

As of the latest 2024 update from the WHO, Bosnia ranks sixth in measles incidence per million population in the WHO European region. According to an email sent to SEE Check by the Institute for Public Health of the Federation of Bosnia-Herzegovina, there have been epidemics of both measles and whooping cough (pertussis) since the beginning of the year.

From the beginning of 2023 to the end of May 2024, Croatia has reported 6,546 cases of pertussis. The Croatian Institute for Public Health communicated to SEE Check that since mid-2023, there has been an increasing number of pertussis cases, a trend that has been repeatedly communicated to the public. They noted that several factors have contributed to this increase, including a gradual decline in vaccination coverage for mandatory childhood vaccines. The South of the country—with lower vaccination rates than the national average—is currently preparing for a potential measles outbreak

Serbia has also experienced a resurgence in measles cases, with recent data indicating a significant increase across all regions. This rise is largely attributed to a decline in routine immunization rates during the COVID-19 pandemic, leaving many children unvaccinated. Additionally, there were a total of 1,595 confirmed pertussis cases reported in 2023 and 2024, which included fatalities among children.

According to the Institute for Public Health of the Federation of Bosnia-Herzegovina, these epidemic outbreaks are not a surprise, mostly due to two main factors: the dynamics of population migration and the low vaccination coverage with vaccines from the regular immunization schedule for children and youth up to 18 years old. Officials reported to SEE Check that vaccination coverage over the last five years has been unsatisfactory. To adequately protect the population from diseases, the vaccination rate needs to reach 95%.There has been a decline in coverage for all vaccines from the regular immunization program, except those administered in maternity wards. Additionally, it has been observed that a certain percentage of children are vaccinated later than the Immunization Schedule recommends, Senad Dorić, the Institute’s spokesperson, reported to SEE Check.

“Delaying or refusing vaccination exposes children and young people to the risk of contracting diseases that can have severe consequences,” the Institute stated.

Dragan Delić, an infectologist from Serbia, told SEE Check that it is unacceptable and completely unjustified for whooping cough to occur when a vaccine exists.

“Every year, 4 million children die because they are not vaccinated against certain infectious diseases. The death rate is undeniably high, not to mention the severe consequences. Measles, for example, can cause serious damage to the central nervous system, epilepsy, blindness, deafness, and cognitive delays. It is a very serious disease and it is much easier, better, more humane, ethically acceptable, and medically justified to vaccinate children to prevent infectious diseases,” stated Delić.

Seeking Expertise on Social Media

While experts continue to highlight the numerous benefits of vaccines, anti-vaccination proponents tirelessly promote various conspiracy theories. Some of these theories absurdly claim that vaccines are being used to implant microchips in people, while others allege they are tools for depopulation. Some conspiracy theories even go so far as to claim that vaccinated people emit a Bluetooth signal or that vaccines are being used to turn people into robots.

One of the most popular claims used by anti-vaxxers is the assertion that vaccines cause autism, which originated from a study by Andrew Wakefield. This study, published in 1998, suggested a link between the MMR (measles, mumps, and rubella) vaccine and autism. However, the study has since been thoroughly discredited and retracted by the journal that published it due to serious procedural errors, undisclosed financial conflicts of interest, and ethical violations. The scientific community universally rejects Wakefield’s findings as fraudulent.

Despite the retraction and discreditation, this claim continues to circulate within anti-vaccine circles. Amar Karađuz, a factchecker at Bosnian Raskrinkavanje, points out that supporters of the anti-vaccination narrative still use Wakefield’s study to argue that all vaccines are harmful to children’s health and development. To sustain their narrative, they do not hesitate to repeatedly share claims from this discredited study on social media. This ongoing dissemination contributes to vaccine hesitancy and disinformation.

Karađuz notes, “They openly refuse to accept the fact that the claims from that study are unfounded, which shows that narratives like the anti-vaccine one are much harder to combat with just facts. Additionally, this study has led even those who are not staunchly anti-vaccine but may harbor some skepticism towards immunization to occasionally mention that vaccines cause autism or are harmful. These direct references to Wakefield’s study demonstrate how deeply its legacy is ingrained in people’s consciousness.”

