At 7pm on Boxing Day evening, Keith* found himself sitting in the waiting room at Birmingham Children’s Hospital, his head spinning as he digested the news.
His twelve-week-old daughter had just been rushed into intensive care, having contracted measles over the Christmas period, and ashen-faced paediatric consultants had just informed him that she might not survive.
“They took me outside to say, ‘Look this is not good. She’s really in a bad way. We’re going to do everything we can, but you need to prepare yourself for the worst’.”
The baby girl had gone into cardiac arrest and was being kept alive on a ventilator. As he watched his baby daughter fighting for her life, Keith’s emotions turned to anger at his partner, a committed antivaxxer. Just 24 hours earlier, Keith had been shocked to discover that their older daughter, aged five, had not received the routine measles, mumps and rubella vaccine (MMR) which protects against measles infection. The vaccine is typically administered on the NHS in two doses, initially when children are one and then again at three years and four months – so their baby was also unvaccinated.
While Keith was aware of his partner’s views on vaccines, he still assumed that his children had been receiving all the necessary childhood jabs, while in reality they had received none of them. When their five-year-old fell ill with an apparently viral infection in late December, he simply assumed it was a bad cold.
Then just before Christmas, their three-month-old came down with a similar infection. She had a high temperature, and when they took her to hospital, consultants noticed a developing rash. “They asked, ‘Can we just confirm that everyone in the house has been vaccinated against measles?’ and at that point I found out that our five-year-old hadn’t,” remembers Keith. “My partner and I ended up having a bit of a domestic, to put it mildly.”
While both daughters ultimately survived, their baby spent five days on life support, and Keith is still concerned about the potential long-term side effects of the infection.
“I’ll be traumatised for the rest of my life, by the image of her being kept alive by a machine,” he says. “She seems to have recovered well and there doesn’t seem to be any acute issues, but there’s obviously medium- and longer-term consequences of a measles infection.”
Only six years ago, the World Health Organisation declared that the UK had eradicated measles. Now, the highly infectious disease is back, with doctors warning of the biggest outbreak in England since the 1990s. In Birmingham and the West Midlands, measles cases have risen by 30 per cent in the last week.
According to health officials in the area, the outbreak has been steadily brewing since the early autumn.
“It was really from early October until the new year where it was quite clear that we were starting to get rising cases,” says Ruth Tennant, director of public health in Solihull. “With measles, if you get one case and you’ve got unvaccinated children around that case, you can then get small clusters. So that’s what we started to see both nationally and within the region.”
While she says that the outbreak is still relatively controlled, steps have been taken to prevent it from escalating further. In particular, any unvaccinated children in schools in the West Midlands are now being required to isolate for up to three weeks.
Public health experts, including Ms Tennant, have attributed the return of measles directly to the problem of rising vaccine hesitancy, particularly against the MMR vaccine.
While the West Midlands is not the only hotspot, with rising cases also being seen in London, it has previously been identified as an area of problematic vaccine hesitancy. As the coronavirus vaccines began to be rolled out, Birmingham lagged behind the national average for uptake, something which was blamed on widespread misinformation and mistrust. The area has a diverse population, and some studies have shown that ethnic minority groups are more likely to be vaccine hesitant.
Having the two MMR doses is 99 per cent effective at preventing measles infection, making the jab one of the most effective vaccines available to doctors, but research shows that parents are increasingly choosing to shun it.
The most recent available data in 2022-23 indicates that 84.5 per cent of five-year-olds in the UK had received both MMR doses – the lowest proportion since 2010-11, and some way below the 95 per cent figure which is needed to stop measles spreading completely.
Dr Sarah Pitt, a microbiologist and infectious diseases expert at the University of Brighton, says that very high vaccination rates are needed to stop measles in its tracks because the virus is extremely infectious. “On average, somebody with measles will infect 15 other people,” she says. “In comparison, the Omicron variant of Covid will infect between five and nine. It’s very frustrating, because the world nearly got measles under control, before anti-vaccine views started to become a bit of an issue. So seeing these cases is extremely worrying.”
Before his daughters contracted measles, Keith admits he assumed that the infection was relatively benign and somewhat akin to chicken pox. However, it is far more serious than many realise. For every 10,000 children infected, 500 develop pneumonia, 2,000 require hospitalisation and between 10 and 30 will die from respiratory or neurological complications. When it doesn’t kill, measles can leave children with lifelong speech or hearing problems.
“The main reason why we started vaccinating against measles was to prevent the development of long-term brain complications which are similar to meningitis, as well as other short-term complications,” says Dr Pitt. She says children from low-income families are particularly vulnerable as they are less likely to have received optimal nutrition in their first years of life.
Opposition to the MMR vaccine has existed since the late 1990s, when the controversial doctor Andrew Wakefield made now-debunked claims that it was associated with autism. Experts have also argued that elimination of the disease in large regions of the world has caused many to become dangerously complacent about the need for immunisation.
There is widespread agreement that the Covid-19 pandemic fuelled the problem.
“I think people got out of the habit of going for routine vaccinations during the pandemic, and I suspect many are now slightly unsure about how easy it is to get an appointment, and they’re not used to engaging with routine health checks in the same way,” says Dr Pitt.
Conspiracy theories surrounding the Covid-19 jab, popularised on social media, have also fuelled vaccine hesitancy.
Ms Tennant says that the current outbreak has reinforced the need for better public engagement across the West Midlands, and suggests that people have forgotten how serious a measles infection can be. She says that her team are working with schools, nurseries, faith leaders and other leading community voices in the region to reinforce the importance of the MMR jab.
“In some communities, there might be a whole range of factors why they haven’t had the MMR vaccine,” she says. “For example, sometimes people need reassurance that there are porcine-free vaccines and for the Muslim community, that’s an important message. So it’s important to have that conveyed from a range of trusted voices, not just NHS or public health experts.”
With anti-vaccine sentiment rising around the world, some countries have resorted to even more extreme measures. In Australia, unvaccinated children are unable to attend primary school, while in Italy, parents can receive fines of up to €7,500 if they don’t comply with national vaccine requirements for their offspring.
However, experts are undecided whether it is necessary to take such steps in the UK. Dr Michael Head, an infectious diseases scientist at the University of Southampton, says he would prefer to focus on engaging families, unless vaccination rates continue to fall drastically.
“I’m not a big fan of excluding children from school, although if you’ve got large proportions of your population unprotected, it is a possible solution,” he says. “On the whole, my preference is education, advocacy, and awareness. I think most of the people with unvaccinated children aren’t anti-vax, they’re probably more vaccine hesitant where they haven’t thought it worthwhile or got around to it.”
Researchers like Dr Head are keen to remind the public that anyone can get two doses of the vaccine, if they haven’t received it as an infant. Early symptoms of a measles infection are runny nose, sneezing, sore and swollen eyes, a persistent fever, and loss of appetite, followed by the appearance of a tell-tale rash within a face days, starting on the face and behind the ears, before spreading to the rest of the body.
Having experienced first-hand how severe measles can be, Keith says that he is now determined to do what he can to spread the message about the importance of vaccination, despite his partner’s misgivings.
“Her family still believe that getting measles or not is down to luck as opposed to the vaccine,” he says. “It’s insane, but there’s so much misinformation out there online. The doctors and nurses at Birmingham Children’s Hospital are incredible but you can see the frustration on their faces. They’re swamped as it is, and now they’re having to deal with a disease that they shouldn’t have to, because there’s a vaccine which protects kids.”
*Name changed on request
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