Danger zones with the lowest child jab rates in England
Are you living in a hot spot? Take-up of routine vaccinations is in decline while fatal diseases are on the rise, report Ben Farmer and Harriet Barber
Colin Powell knows only too well the damage that can be wrought by an unchecked childhood epidemic. Born in the East End soon after the war, he was only an infant when he caught polio. At the time there was no vaccine available and the disease paralysed thousands each year.
Mr Powell went into hospital at the age of six months and remained there for four years, spending his childhood undergoing operation after operation. “You miss bonding with your parents, your mother is just someone who comes to visit you on the ward,” he recalls.
In one 18-month spell, surgery left him encased in plaster from his forehead to his knees. At the age of eight, half of his ribcage was removed and repurposed to support his spine: “I have a totally reconstructed body.”
Mr Powell still suffers paralysis in both legs, has a curved spine and cannot breathe properly. His lungs only developed to a third of their size, so he needs a non-invasive ventilator for nine hours a night. “Polio is a life sentence,” he says.
Seventy years on, there is now concern it is a sentence that could again be served on children in the UK. The detection last month of a strain of polio at the Beckton sewage works in Newham may mean the virus is circulating in parts of London. Moreover, analysis of the latest figures for vaccination rates show they remain stubbornly well below targets in many London postcodes.
The miracle of poliovirus vaccines consigned Britain’s polio wards to history. The last case of paralysis in Britain was in 1984 and old photographs of rows of iron lung machines are unfathomable to most people today.
Childhood jabs have also meant a respite from outbreaks of other childhood diseases, such as measles and meningitis. Yet while the overall take-up for different childhood jabs is high, it has slipped slightly in recent years. Already, the UK has lost its hard-won measles-free status, after the World Health Organisation warned of rising cases in 2019.
Seemingly healthy national figures hide a patchwork of local rates. Some local authorities are well below targets, leaving large numbers of unprotected children who could form a vulnerable pool, creating the conditions for disease to spread.
The latest NHS figures show that many of the areas furthest from hitting the targets are in London, and not far from where Mr Powell contracted polio as a boy.
The World Health Organisation recommends at least 95 per cent of children are immunised against vaccine-preventable diseases.
Overall, by the age of five, 94.5 per cent of children in England received the combined jab given to babies to protect against polio and other diseases such as meningitis. In Kensington and Chelsea that figure is just 86 per cent and in Peterborough it’s 87 per cent.
Data for the booster for polio and other diseases, offered at the age of three, show that just 55 per cent of five year olds have received it in Hackney, 68 per cent in Wandsworth, and 70 per cent in Hammersmith and Fulham and Kensington and Chelsea.
The figures for five-year-olds who have had two doses of vaccine to protect against measles, mumps and rubella are lower still. While in England the rate is 86 per cent, Hackney is again the worst local authority in the country, at 57 per cent, followed by Haringey and Camden both with 66 per cent, Islington with 67 per cent and Enfield with 68 per cent.
In February, the UK Health Security Agency (UKHSA) warned that around one in 10 children starting school were at risk of measles, as vaccination rates dropped to the lowest level for a decade.
Shamez Ladhani, a paediatric infectious diseases specialist who tracks vaccine-preventable diseases for UKHSA, says: “There has been a very small, steady decline in vaccine uptake across the country over the last decade – but it’s difficult to pinpoint why that is.”
Across the world, the rise of anti-vaxx movements has troubled public health experts. Suspicion and conspiracy theories have hit vaccination programmes in places from the West Coast of America to the tribal borderlands of Pakistan.
“Rumours and mis- or disinformation certainly have an effect,” says Joe Swan, a World Health Organisation polio communications officer. “Particularly with the strong focus on and damaging narratives around vaccination that we’ve seen over the past few years.”
But public health experts in the UK doubt that such hesitancy is significantly affecting take-up rates in parts of Britain.
“Generally speaking, outside of Covid, the UK doesn’t have an anti-vaxx problem or movement,” explains Dr Ladhani. “There isn’t any indication that [Covid anti-vaccine sentiment] is filtering into routine immunisations.”
Instead low rates are thought to be caused by a mix of factors affecting mainly urban areas.
“It has always been the case that uptake is lower in England than across the UK, and lower still in London. This has been the picture since way, way back,” says Dr David Elliman, a consultant paediatrician at Great Ormond Street Hospital.
One of the biggest problems is mobility, with a population often moving again and again for work and failing to register with a GP as they shift around. Recent immigrants, who do not speak English as their first language, can be difficult to reach.
“In addition to a lot of mobility, some of that is people coming from other countries, who may not be vaccinated back home,” says Professor Helen Bedford, a children’s health expert at University College London. “They don’t always get into the health system, or don’t know where to get vaccinated, or that they need to be vaccinated.”
Declining numbers of GPs and health visitors are also having an effect on how many people can get inoculations, she believes. Parts of London have some of the most acute shortages of GPs in the country. Disruption to the health service from lockdowns has not helped.
Mr Powell says the detection of the scourge which robbed him of his childhood has highlighted a “major issue” of lethargy around vaccination.
Epidemiologists are now hunting the Beckton poliovirus strain to see if they can narrow down exactly where it has come from. At the same time, health teams are trying to urgently improve vaccination rates and increase monitoring of the virus. But there is no silver bullet, warn doctors.
“Tackling vaccine uptake is not new – we’ve been trying to tackle this for 50 years since vaccines were introduced,” says Dr Ladhani. “There’s not a new magical formula that will solve this - we need long-term engagement, targeted messaging and education.”