UK measles outbreak reveals need to boost child vaccine uptake

A resurgence of measles in England has laid bare the need for authorities to improve access to childhood vaccines and quell rising hesitancy towards jabs in some local communities, health experts have warned.

The Covid-19 pandemic intensified damaging trends including growing logistical obstacles to immunisation and rising suspicion about the risks injections present, according to specialists.

Cases of measles, a respiratory illness commonly found in children, have been rising in other parts of Europe, according to the World Health Organization. However, Britain’s problem has distinctive national characteristics and has fuelled growing debate over whether health services are overstretched because of underfunding.

The debate is also part of a wider European battle to boost vaccination rates for dangerous childhood diseases, with jab hesitancy stoked in some countries by self-styled anti-establishment figures and political movements.

“These infections come back if you don’t keep the firewall up,” said Heidi Larson, professor at the London School of Hygiene and Tropical Medicine and founder of the Vaccine Confidence Project. “Other diseases won’t show as quickly as measles. But they will come if we don’t get ahead of this.”

Annual suspected measles cases in England and Wales have more than doubled for two years in a row, from 360 in 2021 to 735 in 2022 and 1,603 in 2023, according to the UK Health Security Agency, the body responsible for disease protection.

Almost 60 per cent of the confirmed cases in 2023 were in children under 10, with many in London, the West Midlands and Yorkshire and the Humber, the agency said. Birmingham alone registered about 250 confirmed or probable cases between October 1 and January 18.

Measles is a highly infectious viral respiratory disease that can cause brain damage and even death. In 1967, the year before the vaccine’s introduction in the UK, there were more than 460,000 suspected measles cases and 99 fatalities, according to Oxford university’s vaccine knowledge project.

UK immunisation with two doses of the measles, mumps and rubella — MMR — vaccine has fallen in the past 10 years and is well short of the official target of 95 per cent coverage in children by the age of five. It stood at 86.5 per cent in 2021-22, according to official figures, which is likely to reflect in part difficulties in scheduling vaccination appointments during the pandemic.

The principal reason for falling vaccination rates may be the sheer logistical challenges of getting children jabbed, suggested Helen Bedford, professor of children’s health at University College London.

This may particularly affect poorer families, she added, pointing to difficulties taking time off work or in securing appointments at overburdened health facilities. In addition, some ethnic minority groups were more likely than others to take their children to be jabbed, she suggested.

“More than hesitancy or anti-vaccine [sentiment], I think access is the biggest factor,” she said.

Bedford pointed to lessons from the pandemic and even before about the value of bringing vaccination into the heart of communities. One useful pre-Covid model was a mobile vaccination centre, dubbed “the spotty bus”, she said. It visited car parks, supermarkets and school playgrounds in Hackney, eventually vaccinating about 1,000 children.

“We need to be thinking more about taking vaccination to the people, rather than expecting them always to come to us,” Bedford said.

Authorities needed to mount a parallel push to combat vaccine hesitancy, experts said. UK MMR jab rates took a hit after British doctor Andrew Wakefield’s discredited 1998 allegations of a link between the vaccine and autism.

The Covid pandemic has provoked a fresh wave of hesitancy. Social media provided wide circulation for data about real vaccine side-effects and disinformation about false ones.

In the UK in 2018, some 90 per cent of people thought vaccines were safe, 92 per cent believed them to be effective and 93 per cent agreed they were important for children, according to Vaccine Confidence Project data. By 2023, those figures had all fallen by about 20 percentage points.

The pandemic showed how crucial it was for locally respected figures to deliver messages about vaccination’s importance in low jab rate areas, said Ronny Cheung, a consultant paediatrician at Evelina Children’s Hospital in London.

This should expand on work already being done by many local health protection teams, said Cheung, who noted he sometimes sees formerly vaccine-hesitant parents wracked with guilt because their child has fallen ill from a preventable disease.

This approach would help “target people through their own trusted sources, and other members of their community, to reduce the vaccine hesitancy side of things”, he said. “[It would also] communicate to people and point them in the right direction,” he added.

Cheung, who represents the Royal College of Paediatrics and Child Health, welcomed the vaccination strategy published by NHS England in December, although he said the two-year implementation period was “unacceptably long” and more resources were likely to be needed.

The NHS has said it is contacting millions of parents and care givers to book their children in for missed MMR jabs. The longer-term official strategy aims to increase the flexibility of vaccination appointment booking systems and make different vaccines more widely available across locations, said Dr Mary Ramsay, director for public health programmes at the UKHSA.

“While there is much focus on vaccine hesitancy and we shouldn’t be complacent, it is not driving the long-term decline we have seen in uptake,” said Ramsay, who added that government surveys suggested confidence in NHS vaccine programmes actually grew even as coverage fell.

The UK’s outbreak comes as the WHO warns of sharply rising measles case numbers elsewhere in Europe, with an “alarming” 30-fold increase in the 53-country region between December 2022 and November 2023.

Kazakhstan, Russia, Kyrgyzstan, Turkey and Azerbaijan suffered the bulk of the cases, with the UK the tenth most affected. The UK reported more infections by proportion of population than most EU counterparts, including France, Germany, Italy and Spain.

Hans Henri P Kluge, WHO Europe regional director, welcomed the UK’s work on monitoring the measles resurgence and identifying low vaccination weak points.

“Factors determining demand for and acceptance of vaccines in countries are multifactorial, context-specific and vary across vaccines and time,” Kluge said.

“Public health authorities in all countries have to ensure access to equitable vaccination services and address any identified challenges to improving uptake, particularly in vulnerable and underserved communities.”