The United Kingdom is rushing to control a concerning increase in measles cases, labeling the situation as urgent.
In September 2017, the UK was celebrating a major achievement in public health. There had been no reported cases of measles for three years. Despite a fraudulent study in the past that caused doubts about the MMR vaccine, which protects against measles, mumps, and rubella, the World Health Organization announced that the disease had been eradicated in the UK for the first time.
Dr Mary Ramsay, then head of immunisation at Public Health England (PHE), expressed delight. “This is a huge 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.”
The recognition from WHO was accompanied by a cautionary statement. However, Zsuzsanna Jakab, who was the WHO regional director for Europe at the time, reminded us that we cannot let our guard down. She emphasized that outbreaks are still causing unnecessary suffering and death, and there is a decline in routine immunization coverage.
In under two years, the UK lost its designation as a measles-free country.
Currently, there is a measles crisis in the country. Authorities in charge of public health are working urgently to prevent a concerning increase in cases. Due to the Covid pandemic, the UK Health Security Agency (UKHSA) has taken over for PHE and has had to declare a national emergency due to the highly contagious nature of the measles virus.
In the past few weeks, numerous children have become ill with measles. Authorities are concerned that the outbreak in the West Midlands could potentially spread to other areas if immediate measures are not taken to increase the number of vaccinations administered.
Officials estimate that a concerning number of 3.4 million individuals under the age of 16 are in danger of contracting the virus. To address this issue, letters are being sent to parents of children who have not yet received the vaccine. In addition, general practitioners are organizing additional clinics and mobile vaccine buses are focusing on areas with lower rates of vaccination.
The rapidly developing emergency has caused concern among the most prominent health authorities in the UK.
According to Prof Sir Andrew Pollard, chair of the Joint Committee on Vaccination and Immunisation, there is currently a large number of children who are vulnerable to measles. In order to prevent the spread of the disease, it is necessary for over 95% of children to receive vaccinations. However, recent NHS data shows that only about 85% of children have been vaccinated.
The UKHSA recently released data indicating 216 confirmed measles cases and 103 probable cases in the West Midlands starting from October 1st of last year. The majority (80%) were reported in Birmingham, with 10% in Coventry. The majority of cases were in children under the age of 10.
According to Pollard, the current virus is highly contagious and more so than Covid. Therefore, if there are individuals who have not received the vaccine, it can spread rapidly. This is concerning because it can lead to severe complications or even death for those who contract it.
In certain individuals, measles can impact the respiratory and nervous systems, leading to pneumonia, meningitis, vision loss, and seizures. Pollard stated that there are specific groups who are at a higher risk, such as those with weakened immune systems and children undergoing cancer treatment. Younger children are more susceptible to severe complications compared to older children. However, even healthy children can develop severe illness or potentially die from the virus.
It is very concerning to be in a situation where the initial cause of this fire is unknown and its potential outcome is uncertain. However, we have the ability to prevent it by distributing vaccines to safeguard children.
What caused Britain to transition from successfully eradicating measles to being on the verge of a measles crisis? What has led to a decline in MMR vaccination rates? And what steps can be taken to rectify this situation?
According to experts, a variety of factors are probably responsible for the decrease in vaccination rates, leading to the current measles outbreak in Britain.
According to Professor Stuart Neil, director of the department of infectious diseases at King’s College London, the increase in cases can be attributed in part to the ongoing pandemic. Due to the focus on Covid, vaccinations for various diseases, such as measles, have been overlooked. Professor Neil stated that vaccine acceptance has declined overall during the pandemic, partly due to reluctance to visit doctors.
One difficulty is that the kids who did not receive their initial vaccinations from 2020 to 2022 are now beyond the age group that is usually seen at GP clinics for vaccination programs. In the UK, kids are given two MMR shots – at one year of age and again at three years and four months. However, if your child was born during the pandemic, they may have been overlooked and require to get caught up.
Dr Doug Brown, CEO of the British Society for Immunology, states that it is never too late to receive vaccinations. He advises parents to ensure their children are current on their MMR vaccinations and to promptly catch up on any missed doses.
According to Pollard, there has been a gradual decrease in MMR vaccination rates for years leading up to the pandemic. This cumulative decline has increased the risk of a severe measles crisis.
Over the course of one year, it may be manageable. However, if this pattern continues over multiple years, the pool of susceptible individuals grows, making it easier for the virus to spread. The accumulation of unvaccinated children each year leads to a larger pool of vulnerable individuals, ultimately resulting in potential outbreaks when the virus is introduced.
The decrease in vaccination rates and the loss of Britain’s measles-free status can be attributed to a lack of awareness or forgetting about the dangers of measles. According to Dr. David Elliman, a pediatrician at London’s Great Ormond Street hospital, many parents may not have personally witnessed measles due to the success of the UK immunization program. It would be a terrible tragedy if we only start taking this disease seriously after losing children to it.
In 1998, Andrew Wakefield made false statements about the MMR vaccine which continue to have consequences, according to Professor Helen Bedford from UCL’s Great Ormond Street Institute of Child Health. This is not because the public still believes these false claims, but because individuals who were not vaccinated as children due to these claims are now adults and may be contributing to the spread of the virus.
According to Bedford, more than 25 years ago, the MMR vaccine rate decreased due to widely publicized but later disproven studies that claimed a connection to autism. As a result of the intense media attention, numerous parents opted not to vaccinate their children. These children are now in their early adulthood.
“Over time, the population has seen an increase in individuals who have not received vaccinations, allowing for the rapid spread of measles among communities.”
Many professionals believe that false information about the MMR vaccine is not a major factor in the decrease of vaccination rates. Bedford stated, “It is convenient to point fingers at anti-vaccine beliefs for the spread of measles, but research shows that most parents still have confidence in vaccines.”
Encouraging inquiries about vaccination is important, however, there is a need for qualified personnel to handle this task. The NHS and general medical practices are facing immense strain due to reduced resources and workforce.
Pollard argues that limited access to vaccination programs is a more significant issue than misinformation. He states, “We have observed that the areas with the lowest vaccination rates are typically the ones where families face the most difficulties in obtaining these services.”
Dr. Ronny Cheung from the Royal College of Paediatrics and Child Health emphasizes the need for immediate implementation of vaccination rate-boosting measures promised by the NHS and government at a national level.
The vaccination strategy of NHS England was recently released, with a focus on tackling obstacles to access and offering flexible and convenient vaccination options. Cheung expressed approval for this progress, but also voiced concern about the lack of ambitious implementation plans. The current goal is to fully implement the strategy by 2025-26.
“Waiting for two years is too long and unacceptable. We are already behind schedule and are experiencing negative consequences, especially with the MMR vaccine. This is a pressing matter and we need to start working immediately.”
According to Pollard, the increase in measles cases is not exclusive to the UK. Seven years ago, the WHO cautioned the UK, which was then free of measles, about becoming complacent. This week, the WHO reported a 30-fold increase in cases throughout Europe.
Over the course of January to October in the previous year, 40 out of the 53 member states in the region documented a total of over 30,000 cases, significantly higher than the 941 cases reported in the entire year of 2022. Out of these cases, 40% were found in children aged one to four, while 20% were in individuals aged 20 and above.
Pollard expressed concern about the ongoing measles outbreaks occurring worldwide.
Experts suggest that the best solution is to boost vaccination rates by persuading parents to have their children vaccinated against measles. Pollard emphasizes the urgency of the situation, stating that since the virus is currently spreading, it is crucial to vaccinate children immediately without delay. Waiting could jeopardize the health of children, making it imperative to take action urgently.