'If measles cases are such a concern why can’t I get a vaccination for my child?'

As health officials urge parents to give their children the MMR vaccine, Hannah Fearn is worried because her daughter still hasn’t had the second jab.

Only 85% of children start school with two doses of MMR vaccine, whereas a rate of 95% is needed for herd immunity for measles. (Alamy Live News)
Only 85% of children start school with two doses of MMR vaccine, whereas a rate of 95% is needed for herd immunity for measles. (Alamy Live News)

Measles is on the rise across the UK, with dangerous outbreaks in areas of the Midlands and fears it could spread.

In the past few weeks, the UK has launched a campaign to encourage parents to get the measles, mumps and rubella (MMR) vaccine for their children while World Health Organisation (WHO) issued a fresh warning over measles after an almost 45-fold rise in cases across Europe.

Writer Hannah Fearn is worried because her daughter still hasn’t had the second jab. So why are so many children still unvaccinated? She takes a look at the data to find out.

What’s happening? Doctors and public health experts have warned that an outbreak of measles could spread across the UK, causing severe illness and long term disability, because the take up of the MMR vaccine is now at record lows since its introduction. Cases of the disease doubled in the UK in 2023.

Why the worry? Protection against the disease requires two MMR jabs. My own three-year-old daughter has, at the time of writing, only had one jab around the time she turned one. I’ve spent the last year booking appointments for her to have the second vaccination, with around six bookings being cancelled - many by our GP clinic due to staff absence, and some by me due to her being unwell on the morning of the appointment.

How many other children aren't vaccinated? NHS figures show that 3.4 million children under the age of 16 still do not have both jabs, meaning they are either not vaccinated or only partially vaccinated. Data for July to September 2021 reported 88.6% uptake of the first dose at age two years, with 85.5% given two doses by age five. Vaccination rates have improved slightly since then, but are still below expected rates.

That’s still the majority, so why is it a problem? If vaccination rates drop below 95%, herd immunity fails and a serious outbreak becomes very likely. In 2017 the World Health Organization declared that England was free of measles, but that status has now been lost.

But appointments are being cancelled? Most likely. Staff absence rates are high, particularly due to stress and depression. But NHS data on vaccination rates doesn’t distinguish between parents who have refused the vaccine and those who have been unable to get an appointment or have had it delayed by their local clinic.

Which areas have the biggest unvaccinated population? After briefly achieving endemic measles elimination in 2016 and 2017, by 2018 measles virus transmission had re-established in the UK, at a time when the whole of Europe was experiencing large epidemics.

In recent years, the lowest uptake has been in the capital. In some areas of east London half of children do not have full MMR vaccination. Doctors are also particularly concerned about the West Midlands, where more than 300 cases of measles were reported in the last three months leading to the UK Health Security Agency to declare a national incident. Take-up in this area is higher than London, but is dropping the fastest along with the North West.

Why are parents declining the jab? The British Medical Journal reports that since the COVID-19 pandemic populations are suffering “vaccine fatigue”. Concerns about the coronavirus vaccine programme also fuelled aggressive anti-vaccination sentiment worldwide. Lockdown may have played a part too: parents who had babies during the pandemic were told to “stay at home” and may not have realised that routine vaccination services were still available throughout the pandemic.

What about the autism scare? In the 1990s, discredited research by Andrew Wakefield linked the MMR vaccine to cases of autism leading to a downturn in vaccination take up for babies and children. But rates had improved again after that research was thoroughly debunked.

So why are vaccine rates still too low? It's certainly complicated. According to the Nuffield Trust, vaccination uptake is lower in some groups such as those from minority ethnic backgrounds (one of the two types of MMR jabs, for example, contains porcine gelatine which may put off some people, even though another - called Priorix - doesn’t). Vaccination hesitancy and misinformation continue to play a role, too.

But parents have not been helped by the reduced number of health visitors, who are responsible for monitoring their child’s growth and development until school age - such as reminding them about vaccinations and other routine check-ups. According to the Liberal Democrats, their numbers in England have been cut in the last four years from 6,931 to 5,473.

Can anything be done to fix it? Some doctors and policy- makers are now calling on the government to make vaccination mandatory for access to state schools, however this would require a big shift in attitudes as the UK has always committed to a voluntary vaccination programme. Other options include making vaccination easier to access by allowing high street chemists and other community centres to offer vaccination services.