If you think it’s anti-vaxxers that are causing the rise in measles cases in Britain, think again – and look at Scotland | Devi Sridhar

TThe UK was once so good at dealing with measles 2017 and 2021 the World Health Organization declared that we had successfully achieved “elimination status” of the disease, meaning not a single endemic case had been detected in the past year. But those days are over, more than 200 children diagnosed with measles in England and Wales in the last four weeks of 2023. The UK Health Security Agency has declared a national emergency not only because of the cases emerging, but also because of the generally low MMR vaccination rates, leaving a very large population children remain at risk of infection.

Incredibly, around 25% of children in parts of London go to school unvaccinated. NHS England Data shows that more than 3.4 million children under the age of 16 across the country have not been vaccinated. This puts them at significant risk, and measles is incredibly contagious. One person can infect about 12 to 18 othersand spreads through the respiratory tract, such as coughing, sneezing and breathing. Like approx 95% of the population has been vaccinated the virus stops circulating because it cannot find susceptible hosts, but it appears that vaccination rates are below that number in many areas.

Just two doses of vaccine should confer lifelong sterilizing immunity, meaning those who are fully vaccinated are not only protected from infection, but are also very unlikely to transmit the virus to anyone else. So what is the best way to get children vaccinated? Scotland offers a lesson here. In Scotland95.9% of children had one dose by the time they were five years old, while 89.7% had two doses. The result? There was alone one laboratory-confirmed case of measles in Scotland throughout 2023. Researchers from the University of Edinburgh suggest that the increase in vaccination rates in Scotland during the Covid-19 pandemic may have been linked to flexible working for parents (which meant they could attend vaccination appointments) and mobile vaccination centres.

This is a basic principle in global health: if you want parents to vaccinate their children, make it accessible, free and easy, so that it fits within their daily obligations and constraints. And that’s true, whether or not it is Uganda, Pakistan, Scotland or England. As Kirsten Watters, Camden’s director of health and wellbeing, said: “When we talk to parents, we know that most plan to vaccinate their children, and that they have high levels of confidence. They just find it difficult to organize those appointments.” The majority of parents eventually vaccinate their children, but it only takes a few barriers – the inability to easily make an appointment, remote vaccination centers, confusing or inaccessible messaging – to push the vaccination rate a few percentage points below the critical 95% threshold drop it, and the virus can manifest itself.

And yes, there are other issues, such as the general post-Covid-19 vaccine hesitancy and the growing online conspiracy movement, as well as genuine concerns about whether vaccines are necessary given the potential side effects. The pandemic has certainly introduced many people to the world of anti-vax theories and doubts, not to mention previous issues such as Andrew Wakefield’s 1998 study that incorrectly linked MMR vaccination to autism, the influence of which remains persistent has proven difficult to dispel despite being discredited. But we should not exaggerate the “anti-vax sentiment”. The fact that vaccination rates vary widely in some parts of Britain – coverage is around 90% in the South West, for example – tells us that the biggest difference is likely to be logistical. We need communities and better vaccine rollout to underserved areas, all mediated by trusted health workers.

Fortunately, the government has done that announced a vaccination campaign in England, recruiting teachers, GPs and community leaders to promote vaccination, and rolling out pop-up vaccination centers in convenient locations such as schools. If the approach works, it should be built into the annual campaign so that the vaccination rate never becomes so low again.

I remember giving talks at global health meetings in 2003 and 2004, advocating lowering the price of the measles vaccine for poor countries so that health ministries could obtain doses and save the lives of children. At that time, measles was considered a problem in low- and middle-income countries. We thought the problem had been solved in Britain and the United States.

Measles was once a common and fatal disease for children here. In 1962, Roald Dahl’s daughter Olivia died at the age of seven from complications from measles. When a safe combined MMR vaccine was approved, the beloved children’s author advocated for parents to adopt it. In a letter reflecting on the low vaccination rate against measles in 1986, he wrote: “It is not yet generally accepted that measles can be a dangerous disease. Believe me, it is. In my opinion, parents who now refuse to have their children vaccinated are putting the lives of those children at risk.”

Eliminating most viruses is a tall order, but given the MMR vaccine, it is a realistic target for measles. Measles, mumps and rubella are all nasty diseases that should be a thing of the past. Dahl’s daughter did not have the choice of a vaccine, but children in Britain today do not have to suffer the same fate. They live in 2024, not 1962.