"Global health is our responsibility"

Who do you serve as an academic children's hospital? The patients in your own region? Or all children on the planet? Louis Bont and Joost Huijer consider this question from a medical, legal and ethical point of view. 

In the Netherlands, around 2,000 children with the RSV virus end up in hospital every year. Among these, 150 to 200 babies are even transferred to the Intensive Care Unit. ‘But two vaccines are now being developed that will enable us to get the common RSV virus pretty much under control. If RSV is included in the National Vaccination Programme, the problem will be solved in this part of the world’, says paediatrician-infectiologist Louis Bont.

Right to health

The National Vaccination Programme ensures that vaccination coverage in the Netherlands is still veryhigh, says Joost Huijer, associate professor of family and juvenile law. He specialises in youth protection and the legal position of children. Sporadically, a case appears before the court, for instance, when parents argue about whether their child should be given a shot. Then, the National Vaccination Programme also provides legal guidance. ‘The judge then bases himself on the programme’s advice on the vaccinations covered by it and usually grants substitute consent to vaccinate the child anyway. Especially with young children, the right to health and protection against health damage prevails.’

From the age of 12, the minor’s own opinion is decisive. It is different in child protection cases when the request comes from youth welfare. Joost: ‘Then the judge only grants substitute consent if there is an urgent medical reason. That does not include a preventive vaccination such as RSV.’

Taking into account the needs of Low- and Middle-Income Countries

But if you look worldwide, RSV is still the second leading cause of death among infants - only malaria kills more babies. In many places around the world, there is no easily accessible hospital you can go to with your infected child. Indeed, most people do not even know of the existence of this virus. Let alone that they recognise it and can take action against it. RSV thus remains a life-threatening disease for very large groups of people.

So, what do you do as an academic hospital? Do you have a moral obligation to use your fantastic research skills and budgets for those children as well? How far does your social responsibility extend beyond the hospital? What do you focus on? According to Louis, a hospital should do everything within its power to reach those children as well. According to Joost, there is also a legal basis for this in the UN Children’s Rights Convention ratified by the Netherlands. This convention states that every child has the right to the best possible health and the right to healthcare. Vaccinations are important because they reduce the chances of children becoming seriously ill or dying. Article 24 of this convention states that signatories should also consider the needs of Low and Middle-Income Countries.

More knowledge can help people take a considered decision for their children. Scientific research can provide that knowledge.

The next step

As head of the RSV Research Group, Louis now focuses mainly on bridging the ‘knowledge gap’: ‘We are supported in this by the Wellcome Trust and Gates Foundation. Their support is important because it involves expensive research. For example, we are currently researching awareness of RSV in Mozambique together with colleagues there. This starts with measurement: what do people know? What are their core beliefs about disease and health? What do they know about RSV? Can they distinguish it from other diseases? What are their attitudes towards vaccination? What factors might stand in the way of vaccination?’

According to Joost, the next step - proper information provision from the government - is an important prerequisite for awareness. ‘But it is not a guarantee. Sometimes, centrally provided information does not help because people distrust government bodies. Moreover, the right to medical care can clash with other fundamental rights, such as the right to religious freedom. More knowledge can help people make a considered decision for their children. Scientific research can provide that knowledge.’

Louis is happy to facilitate research that helps reduce RSV mortality among babies. ‘I think that’s a great mission. It’s Global Health in practice. Frankly, I’m very proud of that.’

It's Global Health in practice. Frankly, I'm very proud of that.

This article was previously published in the magazine Be real

This magazine, Be real, focuses on the collaborative efforts in Utrecht's child and youth research. It is a publication by Utrecht University's Dynamics of Youth and Child Health, one of the six focus areas of UMC Utrecht. The magazine is intended for professionals, as well as parents and young people who are central to our research. In Be real, child and youth researchers discuss equal opportunities and how we can contribute to this for children and young people.