According to the NHS one person can infect nine out of 10 unvaccinated close contacts. The infection can have a number of serious complications, including pneumonia, blindness, seizures and meningitis. Babies under the age of one, young children, pregnant women and immunocompromised people are vulnerable to the more aggressive side effects.
Before a vaccine for measles was created, there were regular epidemics that caused approximately 2.6 million deaths worldwide each year. In England, the year before the vaccine was introduced in 1968, there were 460,000 cases of measles – by the 1980s that number had dropped to about 10,000 suspected cases a year.
To drive home the importance of getting protected from this highly contagious infection, the government implemented a national vaccination campaign in 1994 – the impact was immediately felt. There have been no measles epidemics since 1995 and in 2017, the World Health Organisation (WHO) declared England measles free.
So, how, in just seven years, is measles back at the top of the health agenda?
A combination of factors means measles cases are rising rapidly in England and Wales. Figures from NHS England suggest more than 3.4 million children under the age of 16 years are unprotected against measles, mumps and rubella.
The steady decline of MMR vaccine uptake has made measles outbreaks increasingly common. Certain regions are worst affected, particularly the West Midlands, where more than 300 cases were reported between 23 October and 15 January. After these outbreaks, the UK Health Security Agency (UKHSA) declared a national incident and warned that further outbreaks could spread across the country, even though 85% of children nationally have had their second dose of the MMR vaccine. This is because, to ensure herd immunity, 95% of the population has to be fully vaccinated.
When did this start?
Though the problems surrounding MMR vaccine coverage have become particularly amplified in recent months, it is not a new issue. In 1998, former physician Andrew Wakefield put forward a widely and since comprehensively debunked hypothesis linking the MMR vaccine to autism. What we saw after that was a drop in uptake because people were worried about this false link, It meant that quite a lot of people born in that time did not have two doses of the vaccine, leaving a lot of late teens and young adults vulnerable to measles in the late 2010s.” Before the Covid pandemic hit, there were a number of outbreaks of mumps and measles in secondary schools and universities, in part because of Wakefield’s hypothesis.
There has also, separately, been a slow decline over the last decade in vaccine uptake, meaning that young children are now also vulnerable – 60% of cases in current outbreaks are assumed to be in children under the age of 10. Any drop in uptake is a problem.
Measles is a nasty infection, so this is serious. About one in five kids who get the disease have been admitted to hospital for treatment. It can cause very serious infection – about one in 1,000 people get inflammation of the brain and about one in 5,000 in countries like the UK can die”.
Why are people not getting vaccinated?
Though vaccine misinformation has played a role in the decline, it is not the only factor. Most parents do get their children vaccinated, as we can see from the figures. Parental confidence in vaccines is high: a 2022 survey conducted by the UKHSA found that 95% of parents agree vaccines work, 91% think they are safe and 90% agree they trust vaccines – so what is stopping parents from getting the jabs into their children’s arms?
The first issue is access and flexibility when it came to booking the appointment initially. There is also underinvestment in the NHS has meant that we don’t necessarily have systems where people are being chased up, reminded and given that extra encouragement to get this done.
The irony of the measles conundrum is that the efficacy of the vaccine has meant that most people are not aware of how serious the infection can be, and therefore there is not much urgency when it comes to getting vaccinated. Most of us will never have actually seen measles and could mistakenly think that it is just a bit of a rash that clears up after a few days, not realising that this is a very serious and potentially fatal disease.
During the height of the pandemic, many parents were also nervous or hesitant to go into hospitals or other health settings to get children vaccinated for fear of getting infected with Covid and others simply did not know that these routine vaccinations were still happening at that point. So there’s a melting pot of reasons for the decline.
If the government and the NHS deal with all of the various components of this problem, they can stop the infection from becoming a full-blown health crisis. Conversely, any level of complacency will exacerbate the problem.
We have a safe and highly effective vaccine; we shouldn’t have measles in the UK. So it’s about putting resources into getting jabs into the arms of those who are unvaccinated and highlighting it to all.