| Just a few decades ago, the likelihood of a child dying from measles in a UK hospital would have seemed remote, if not almost impossible. Yet Dr Elizabeth Whittaker said that the disease’s resurgence has almost been a foregone conclusion as vaccination rates have steadily fallen over the past 10 years. To ensure herd immunity against measles, where enough people are protected to prevent the virus spreading, vaccination rates must hit 95%. The current rate across England is 84%. “Measles has never been eradicated in any part of the world and if a country drops below that 95% herd immunity threshold then the disease will return,” said Whittaker. “I think a huge part of the problem is that we have been so good at preventing measles, none of us really have any lived experience of understanding how devastating these infections can be.” How fast is measles spreading in the UK? According to NHS data, there have been 529 confirmed cases in England so far this year, with 68% occurring in children under the age of 10. The disease is highly infectious and airborne. In the past few years, outbreaks have occurred around the country, with the West Midlands experiencing cases at their highest level since the mid-1990s. The uptick in measles cases comes as no surprise to infectious disease experts such as Whittaker, considering that figures from NHS England show that 3.4 million children under the age of 16 years have not been fully immunised with the MMR vaccine. The UK’s rising measles rates are part of a global upward trend. Measles cases in the US and Europe are at their highest levels in 33 years and 25 years respectively. Why are parents not getting their children vaccinated? Whittaker said that while there has certainly been a barrage of misinformation and conspiracy theories around the MMR vaccine – and vaccines in general – in recent years, she believes that this is only part of the story. “Of course there is some vaccine hesitancy out there, but the bigger lesson here – and it’s a good one because this is much easier to tackle – is that access is a massive issue,” she said. She said a recent report from the Royal College of Paediatrics and Child Health (RCPCH) found that there was a reasonably good uptake in early childhood vaccines when women were on maternity leave and in close contact with healthcare professionals, but then this tailed off by the time children should be getting their first MMR jab at 12 months. This declined even further by the time the second jab was due at three to five years. “It’s things like parents working zero-hours contracts who can’t afford the day off, or vaccines only being offered on certain times of the week, or a lack of transport or not being able to navigate the GP practice appointment system,” said Whittaker. “So the key thing to tackle is increased flexibility on how, where and when these vaccines are being offered.” How have cuts to NHS services contributed? Another barrier to access is the way that information about the vaccine is being disseminated. “Trusted individuals like midwives who are in contact with new mothers are replaced often by people who families don’t know,” said Whittaker. “Before you’d have a family doctor, now you see a different GP every time you go into the surgery. Health visitor resourcing is inadequate, so this means that trusted touch points between the health system and new parents have been lost.” Without access to the information and the vaccine, anti-vax messaging can move into this vacuum and become the dominant narrative. “We’ve had parents reporting that they were never worried about vaccines, but that since all the doubt and conspiracy theories that took hold about the Covid vaccine, they’re now questioning the credibility and safety of all vaccines, including the MMR,” said Whittaker. “For a lot of women having a baby or being on your own with multiple small children is a very isolating experience and exposure to misinformation online isn’t counteracted by contact with a trusted healthcare professional.” What can be done to reverse this? Whittaker said that there has to be an awareness that “what works for us in north London may not work in Liverpool. We can make the systems as good as possible, but we need to provide solutions that are specific to the local population.” She points to a project she has recently visited in west London run in partnership with a local community group called Why Did Nobody Ask Us?, which attempts to work with parents from diverse backgrounds to understand the reasons underpinning slow vaccine take-up in their communities. “We know Black African women have the lowest uptake of vaccines but nobody is really asking why,” she said. “We need to listen to parents because their answers are probably the most crucial tool we have in tackling declining vaccination rates. Information has to be disseminated in as many ways and languages as possible.” Whittaker is also optimistic about other developments taking place, such as rolling out vaccination appointments and reminders through the NHS app. Yet what is clear is that there needs to be a massive and rapid investment into prioritising child health across the NHS. She sees the decline in vaccines as a manifestation of “a real neglect of children’s health across the board and it’s something that has to change if we’re going to reverse this trend”. What will happen if measles continues to spread? Whittaker said that if measles begins to spread and vaccinations levels continue to fall, the health system is likely to come under increasing strain. “Measles comes with a huge health risk. Not only can children get really ill from the disease but they have a high risk of secondary bacterial infections,” she said. “This all places a huge burden on an already overstretched system and means health care could be diverted from other children who desperately need it and comes at a significant economic cost.” Often the first time the hospitals come into contact with an infected child, “they present with symptoms that aren’t obviously measles and have sat in a waiting room and interacted with multiple other children and adults”. This means that when children do come back with all the visible signs of the disease, “we then need to go back and contact trace everyone they might have been in contact with who could then be spreading infection through their community. It’s a huge job and not one that we’re currently prepared for.” She points out that this is a disease that could swiftly get out of hand if vaccination levels remain low. “Unless we tackle this now, we’ve got a very big problem coming down the line.” | 