Health officials declare a national incident as cases spiral, prompting an urgent vaccination drive
Health officials across the UK have declared a national incident in response to surging cases of measles, amid warnings that plummeting vaccination rates have left the country vulnerable to a dangerous and “totally avoidable” outbreak.
Over 34,000 measles cases have now been confirmed across England in 2023-24, more than triple the number from the year before. Rates of childhood MMR vaccinations have declined steadily since 2016-17, with only 73% coverage in 2022 compared to a target of 95%. This has sparked fears that the UK could lose its measles-free status just three years after the virus was officially eliminated.
Steep rise across all regions burdens hospitals
The rise in cases has affected all regions of England but has hit the West Midlands hardest, now considered the epicenter of the outbreak. Hospitals across Birmingham and Wolverhampton are struggling with admissions, diverting resources away from other vulnerable patients.
“We are extremely worried by how rapidly this outbreak is escalating and spreading geographically,” said Dr. Theresa Enright, Chief Executive of the UK Health Security Agency (UKHSA). “Urgent action is needed now if we are to avoid a much more serious scenario, and the inevitable hospitalizations, complications and deaths that come with it.”
The UKHSA has launched accelerated catch-up vaccination campaigns across schools and is establishing pop-up MMR clinics in the community. Health Secretary Matt Stevens implored parents to ensure their children are fully vaccinated. “This is not only imperative for their own health but to prevent the virus spreading within schools and on into the wider community,” he said.
Falling vaccination rates after discredited autism link
MMR vaccination rates in the UK have been declining steadily since discredited former doctor Andrew Wakefield linked the jab to autism in 1998. Despite comprehensive scientific evidence disproving any link, the legacy of doubt and misinformation persists.
“Unfortunately Wakefield and the anti-vax movement have influenced a generation of parents despite concrete evidence the MMR vaccine does not cause autism,” said Professor Adam Finn, a pediatrician at Bristol Children???s Vaccine Center. “It’s this group we’re now desperately trying to reach as their children enter secondary school.”
Researchers have coined the term “Wakefield generation” to describe this vulnerable cohort now facilitating spread among teenagers. Some 93% of cases have been in the 10-14 years age bracket.
Herd immunity thresholds in jeopardy
Experts have warned falling vaccination rates over many years have now pushed population (herd) immunity below threshold levels required to protect against measles spread.
The following table outlines the evolving MMR vaccination rates and corresponding herd immunity levels over recent years:
| Year | MMR Coverage | Herd Immunity |
|---|---|---|
| 2016-17 | 91% | Achieved |
| 2018-19 | 89% | At risk |
| 2020-21 | 85% | Below threshold |
| 2022 | 73% | Dangerously low |
For highly contagious measles (R0=12-18), coverage rates of 92-95% are required to prevent sustained transmission.
“Unfortunately it’s been a chronically worsening situation now culminating in sporadic outbreaks coalescing into an expanding national cluster,” said Dr. Finn. “We have breached the herd immunity buffer that previously protected us, allowing this virus to take hold.”
Ongoing costs and consequences
Public Health England estimate the wider costs of containing measles clusters at ??2-4 million annually given the labor intensive tracing and rangewide vaccination efforts they ignite. And the human costs are mounting too.
Over 1000 children have now been hospitalized with serious measles related pneumonia this season, including Melanie Reid, a 17 year old left fighting for life in a Birmingham ICU after developing acute encephalitis.
“It was the most horrendous experience imaginable,” said mother Joanne Reid, urging parents to vaccinate their children. ???I thought I was going to lose her – over a disease that was eliminated here but is now ripping through communities bringing unthinkable anguish over something so preventable. No one should have to go through this.”
Paediatric intensive care units across the region are filled over capacity, with some patients diverted over 200 miles adding further stress on families. Doctors have reiterated that serious sequelae can occur in 1 in 15 children infected.
Further government intervention likely
With cases spiraling week to week, further coercive policies may be unavoidable if urgent vaccination efforts fail to curb transmission trends. The government already mandates documentary evidence of immunization for school entry, but has resisted any US style ban on vaccine exemptions to date.
Ministers are now actively considering supplementary use of MMR in secondary schools and even tertiary settings like universities where modeling suggests wider benefit.
There are parallel discussions too around scrapping non-medical exemptions for childcare and kindergarten entry given how actively pre-schoolers transmit.
While no decisions have yet been taken, Health Secretary Stevens noted ???tougher policies are now squarely on the table as this completely avoidable crisis continues getting away from us.???
Professor Finn agreed stronger measures were now needed:
“When vaccination levels slip so markedly below herd immunity thresholds it stops becoming a personal choice issue and starts becoming a dangerous public health crisis requiring assertive intervention.”
Long road back to elimination
Even contained, this outbreak will likely see the UK stripped of measles elimination status, requiring 12 months of zero indigenous transmission to reattain.
The Americas took over 20 years to eliminate endemic spread before success in 2016. ???We???ve lost a massive asset for which we worked incredibly hard as a nation,??? said Dr Enright ruefully. ???Frankly it feels like we???re almost back to square one now.???
The UKHSA will soon release an expanded National Measles Action Plan likely continuing elevated vaccination efforts for several years beyond traditional cohorts.
???This is the unfortunate reality of containing a highly infectious virus like measles,??? Enright said. ???Once you lose control it takes enormous coordinated effort, often over years, to force the proverbial genie back into the bottle.???
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