Tuesday briefing: Measles cases are rising and its about more than vaccine misinformation – The Guardian
First Edition newsletter
Tue 23 Jan 2024 01.35 EST
Good morning. Before a vaccine for measles was created, there were regular epidemics that caused approximately 2.6 million deaths worldwide each year. In England, the year before the vaccine was introduced in 1968, there were 460,000 cases of measles by the 1980s that number had dropped to about 10,000 suspected cases a year.
To drive home the importance of getting protected from this highly contagious infection, the government implemented a national vaccination campaign in 1994 the impact was immediately felt. There have been no measles epidemics since 1995 and in 2017, the World Health Organisation (WHO) declared England measles-free. So, how, in just seven years, is measles back at the top of the health agenda?
A combination of factors means measles cases are rising rapidly in England and Wales. Figures from NHS England suggest more than 3.4 million children under the age of 16 years are unprotected against measles, mumps and rubella.
The steady decline of MMR vaccine uptake has made measles outbreaks increasingly common. Certain regions are worst affected, particularly the West Midlands, where more than 300 cases were reported between 23 October and 15 January. After these outbreaks, the UK Health Security Agency (UKHSA) declared a national incident and warned that further outbreaks could spread across the country, even though 85% of children nationally have had their second dose of the MMR vaccine. This is because, to ensure herd immunity, 95% of the population has to be fully vaccinated.
To get a sense of why this is happening, for todays newsletter I spoke with Guardian science correspondent Nicola Davis. But first, the headlines.
Energy | More than 2 million people across the UK will be cut off from their gas and electricity this winter because they cannot afford to top up their prepayment meters, according to Citizens Advice.
Immigration and asylum | Rishi Sunaks plan to deport asylum seekers to Rwanda has received its first parliamentary defeat after the House of Lords voted for a motion that sought to delay ratification of the new treaty until the government can show the country is safe.
Weather | Two people have died and tens of thousands were left without power after Storm Isha wreaked havoc across the UK with gusts as high as 107mph.
Middle East | The White House has called on Israel to protect innocent people as Palestinian officials said the Israeli military had stormed al-Khair hospital in Gaza and placed another, al-Amal, under siege.
UK news | A coroner has ruled that a 13-year-old black boy, Christopher Kapessa, was deliberately pushed into a Welsh river by an older white boy as a dangerous prank. But the coroner, David Regan, said there was no evidence that the child who pushed Christopher had intended to cause his death or that there was a racist motive behind it.
Measles is a highly contagious infection. According to the NHS one person can infect nine out of 10 unvaccinated close contacts. The infection can have a number of serious complications, including pneumonia, blindness, seizures and meningitis. Babies under the age of one, young children, pregnant women and immunocompromised people are vulnerable to the more aggressive side effects.
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When did this start?
Though the problems surrounding MMR vaccine coverage have become particularly amplified in recent months, it is not a new issue. In 1998, former physician Andrew Wakefield put forward a widely and since comprehensively debunked hypothesis linking the MMR vaccine to autism. What we saw after that was a drop in uptake because people were worried about this false link, says Nicola. It meant that quite a lot of people born in that time did not have two doses of the vaccine, leaving a lot of late teens and young adults vulnerable to measles in the late 2010s. Before the Covid pandemic hit, there were a number of outbreaks of mumps and measles in secondary schools and universities, in part because of Wakefields hypothesis.
There has also, separately, been a slow decline over the last decade in vaccine uptake, meaning that young children are now also vulnerable 60% of cases in current outbreaks are assumed to be in children under the age of 10. Any drop in uptake is a problem.
Measles is a nasty infection, so this is serious, Nicola says. About one in five kids who get the disease have been admitted to hospital for treatment. It can cause very serious infection about one in 1,000 people get inflammation of the brain and about one in 5,000 in countries like the UK can die.
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Why are people not getting vaccinated?
Though vaccine misinformation has played a role in the decline, it is not the only factor. Most parents do get their children vaccinated, as we can see from the figures, Nicola says. Parental confidence in vaccines is high: a 2022 survey conducted by the UKHSA found that 95% of parents agree vaccines work, 91% think they are safe and 90% agree they trust vaccines so what is stopping parents from getting the jabs into their childrens arms?
The first issue Nicola pointed out was access and flexibility when it came to booking the appointment initially. She also noted that underinvestment in the NHS has meant that we dont necessarily have systems where people are being chased up, reminded and given that extra encouragement to get this done.
The irony of the measles conundrum is that the efficacy of the vaccine has meant that most people are not aware of how serious the infection can be, and therefore there is not much urgency when it comes to getting vaccinated. Most of us will never have actually seen measles and could mistakenly think that it is just a bit of a rash that clears up after a few days, not realising that this is a very serious and potentially fatal disease, Nicola says.
During the height of the pandemic, many parents were also nervous or hesitant to go into hospitals or other health settings to get children vaccinated for fear of getting infected with Covid and others simply did not know that these routine vaccinations were still happening at that point. So theres a melting pot of reasons for the decline, Nicola says.
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Fighting the infection
The government has announced a national campaign to encourage parents of children between the ages of six and 11 to make an appointment with their GP to administer any missed MMR vaccines. The campaign will also target a million people in the West Midlands and London between the ages of 11 and 25 particularly as measles can be more serious if it is contracted in adulthood.
If the government and the NHS deal with all of the various components of this problem, they can stop the infection from becoming a full-blown health crisis. Conversely, any level of complacency will exacerbate the problem.
We have a safe and highly effective vaccine, we shouldnt have measles in the UK. So its about putting resources into getting jabs into the arms of those who are unvaccinated, Nicola says.
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A bit of good news to remind you that the worlds not all bad
Hurtling towards her 40s as a single mother, relying on benefits to support her three children, Zoe Smith, made the decision to quit the UK and return to Grenada, the island her paternal and maternal grandparents had left in the 1950s.
If I couldnt make it work in the UK, what chance did my children have in a country in which, on every indicator from education to employment, health to housing the odds of success as black citizens were clearly stacked against them?
Smith decided to leave the UK in the middle of the pandemic and when she finally landed after many cancelled flights she describes feeling a sense of overwhelming relief. Moving to Grenada has thrown up its challenges but her ultimate motivation is to raise her children in an environment where they could feel that freedom is their birthright.
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