IIn September 2017, Britain basked in the glory of a public health success story. No indigenous cases of measles were recorded for three years. Decades after a sham study threatened to permanently undermine confidence in the MMR shot, which protects against measles, mumps and rubella, the world Health Organization declared that the disease has been eliminated in the United Kingdom for the first time.
Dr Mary Ramsay, then head of immunization at Public Health England (PHE), expressed her delight. “This is a great achievement and a testament to all the hard work by our health professionals in the NHS to ensure that all children and adults are fully protected with two doses of the MMR vaccine.”
However, the WHO award came with a warning shot. “We cannot become complacent,” said Zsuzsanna Jakab, then WHO regional director for Europe. “Outbreaks continue to cause unnecessary suffering and loss of life. Routine immunization coverage is declining.”
Less than two years later, the UK was stripped of its measles-free status.
Today is the country in the midst of a measles emergency. Public health officials are trying to stem an alarming wave of infection. And the UK Health Security Agency (UKHSA), which replaced PHE during the Covid pandemic, was forced to declare a national incident, indicating a major public health risk from one of the world’s most contagious viruses.
Hundreds of children have been sick with measles in recent weeks. Officials fear a growing outbreak in the West Midlands could spread to other towns and cities unless urgent action is taken to boost vaccination uptake.
A staggering 3.4 million under-16s are at risk of contracting the virus, officials say, and letters are being sent to parents of unvaccinated children. GPs are setting up extra clinics and vaccine vans are targeting communities with low vaccination rates.
The unfolding crisis has alarmed the UK’s top health officials.
“We are at a point where there is a very large susceptible population of children,” Prof Sir Andrew Pollard, chairman of the Joint Committee on Vaccination and Immunisation, told the Guardian in an interview this week. “To keep measles away, we have to get more than 95% of children vaccinated. The NHS figures suggest we are at around 85%. “
Data released by the UKHSA showed there had been 216 confirmed measles cases and 103 probable cases in the West Midlands since October 1 last year. Four fifths (80%) were found in Birmingham, while 10% were identified in Coventry. Most were in children under the age of 10.
“Now that it’s started, with a virus that’s so contagious — it’s much more contagious than Covid was — then if there are people who aren’t vaccinated, it can spread like wildfire,” Pollard said. . “The reason it’s so worrying is that it then finds individuals who, rather than just getting a horrible disease, will actually get serious complications or die from it.”
In some people, measles can affect the lungs and brain and cause pneumonia, meningitis, blindness and seizures. Pollard said: “There are certain risk groups: people whose immune systems are not working well, children who are receiving cancer treatments, for example. Younger children are more at risk than older children due to serious complications. But there will also be some perfectly healthy children who can get very serious illness or even die from this virus.
“It’s extremely worrying to be in this situation where the spark of this fire has started, we don’t quite know where it will end, but we can stop it if we get vaccines out there to protect children.”
So how did Britain go from measles elimination to the brink of a measles catastrophe? Why have MMR vaccination rates fallen? And how can the country get out of this mess?
Experts say a combination of factors probably explains the drop in vaccination rates – and the measles crisis now engulfing Britain.
The increase in cases is partly a legacy of the pandemic, says Prof Stuart Neil, head of the department of infectious diseases at King’s College London. Vaccinations against many diseases, including measles, have been neglected because people have focused on Covid. “Vaccine uptake has generally fallen over the pandemic, partly because of reluctance to see doctors during it,” he said.
Another challenge is that the children who missed their first boosts between 2020 and 2022 are now older than the age group usually seen regularly at GPs for vaccination programmes. In the UK, children are offered two doses of MMR – first at the age of one, then at three years and four months. But if your child was born during the pandemic, they may have been missed and need to catch up.
“It’s never too late to get vaccinated,” said Dr Doug Brown, chief executive of the British Society for Immunology. “We encourage parents to make sure their children are up to date with their MMR vaccines and catch up on any missed as soon as possible.”
Pollard said there had been a “gradual decline” in MMR coverage for years before the pandemic, cumulatively increasing the threat of a full-scale measles crisis.
“In one year it’s manageable, but over successive years you build up this increasing pool that allows the virus to transmit,” he said. “If you think about the accumulation of groups of children over several years, every year that you have low coverage, more and more children are added to this pool of susceptible people, which means that when the virus does arrive, you have this explosive can have outbreaks.”
Falling vaccination rates and the demise of Britain’s measles-free status also stem from people not knowing – or forgetting – about the risks of measles. “Because of the success of the UK immunization programme, many parents will have no first-hand experience of measles,” said Dr David Elliman, a pediatrician at London’s Great Ormond Street Hospital. “It will be a great tragedy if we have to learn from the sad deaths of children before the disease is taken seriously.”
False claims made by Andrew Wakefield in 1998 about the MMR vaccine still have an impact, says Prof Helen Bedford, professor of child health at the UCL Great Ormond Street Institute of Child Health. Not because the false claims still hold weight with the public, but because because of the scare, children who were not vaccinated are now adults – and may be helping the virus to spread.
“More than 25 years ago, MMR vaccine uptake dropped because of highly publicized but subsequently discredited research suggesting a link to autism,” Bedford said. “Unsurprisingly, given the intense media coverage at the time, many parents chose not to have their children vaccinated. Those children are now young adults.
“Over the years, the number of unvaccinated people in the population has accumulated, enabling measles to take hold and spread rapidly within communities.”
Most experts agree that misinformation about the MMR shot abounds is unlikely to play a significant role in declining vaccination rates. “It’s too easy to blame anti-vaccine sentiment for the measles outbreaks,” Bedford said. While some mistrust of vaccines may play a small role, research shows that parental vaccine confidence remains high, she added.
“Asking questions about vaccination should be encouraged, but we need trained staff to do this, and the NHS and general practice are under significant pressure, with cuts to funding and staff.”
Pollard believes families struggling to access vaccination programs is a much bigger factor than misinformation. “We know the biggest pockets of low coverage are in the parts of the country where families have the hardest time accessing vaccination services,” he said.
Nationally, strategies promised by the NHS and the government to increase vaccination rates need to be implemented urgently, says Dr Ronny Cheung of the Royal College of Paediatrics and Child Health.
NHS England recently published its vaccination strategy, which focused on addressing challenges around access and included proposals to provide flexible and convenient vaccination services. “This is a most welcome development, but we are concerned that implementation plans for this strategy are not nearly as ambitious as we need them to be,” Cheung said. “The current goal is full implementation by 2025-26.
“Two years seems an unacceptably long wait. We are already arriving late to this work and feeling the effects of low uptake, particularly in the MMR vaccine. It is urgent – we must get to work immediately.”
Pollard points out that the UK is not unique when it comes to rising cases of measles. Seven years after the WHO warned the then measles-free UK against complacency, this week it warned of a 30-fold increase in cases across Europe.
More than 30,000 cases were reported by 40 of the region’s 53 member states between January and October last year, compared with 941 cases in all of 2022. Two in five cases were in children aged one to four, while one in every five among people were. age 20 and over.
“There are measles outbreaks happening all over the world,” Pollard said. “This is a worrying moment worldwide.”
The only way out? Boost vaccination rates by encouraging parents to get their children vaccinated against measles, experts say. “The virus is spreading today, so we need to vaccinate children today,” says Pollard. “There is no time to wait. It is urgent and tomorrow may be too late.”