Representatives from the Institute for Public Health of Republika Srpska, epidemiologists Dr. Irena Špegar-Drobac and Dr. Jelena Đaković Dević, confirm the impact of disinformation on vaccine uptake. They explain, “The reduced interest in the MMR vaccine is linked to the publication of the article about the alleged connection between the vaccine and the occurrence of autism in children. Subsequent extensive epidemiological studies, which covered over 25 million children, found no connection between this vaccine and autism, which was then refuted by experts. Punitive measures were also enforced against the author who published it. Additionally, the negative attitude towards the MMR vaccine has been fueled by the rise of anti-vaccine movements and their active engagement on social media without scientific evidence.”

They emphasized that “vaccination is the most effective, safest, and cheapest way to prevent infectious diseases.”

However, despite the evident benefits and the mandatory nature of vaccinations in Southeast Europe, a significant portion of the population turns to social media and alternative “experts” for advice. Online forums, especially Facebook groups for parents who are against vaccination, are bustling with discussions on how to circumvent the legal obligations of vaccination. These groups often share strategies on how to avoid penalties associated with not vaccinating children, which is mandated and free in these countries. Concerns rise especially around the time of school enrollments, where vaccination checks are standard procedure. One parent in a large group with nearly 43,000 members raised concerns about children being sent back from school enrollment tests if they hadn’t received the MMR vaccine, indicating that such measures are already being enforced.

A fellow group member responded, “Primary school is mandatory; you can sue them, and you will win, so they won’t dare do such a thing.” Occasionally, similar-minded lawyers support anti-vaxxer parents with legal advice on how to evade mandatory vaccinations without facing penalties.

Despite the legal requirements to vaccinate children, a report by Serbian Raskrikavanje noted that in two years, the number of requests to initiate misdemeanor proceedings against parents who refuse to vaccinate their children nearly tripled. However, nearly a third of these cases become outdated, and monetary fines are relatively rare, indicating challenges in enforcing these laws effectively.

Health Literacy Issue

Dragan Delić emphasizes the need for accountability among faux experts discussing vaccines, highlighting a major issue of misinformation in the medical community. He states, “It’s like me, an infectologist, talking about surgeries or treating depression. This is a significant problem even within our medical circles, where some doctors, driven by a desire for marketing presence or popularity, make public statements that lack justification in science or research, which is inadmissible. Moreover, our professional associations remain silent. In my view, they must take action.”

Amar Karađuz, however, highlights the challenges associated with accessing reliable information, particularly in the health sector, adding to the reasons people turn to social media for help. 

“Some medical authorities have recognized this and opened their channels of communication with the public via social media. However, in a state of general ignorance and disarray, like at the beginning of the pandemic, there is a danger of falling into the trap of bad, unverified sources on social media, which can later have adverse effects,” he notes. 

Information literacy skills are thus, believes Karađuz, crucial in avoiding potential pitfalls.

Dragan Delić points out that the main issue is an uneducated population lacking health education, with health information and advice increasingly being seeked through social media platforms.

Meanwhile, some health institutions have taken proactive measures to educate the public. The City Institute for Public Health in Belgrade (GZZJZ Beograd) informed SEE Check that their immunization unit and epidemiological service actively engage in educating those eager to learn more about immunization as well as those skeptical about the vaccination process. The epidemiologists at this institution not only respond to queries but also organize lectures and educational activities both in the field and for other healthcare workers, they say.

Since the beginning of this year, they have had 618 media appearances—87 on television, 525 in newspapers and online portals, and 6 on radio stations.

Miroslav Matijević, the spokesperson for GZZJZ Beograd, acknowledged the impact of social media on declining vaccination rates due to the spread of unverified and false information. He stated, “Social media has certainly influenced the decline in vaccination coverage by spreading unverified and untrue information. However, apart from our current activities, we do not have the authority to do more than that.”

Despite efforts by health institutions like GZZJZ Beograd to educate the public through widespread media engagement, these initiatives seem to have limited impact. Many citizens continue to prefer sources that align with their existing beliefs, often turning to laypeople and so-called experts on social media who echo their skeptical views about vaccinations and the healthcare system.

Dragan Delić articulates the root of the problem: “A great issue is the existing distrust. We are paying a high price for it, the distrust people have toward the health system.”

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