Resurgence of Measles in England Highlights Need for Improved Vaccine Access and Addressing Hesitancy, Health Experts Warn
Measles, a highly contagious respiratory illness commonly found in children, is making a comeback in England, raising concerns among health experts about the need for improved access to childhood vaccines and addressing vaccine hesitancy. The Covid-19 pandemic has exacerbated existing challenges in immunization efforts and fueled suspicion about the risks of vaccinations in some communities.
The World Health Organization has reported a rise in measles cases across Europe, but the situation in Britain has its own unique characteristics that have sparked a debate about the strain on health services due to underfunding. This issue is part of a larger battle in Europe to increase vaccination rates for dangerous childhood diseases, with anti-establishment figures and political movements contributing to vaccine hesitancy in some countries.
“These infections come back if you don’t keep the firewall up,” warns Heidi Larson, professor at the London School of Hygiene and Tropical Medicine and founder of the Vaccine Confidence Project. “Other diseases won’t show as quickly as measles. But they will come if we don’t get ahead of this.”
According to the UK Health Security Agency, suspected measles cases in England and Wales have more than doubled for two consecutive years, reaching 1,603 cases in 2023. Nearly 60% of these cases were in children under 10, with hotspots in London, the West Midlands, and Yorkshire and the Humber. Birmingham alone recorded around 250 confirmed or probable cases between October 1 and January 18.
Measles is a serious viral disease that can cause brain damage and even death. Prior to the introduction of the measles, mumps, and rubella (MMR) vaccine in the UK, there were over 460,000 suspected measles cases and 99 fatalities in 1967, according to Oxford University’s vaccine knowledge project.
However, immunization rates in the UK have fallen in the past decade and are far below the target of 95% coverage in children by the age of five. Official figures show that only 86.5% of children received the recommended two doses of the MMR vaccine in 2021-22, which can be attributed in part to difficulties in scheduling vaccination appointments during the pandemic.
The main reason for the decline in vaccination rates is believed to be the logistical challenges faced by families in getting their children vaccinated. Helen Bedford, professor of children’s health at University College London, suggests that this particularly affects poorer families who struggle to take time off work or secure appointments at overburdened health facilities. Additionally, certain ethnic minority groups are less likely to vaccinate their children.
To address these challenges, experts recommend bringing vaccination services into the heart of communities. Mobile vaccination centers, such as the “spotty bus” that visited car parks, supermarkets, and school playgrounds in Hackney, have proven successful in reaching underserved populations. “We need to be thinking more about taking vaccination to the people, rather than expecting them always to come to us,” says Bedford.
In addition to improving access, authorities must also combat vaccine hesitancy. The discredited allegations made by British doctor Andrew Wakefield in 1998 linking the MMR vaccine to autism had a significant impact on vaccine rates. The Covid-19 pandemic has further fueled hesitancy, with social media spreading both real and false information about vaccine side effects.
According to data from the Vaccine Confidence Project, public confidence in vaccines has declined significantly in the UK. In 2018, 90% of people believed vaccines were safe, effective, and important for children. By 2023, these figures had dropped by about 20 percentage points.
To address vaccine hesitancy, it is crucial to involve locally respected figures who can deliver messages about the importance of vaccination in low-coverage areas. Ronny Cheung, a consultant pediatrician at Evelina Children’s Hospital in London, emphasizes the need to target people through their own trusted sources and community members to reduce hesitancy. Cheung welcomes the vaccination strategy published by NHS England but believes that the two-year implementation period is too long and more resources will be needed.
The UK’s measles outbreak is part of a larger trend in Europe, with the WHO reporting a 30-fold increase in measles cases in the region between December 2022 and November 2023. Countries such as Kazakhstan, Russia, Kyrgyzstan, Turkey, and Azerbaijan have been heavily affected, with the UK ranking tenth in terms of infections per population. Hans Henri P Kluge, WHO Europe regional director, commends the UK’s efforts to monitor the resurgence of measles and identify areas with low vaccination rates.
Addressing vaccine hesitancy and improving access to vaccines are crucial steps in preventing the further spread of measles and other preventable diseases. Public health authorities must ensure equitable access to vaccination services and address challenges specific to each community to improve vaccine uptake, particularly in vulnerable and
