Will fiscal ‘austerity’ in Europe damage immunisation?

As austerity bites across Europe, there are growing concerns that cutbacks will exacerbate health inequality if spending reductions are made in too blunt a manner. The combination of falling immunisation rates, weakened health surveillance and over-burdened emergency services could prove to be a dangerous mix, scientists and sociologists have warned.

Speaking at the European Public Health Conference in Copenhagen, Ulla-Karin Nurm, a senior expert at the European Centre for Disease Prevention and Control (ECDC), said preventative health programmes are often the first to be hit by budget cuts.

Vulnerable populations such as migrants and prisoners are already known to be at heightened risk of contracting TB, and there is evidence that low immunisation uptake in the Roma community has led to a spike in measles rates.

Watch: Childhood Tuberculosis in the EU

These concerns were echoed by Dr David Stuckler, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, Cambridge University who has co-authored a review of research on the public health impact of economic recessions.

He said that while the impact of deep recessions on public health can be mixed – some health behaviours worsen, yet people smoke less and walk more – there is evidence that countries implementing radical austerity plans suffer a spike in communicable diseases.

Dr Stuckler said countries in International Monetary Fund (IMF) bailout programmes, which typically require governments to curtail public spending, tend to see increases in TB.

In Greece, one of three European countries currently in formal IMF programmes, HIV has soared by 52% as needle-exchange programmes and drug-user outreach programmes are pared back.

Greek hospital budgets have been slashed by 40% leaving street clinics overrun with patients, according to Dr Stuckler.
 “Prevention services were deemed particularly susceptible to budget cuts as a result of the economic crisis compared to primary care,” Dr Stuckler told the conference, adding that there are few national policies aimed at mitigating the impact of the economic crisis.

He said services targeted at vulnerable and hard-to-reach population groups were perceived to be at particular risk of deterioration and he called for close monitoring of vulnerable groups.

Disease in an age of austerity

Accurately forecasting the impact of radical health spending cuts is an imprecise science as each case is unique.

After the Soviet Union collapsed, there was an increase in tick-borne encephalitis as more people reverted to mushroom farming; diseases spread by rodents rose in the wake of the economic meltdown experienced by Kosovo in the 1990s; West Nile virus cases soared in California in 2007 when mosquito populations thrived in the swimming pools of abandoned homes which owners could no longer afford.