What is the situation today in Romania regarding vaccine uptake? 

Unfortunately, it is slowly but constantly decreasing since 2010. According to the National Institute for Public Health (CNSCBT) we are now below the herd-immunity cut-off. The latest annual report shows a constant downward trend for measles-mumps-rubella vaccine uptake. Only 74.5% of children have had two doses of vaccine. So, the current epidemic could have been prevented because there have been serious warnings since May 2016.
Using three doses of DTP as a surrogate-marker for immunization, we also see a decrease, according to UNICEF data which puts the current level at 84% nationally. However, in some counties in Romania, it is as low as 50%. 

Is there widespread public concern about measles cases?

Yes, there has been constant coverage by media and official weekly reports from the CNSCBT on total number of confirmed cases and number of deaths. But the loudest voices are those of the anti-vaccine movement claiming that these numbers are incorrect and over-report measles cases and deaths.

Are you concerned by the level of anti-vaccine commentary in the media and online?

Yes, I am concerned because these rumours have grown into a structured movement with political implications. Clergy members, religious groups, artists and lawyers are joining forces.

There is a broad group of parliament members (more than 80 people) that have been able to block the Immunization Law. The Health Ministry appointed a group of experts two years ago when the first cases of measles were confirmed. I was appointed as a paediatrician, but there have been GPs, microbiologists, infectious diseases experts, epidemiologists, lawyers, and specialist representing the child-protection authorities among others.

The Immunization Law was evaluated by Health Ministry experts and then presented for a public debate. I was terrified by the verbal violence of opponents. Finally, after six hours of parallel dialogues, no basic consensus could be reached. The Senate had a relative short debate on this project and generated a positive vote. But the lower chamber of Parliament has the deciding vote. For more than a year there has been no progress.

Where does that leave the public debate?

Today there are no consequences for providing any fake-news regarding immunisation in Romania. The anti-vaccine people went so far as to distribute flyers by mail with UNICEF,WHO and Health Ministry logos stating that vaccines are harming children and are producing the measles epidemic. Dr Pintea, our Health Minister, has said that legal prosecution will follow. 

Do you also hear these concerns from parents in your clinic? How do you respond?

Parents are extremely vocal in social media, both pro and against vaccination. In the clinic most of the people that approach physicians are hesitant people. Some of them are not opponents of all vaccines. MMR uptake is still affected by the bad Wakefield story and we are still debating with many parents on autism causality issues. There are also a large group of parents who are hesitant because their GP is hesitant.

With my colleagues from the National GP Society we produced short online cases or scenarios related to vaccine-preventable diseases. We also posted, on the Society portal, a structured catch-up schedule for those children whose parents can be convinced. This portal is open also for lay people.

When did you begin using Facebook to communicate about paediatrics and vaccination?

More than four years ago we started to provide online education for parents of children with asthma through our Institute’s online portal. The Virtual Asthma Hospital has proven that people are reading these posts. And children that were instructed to use this portal were less likely to have unscheduled medical visits to the Emergency Department. We were able to present a paper at an international conference on the Virtual Asthma Hospital impact on quality of life.

Parents are using virtual media a lot. Current data reveal that 74% of Romanians with a smartphone or PC are going online first if they experience a health issue. Only 26% are asking their GP. So, I realised that a Facebook page can reach more people than I could see in our clinic.

I attended a training session in Bruxelles in January 2017. I was concerned by the extremely low number of pro-immunization voices online. If anybody was searching online for information about a vaccine-related topic in 2016 or 2017 the first page they would find was full of anti-vaccination opinion.  

There are some isolated voices of physicians like Irina Costache, mother of two and paediatrician. Her blog, Mamica Pediatru, is a nice and positive voice. Prof Maria Livia Ognean, neonatologist and one of the most active physicians on-line, has a page called Baby Care Sibiu. And Dr Otilia Tiganas, a GP in a small rural area of western part of Romania writes a blog with a simple and sometimes humorous approach to medial issues – Blogul Otiliei.

Has your social media work been a success? 

I think so – last year at the COPAC Gala my Facebook page (Spitalul Virtual de Copii) was awarded a special prize in a communication contest. It was the first time that a paediatric pro-immunization page was nominated for such a competition in Romania.

More than 97,000 people are reading this page and a lot of children have been immunized after their parents had an online pro-con debate on this page. Positive open dialogues on vaccine related-issues are common on my page. It is not entirely dedicated to vaccines but covers a rather large area of childhood diseases or health-related issues like growth and development, emergencies, diet etc.

Have you had any negative experiences?

Yes, several. But during my 20 months experience I found the right approach – I hope! Some unexpected negative experiences were related to other physicians that were not very happy – unfortunately we have some doctors in Romania that are organizing, along with religious groups or notorious anti-vaccine champions, public events where fake science is promoted.

How do you respond to anti-vaccine comments on Facebook?

If they are aggressive or deliberating misleading I warn them in a polite manner. Some fake-news are useful because I can answer in a scientific way and I am able to provide data and documentation sources for hesitant parents. A lot of hesitant people sent me private messages seeking guidance or even asking me to immunize their child.

Some vulgar or aberrant posts are deleted. But more than 90% of my Facebook followers are rather polite.

Would you encourage other health professionals to use social media in this way? 

Yes, I have presented my work at several local or regional meetings. This month I was an invited speaker at the 3rd Balkan Paediatric Meeting where I presented my online activities. Next month I will attend a national joint meeting of paediatricians, GPs and media people and I will present also a SWOT analysis of my Facebook page.

What skills or training do you need, if any?

I need better skills for video editing – short videos are the most commented posts on my Facebook page. One of them had more than 500,000 views. 

A lot of trouble-shooting issues are also needed – how to respond to a special type of approach? Tailored "treatment" in a rising rather aggressive Romanian Social Media environment is needed.

Does it take a lot of your time? 

Yes. At least 3-4 hours a day. But it has been a huge real-life experience. During a one-to-one dialogue in hospital I am rather protected. I am in a comfortable position of being a senior physician and patients are rather compliant. But online I have met the real patients. There are no limited on sincere and uncensored dialogue.

One parent has said: "If I am not in the GP’s office I can ask about my fears or dilemmas. You are listening. Or at least you cannot interrupt my questions…".

Do you believe your social media work is having an impact on public attitudes? 

Yes. Or I hope so! Many of my residents and students in medical school have changed. And our hospital is now the leading paediatric hospital in parental perspective. Because dialogue style changed. 

The future is now. Social media tools will impact more and more medical issues – not only vaccination.