IIn September 2017, Britain was basking in the glory of a public health success story. There had been no recorded indigenous cases of measles for three years. Decades after a sham study threatened to permanently undermine confidence in the MMR jab, which protects against measles, mumps and rubella, the World Health Organization declared the disease had been eliminated in Britain for the first time.
Dr. Mary Ramsay, then head of immunization at Public Health England (PHE), expressed her delight. “This is a huge achievement and testament to all the hard work of our healthcare workers 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 the WHO regional director for Europe. “Outbreaks continue to cause unnecessary suffering and loss of life. Coverage for routine vaccinations is declining.”
Less than two years later, Britain was stripped of its measles-free status.
The country is currently in the midst of a measles crisis. Public health officials are scrambling to stem an alarming surge in infections. And the UK Health Security Agency (UKHSA), which replaced PHE during the Covid pandemic, has been forced to declare a national incident, highlighting a major risk to public health from one of the world’s most contagious viruses.
In recent weeks, hundreds of children have become ill with measles. Officials fear a growing outbreak in the West Midlands could spread to other towns and cities unless urgent action is taken to boost vaccination rates.
As many as 3.4 million under-16s are at risk of contracting the virus, officials believe, and letters are being sent to parents of unvaccinated children. General practitioners are setting up additional clinics and vaccine buses are targeting communities with low vaccination rates.
The unfolding crisis has alarmed Britain’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 Immunization, told the Guardian in an interview this week. “To keep measles at bay, we need to vaccinate more than 95% of children. The NHS figures show we are at around 85%.”
Data released by the UKHSA shows that there have been 216 confirmed cases of measles 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 cases involved 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 — and if there are people who haven’t been vaccinated, it can spread like wildfire,” Pollard said. “The reason why that’s so worrying is that people are then found who, instead of just getting a horrible disease, will actually develop serious complications or die from it.”
In some people, measles can affect the lungs and brain, causing pneumonia, meningitis, blindness and seizures. Pollard said: “There are some high-risk groups: people whose immune systems are not working properly, for example children receiving cancer treatments. Younger children are more at risk for serious complications than older children. But there will also be completely healthy children who can develop a very serious illness or even die from this virus.
“It is extremely concerning to be in this situation where the spark of this fire has started. We don’t know exactly where it will end, but we could stop the fire if we have vaccines available to protect children.”
So how did Britain go from eliminating measles 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 likely explains the drop in vaccination rates – and the measles crisis now sweeping Britain.
The rise 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, were neglected as people focused on Covid. “Vaccine use has fallen across the board during the pandemic, partly due to hesitancy to see doctors during the pandemic,” he said.
Another challenge is that the children who missed their first jabs between 2020 and 2022 are now older than the age group typically seen routinely at GP practices for vaccination programmes. In Britain, children are offered two MMR doses: first at the age of one year, then at three years and four months. But if your child was born during the pandemic, it may have been missed and will need to be caught up.
“It’s never too late to get vaccinated,” said Dr Doug Brown, CEO of the British Society for Immunology. “We encourage parents to ensure their children are up to date on their MMR vaccines and to catch up on any missed vaccines as soon as possible.”
Pollard said there had been a “gradual decline” in MMR coverage for years before the pandemic, which had cumulatively increased the threat of a full-blown measles crisis.
“In one year that is manageable, but over the years you build up an increasing amount that allows the virus to be transmitted,” he said. “If you think about the accumulation of cohorts of children over several years, every year that you have low coverage, more and more children are added to this pool of susceptible people, meaning that when the virus arrives, you have these explosive outbreaks.”
The falling vaccination rate and the demise of the UK’s measles-free status are also the result of people not knowing – or forgetting – the risks of measles. “Due to the success of the UK immunization programme, many parents will not have direct experience of measles,” says Dr David Elliman, a pediatrician at London’s Great Ormond Street Hospital. “It would be a great tragedy if we have to learn from the sad deaths of children before the disease is taken seriously.”
False claims made in 1998 by Andrew Wakefield about the MMR vaccine are still having an impact, says Prof Helen Bedford, professor of child health at UCL Great Ormond Street Institute of Child Health. Not because the false claims still carry weight with the public, but because children who were not vaccinated due to fear are now adults – and may be fueling the spread of the virus.
“More than 25 years ago, MMR vaccine uptake declined because of widely published but subsequently discredited research suggesting a link with autism,” said Bedford. “It is not surprising that, given the intense media coverage at the time, many parents preferred not to have their children vaccinated. Those children are now young adults.
“Over the years, the number of unvaccinated people in the population has increased, allowing measles to spread rapidly within communities.”
Most experts agree that it is very unlikely that misinformation about the MMR shot will play a significant role in the declining vaccination rate. “It’s too easy to blame anti-vaccine sentiment for the measles outbreaks,” says Bedford. While some mistrust of vaccines may play a small role, research shows that parental confidence in vaccines 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 staffing levels.”
Pollard believes families struggling to access vaccination programs is a much bigger factor than misinformation. “We know that the largest areas of low coverage are in the parts of the country where families have the hardest time accessing vaccination services,” he said.
At a national level, strategies promised by the NHS and government to increase vaccination rates need to be urgently implemented, says Dr Ronny Cheung of the Royal College of Paediatrics and Child Health.
NHS England recently published its vaccination strategy, which focused on tackling challenges around access and included proposals to provide flexible and convenient vaccination services. “This is an extremely welcome development, but we are concerned that the implementation plans for this strategy are not nearly as ambitious as we need,” Cheung said. “The current target is full implementation by 2025-2026.
“Two years seems like an unacceptably long waiting period. We are already late in this work and are feeling the consequences of low uptake, especially with the MMR vaccine. This is urgent, we have to get to work immediately.”
Pollard points out that Britain is not unique when it comes to rising measles cases. Seven years after the WHO warned the then measles-free UK against complacency, it this week warned of a 30-fold rise 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 to 941 cases in all of 2022. Two in five cases occurred in children aged one to four years, while one in five among people. of 20 years and older.
“Measles outbreaks are happening all over the world,” Pollard said. “This is a worrying moment worldwide.”
The only way out? Increase vaccination rates by encouraging parents to give their children a measles shot, experts say. “The virus is spreading today, so we need to vaccinate children today,” Pollard said. “There is no time to wait. This is urgent and tomorrow may be too late.”