Antivaxers are on the rise in countries such as Italy, Poland and France where the far right has made gains

As long as there have been vaccines, there have been doubters. Some people have religious or philosophical reservations. Others are more anxious about the possible side-effects of a jab than about falling sick with a poorly understood disease.

But now vaccine doubt is spreading faster and further than ever through social media, and populist rightwing politicians in Europe and the US are riding on the back of a wave of mistrust of vaccine science.

The arguments align. Populists are often suspicious of the establishment and authority figures. Antivaxers are hostile to government, medical institutions, Big Pharma and science. In several countries – Italy, France, Poland, the US – both are on the rise.

Last year Italy had the second largest measles outbreak in Europe, with more than 4,000 cases and four deaths. That followed two years when vaccination rates fell below 90% for the first time in a decade, while the anti-establishment Five Star Movement (M5S) and the far-right League vocally backed the antivaxers’ conspiracy theories.

In 2015 M5Seven proposed legislation against vaccines, claiming they caused disease rather than prevented it. In office they have softened their stance, and last month Italy’s new populist government performed a U-turn and supported measles vaccination.

But now Giulia Grillo, Italy’s health minister, has sacked the government’s board of expert health advisers, to replace them with “other deserving personalities”. Vaccine experts are holding their breath.

Grillo, who trained as a doctor, has said she will vaccinate her own newborn baby. But the dismissal of Roberta Siliquini, the head of the school of hygiene and preventive medicine at the University of Turin, and the rest of the 30-member board will reignite fears for public health in Italy.

“We are worried about why they have decided to remove people who were selected due to their experience and competencies at the highest level,” said Siliquini. “We are also worried about who will make up the next council and especially if the nominations are politically motivated.”

Measles is the most urgent cause for concern because a disease that could be eradicated in Europe is instead resurgent, with 41,000 cases in the first six months of this year.

Worldwide, the numbers rose by 31% in 2017, driven by an explosion of cases in Venezuela, where the health system has collapsed, as well as falling vaccination rates in Europe. But every continent had an increase in cases except for the western Pacific, data from the WHO and the US Centers for Disease Control shows. The global vaccination rate has stalled at 85%, well below the 95% necessary to prevent outbreaks.

Twenty years after the discredited British gastroenterologist Andrew Wakefield wrongly claimed a link between the measles, mumps and rubella (MMR) vaccine and autism, his theory has never been more pervasive.

An Ipsos Mori poll commissioned by King’s College London and carried out in 38 countries found that six out of 10 adults either thought there was a link between MMR and autism or were not sure. In France the proportion was 65%, in Britain 55% and in Italy 52%.

It’s not just about measles, experts say. What the WHO calls vaccine hesitancy is complex. The anthroposophy movement started by Rudolf Steiner in Germany, and now also big in Sweden, does not embrace vaccines. Nor do some religious groups, and there are refuseniks among rightwing anti-authoritarians, anti-establishment movements and liberal-leaning enthusiasts for alternative lifestyles. And sometimes there are availability issues.

Anti-vaccine or ‘pro-patient’

Antivaxers fight mandatory vaccination wherever it exists. Justyna Socha, an insurance agent and mother of four from Poznań, in north-west Poland, started to campaign after she was fined for refusing to vaccinate one of her children.

Socha is the president of Stop Nop (a Polish acronym for undesirable vaccine reactions). This year the group gathered more than 100,000 signatures calling for a change in the law on mandatory vaccination. The proposals were considered by the Polish parliament before being thrown out.

Socha and her supporters argue that the medical profession in Poland is engaged in a large-scale cover-up of the adverse effects of vaccinations on young children, a conspiracy they attribute to pressure from regulatory institutions and financial inducements from vaccine producers.

“We don’t identify as anti-vaccine, we are pro-patient,” Socha told the Guardian. “Doctors who try to report their concerns are threatened with medical tribunals and with losing their jobs, so it falls to me as a patient, and as a mother, to change the system.”

The group evokes the spectre of the authoritarian past. “This is a post-communist country, where various cliques rooted in the previous system are exploiting our children,” said Socha, citing other countries in the former Soviet bloc where vaccination is also compulsory. “The citizen is a slave to the authorities.”

Poland’s rightwing government refuses to make vaccination voluntary, but Socha’s cause is backed by small numbers of populist politicians. Most prominent among them are members of Kukiz 15, an “anti-systemic” party similar to Italy’s M5S. Socha has stood as a parliamentary candidate for the party.

Socha’s supporters in the party include Piotr Liroy-Marzec, a former hip-hop artist, and Wojciech Bakun, an MP and IT specialist who has said he will not vaccinate his young son because he blames vaccines for his daughter’s type-1 diabetes.

Across the border in Ukraine, the dynamic is different but just as troubling. Here, politicians have whipped up a culture of suspicion about foreign medicines.

In early November, Olga Bohomolets, a dermatologist and head of parliament’s medicine committee, said Ukrainians should be given locally produced vaccines created “according to the nation’s immunity needs”. The health ministry later called her comments “unscientific” and said it was the vaccines that used to be produced in Ukraine that did not comply with international standards.

Oleksandra Ustinova, a board member of the Kiev-based Anti-Corruption Action Centre, said the low vaccination rate was a result of several antivax campaigns.

Both Ustinova and Kateryna Bulavinova, a medical expert at Unicef Ukraine, said vaccination was likely to be an issue in parliamentary and presidential campaigns next year. “With any elections, with any power change, politicians speculate on vaccines, which is very bad,” Bulavinova said.

Five signs of denialism

Until the turn of the century, around 90% of French people were pro-vaccine, but then scandals involving drug companies shook public confidence, said Jocelyn Raude, a sociologist who has studied the French anti-vaccine movement. In 2009 the French government ordered huge quantities of vaccine against the swine flu epidemic, but less than 10% of people took up the offer. Later it emerged that the vaccine caused a small increase in narcolepsy cases in children. The government was accused of wasting money and having ties to Big Pharma.

Also in 2009, the weight loss drug Mediator was withdrawn in France, triggering a scandal. It was found to cause heart valve damage and was believed to have killed at least 500 people. The maker, Servier, and the drug regulator faced trial. Anti-pharma groups sprung up. Henri Joyeux, a doctor who promoted healthy eating and opposed the pill, led a petition against aluminium in vaccines that gained 1m signatures.

Faced with low vaccination rates, in January the French government added eight more vaccines to the three that were already compulsory for school entry. The far-right leader Marine Le Pen opposed the change, citing arguments used by antivaxers that nobody could be sure of the long-term safety of multiple vaccines.

“So the populist far-right did not start the anti-vaccine movement in France, but the populist far-right later sought to opportunistically get on board with it when they saw it was becoming a public issue,” said Raude.

There was a time when health experts studiously ignored the antivaxers. But as misinformation spread on social media, they realised they needed to take them on. The WHO produced a document entitled “How to respond to vocal vaccine deniers in public”, based on psychological research.

“Addressing vocal vaccine deniers in the media can be fraught with danger and angst,” it says. The first rule is that “the general public is the target, not the vaccine denier”, who is unlikely to change their mind. It notes “five characteristics of science denialism”: conspiracies, fake experts, selective use of evidence, impossible expectations (such as 100% safety) and misrepresentation and false logic.

Heidi Larson, director of the Vaccine Confidence Project, believes public health officials should engage on social media. They too often shied away, she said in the Lancet recently, “but they and other relevant stakeholders need to go where the discussions are happening and where influence is being leveraged.”