Why measles is back with a vengeance
As unvaccinated children prompt outbreaks across Europe, is it time to make the MMR jab compulsory? Chloe Lambert reports
Even the most rational, coolheaded parent dreads their child’s first vaccinations. I had no doubt about the benefits of immunisation for my one-year-old daughter’s future health, yet at our first appointment, the scream she made when the needle went into her tiny, chubby thigh made me weep (which then set the nurse off).
Nevertheless, the alarming recent recurrence of measles in the UK and Europe is a reminder that the protection the injections gave her were worth the short-term trauma.
Measles, which had virtually disappeared in the UK and much of the developed world, is returning with a vengeance, despite the fact we’ve had a cheap and effective vaccine for it since the Sixties. Cases quadrupled in Europe in 2017 and at least 35 people died, according to the World Health Organisation. The countries worst affected have been Ukraine, Romania and Italy – where poorly funded health systems and cultural beliefs among some groups mean take-up of the vaccine is patchy. But the modern pace of migration and foreign travel has seen the disease spreading across the Continent, including to Belgium, Portugal, France and Germany; measles is also on the rise in the United States and even Australia.
In England and Wales, there were 696 suspected cases of measles in the first three months of this year – nearly twice as many as reported in the whole of 2017 – with outbreaks from Birmingham to London, Leeds, Liverpool and Cardiff. Technically, measles has been eradicated in the UK, but the disease is being imported as a result of unvaccinated children and adults travelling to countries with large outbreaks.
Health authorities are on high alert and governments are so concerned about the return of measles that laws have been recently passed in France, Germany and Italy making it mandatory that all parents give their children the combined measles, mumps and rubella (MMR) jab, or at least consult their doctor about it.
Measles is one of the most contagious diseases known, but experts warn that the elimination of the disease in large regions of the world has caused many to become dangerously complacent about the need for widespread immunisation.
“Sixty years ago, people queued up to have the whooping cough jab because it was killing children – the risk was obvious and present,” says Adam Finn, professor of paediatrics at the University of Bristol. “Now, no one is dying from these things.
“The main driver of people buying into a vaccine is fear, and without that fear it opens people up to doubt.”
All this is compounded by persistent anti-vaccine movements, which have a long history in the UK and Europe. This year marks two decades since the British researcher Andrew Wakefield published a paper linking the MMR vaccine with autism, prompting a wave of hysteria across the world, and a dramatic fall in the rate of parents vaccinating their children.
Wakefield was later struck off, and his theory has been exposed as groundless in multiple studies since, but for many the stigma surrounding the vaccine stuck and planted seeds of doubt and worry in people’s minds. When my daughter had her first dose recently, I was struck by the number of friends and family members – rational and well-educated people – who expressed vague suspicion about it; I know at least one couple who chose not to give their baby the jab.
Though coverage of the MMR among babies in the UK is now high, the latest figures from NHS Digital showed it fell in England last year for the third year in a row, and is still below the WHO target of 95per cent.
“Wakefield has to carry some responsibility for what’s going on here,” says Prof Finn. “A lot of people still see the MMR as controversial. There’s a question mark. There’s an element of doubt which didn’t really exist before, in my view.”
Take-up of the MMR is now back to pre-wakefield levels, but a generation of children who were born at the height of the controversy and didn’t have the jab are now at university age, when close contact means diseases like measles can spread quickly.
“There are still a significant number of people who didn’t get the vaccination historically because of the MMR scare,” says Prof Finn. “Measles is incredibly infectious, and if you’ve never had it and you didn’t
get the vaccine, it’s a bit like being in a forest of dried trees waiting for someone to strike a match.”
And if you think getting measles is no big deal, it is worth taking heed from Andrew Wilson whose 19-yearold daughter caught measles in February, having just started her second term at university.
“We got a phone call about 10 o’clock at night from her housemate saying they’d just called an ambulance because her heart rate was through the roof, she’d come out in a rash and her temperature was over 40 degrees,” says Andrew, 48, who lives in the Isle of Wight.
“She was in hospital for a week, being sick constantly and unable to eat. She lost a stone in weight, only being slight to begin with.
“I was shocked. I had no idea measles was so serious.”
She has thankfully made a full recovery, having provided details to the hospital of every person she had been in touch with in the previous days to prevent further infection. But Andrew remains haunted by his decision not to vaccinate her when she was just a baby.
“Around the time she was born, there were all these scare stories about autism,” he recalls. “As a parent, a little bit of information can be dangerous. I was concerned about having a child with a new immune system being bombarded with all these vaccines. So we took the decision not to. Which, in hindsight, was not a good decision.”
Andrew and his wife agreed they would vaccinate their children when they got older, and he arranged for his daughter to have the MMR jab, with other vaccinations, before university.
The family are now uncertain about whether she was actually given the injection, or whether she was, but still caught measles because she was under-vaccinated, having only had one jab and not the follow-up booster needed for the best level of protection. “I suppose people will hear this and think we were stupid and it’s our own fault – and yes, I feel stupid,” says Andrew. “It was an extremely upsetting experience. It’s not something I would ever want to put my children through again, and if it comes to grandkids later down the line, I would want them to be vaccinated.”
The MMR is safe and effective at any age, and experts are urging anyone who missed having the vaccination to have it – especially anyone who is planning to travel to countries suffering measles outbreaks, such as Italy. They should also check that they have had their booster, which usually comes two years after the first MMR vaccination.
“The [current] cases of measles are often in older teens who didn’t have the MMR when they were babies because of the concerns in the press,” says Helen Bedford, professor of children’s health at University College London.
“You can completely understand why, 20 years ago, parents were concerned about the jabs.
“Now they think, ‘My child is too old to have it’, and never have it done.”
Today, the anti-vaccine movement remains small but vocal, with a strong presence on social media.
It was bolstered by the election of Donald Trump, who has shown support for the theory that vaccines cause autism. Andrew Wakefield, unable to practise in the UK, continues to promote his agenda in the US; he attended President Trump’s inaugural ball in 2017. In Texas, where Wakefield now lives, vaccination rates are reportedly falling.
In the era of fake news, Prof Finn says public health bodies must rethink how they communicate with the public.
“I hear people saying how destructive and awful the anti-vaccine movement is, but we are still putting leaflets into GP waiting rooms, while the rest of the world gets their information from social media. We’ve got to pull our socks up.”
Depressingly, experts warn that the consequences of Western paranoia about vaccinations will be felt most sharply in lower income countries, where malnutrition and poor healthcare mean the disease is much more likely to kill.
Only two years ago, Latin America declared measles eradicated, after a massive, decades-long campaign by the WHO. Now, it’s back: a virulent outbreak in Venezuela has already killed at least 70 children. Proof, if it were needed, that vaccination is an act for the greater good.
♦ Protect yourself and your family by learning more about Global Health Security telegraph.co.uk/global-healthsecurity