If low vaccination coverage of children continues, Montenegro could face a return of diseases that parents mostly don't remember today, warned epidemiologist, Prof. Dr. Dragan Laušević.
"Parents today mostly don't know what polio is, what diphtheria is, what whooping cough is. We haven't had any deaths from these diseases for half a century and then it seems like they don't exist anymore. But if we stop vaccinating, they will come back," said Laušević during the thematic roundtable "Immunization in the Information Society: Between Facts and Perception", held at the Montenegrin Academy of Sciences and Arts (CANU).
The meeting was organized by the Medical Committee of the Department of Natural Sciences of the Academy of Sciences and Arts, and was attended by epidemiologists, pediatricians, and public health experts.
Speaking about the dilemma between personal freedom and public health protection, Laušević assessed that the right of parents to choose cannot be above the child's right to health and community safety.
"It is not fair that everyone benefits from collective immunity, while only some take on the minimal risk of vaccination. That is not solidarity," said Laušević.
He said that he is not a supporter of punishing parents, but of a system in which vaccination is not necessarily presented through punishments, but through clear conditions for entering the collective.
"If you want to be part of the collective, you have to meet the conditions. If you don't, that's your choice, but then you can't endanger others," he said.
Laušević stated that European legal practice gives states the space to prescribe mandatory vaccination measures, if they are legally based, medically justified and proportionate. He stressed that the aim of such measures is not punishment, but the protection of public health, especially children and people who cannot be vaccinated for medical reasons.
Laušević recalled that Montenegro, as part of the former Yugoslavia, had an immunization system that was recognized for its high coverage, but that in recent years it had entered a "dangerous risk zone."
"The fact that we are not experiencing major epidemics yet does not mean that they will not happen. It just reminds us that we have to do something," he said.
According to him, vaccines are "a victim of their own success," because serious infectious diseases, thanks to immunization, have become invisible to the majority of the population.
He explained that the goal of vaccination is not only to protect the individual, but also to reduce the incidence of disease, complications, mortality, and pressure on the healthcare system. He recalled that the Covid pandemic showed how mass illness can block hospitals and prevent the treatment of other patients.
"The task of the health system is to prevent everything it can prevent. What it cannot prevent, it must detect early," said Laušević.
Montenegro, the infamous European record holder
Epidemiologist Senad Begic from the United Nations Children's Fund (UNICEF) in Podgorica, said that the problem in Montenegro is not the lack of medical evidence about the importance of vaccination, but the way in which the immunization program is implemented.
"Vaccination is mandatory in our country only on paper. The key question is how to make the mandatory immunization program actually work," said Begić.
He recalled that mandatory immunization in Montenegro has a long tradition and that it cannot be viewed as a new concept, but rather as part of a public health policy that has existed for more than a century.
Begić warned that Montenegro has extremely low vaccination coverage compared to European countries. He particularly pointed to the decline in coverage of the MMR vaccine, which protects against measles, mumps and rubella.
According to the data he presented, the European average coverage with the first dose of the MMR vaccine in 2024 was around 95 percent, while in Montenegro it was many times lower.
"Montenegro, unfortunately, is the European record holder for low coverage. There is no country in our region or in the wider European space that has such low results," said Begić.
He assessed that low coverage speaks not only about parents' attitude towards a single vaccine, but also about the organization and use of health services.
Begić also recalled the period of the former Yugoslavia, when parents had a different attitude towards the healthcare system and healthcare workers.
For many generations, he said, the first association with the healthcare system was the authority of doctors, nurses, and available services.
"Today we must rebuild trust, but in a way that suits the times we live in," said Begić.
Fear faster than facts
Immunologist Milos Markovic He spoke about adverse reactions to vaccines and myths that cause fear and delay immunization among some parents.
He explained that every health problem that occurs after vaccination cannot automatically be considered a consequence of the vaccine.
"An adverse event following immunization is any adverse sign, symptom, or disorder that occurs after vaccination. But it may or may not be related to the vaccine," Marković said.
According to him, it is most often a matter of temporal coincidence, not a cause-and-effect relationship.
"When you vaccinate a large number of children, it is inevitable that some health events will occur immediately before or after the vaccination. This does not mean that the vaccine caused them," he explained.
Marković said that the link between the MMR vaccine and autism is one of the most famous examples of false associations.
"The only substantial link between the MMR vaccine and autism is timing, as the vaccine is given at an age when symptoms of autism are commonly recognized," he said.
He emphasized that vaccine safety is monitored strictly and continuously, from vaccine development to its application in the population.
"Vaccines are probably the safest medical product a person will receive in their lifetime," said Marković.
He added that mild and transient reactions, such as fever, pain at the injection site, or malaise, are not uncommon, but that serious reactions are rare and extremely rare events.
"It is important to distinguish real adverse reactions from myths. Fear exists, but decisions must be based on evidence," said Marković.
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