Is London’s latest measles outbreak containable?

0:05Dr Helen Bedford: Since January, there have been close to 100 cases of measles reported in North London. The UK achieved measles elimination just under 10 years ago. How did we get here and how serious is the epidemic? Hi and welcome back to the Standard Podcast. I'm Tamara Kormornick. For all the latest news, head to standard.co.uk. Coming up. Is London's latest measles outbreak containable?

0:38Dr Helen Bedford: Over the past week, one in five children with measles in Enfield have been hospitalised. The virus is more contagious than Covid, and one case can cause between 12 and 18 infections. So why have MMR vaccine levels dropped below 70 % in some pockets of London? In today's episode, I'm joined by Helen Bedford, Professor of Children's Health at UCL Great Ormond Street Institute of Child Health, who specialises in child immunisation and advises the all-party parliamentary group on vaccination. But first, I'm joined by Neva Yadav, the Standards Trainee Journalist, who has spoken to parents and GPs in Enfield, one of the measles outbreak zones.

1:26Dr Helen Bedford: Hi Neva, thanks so much for jumping on. Thanks for having me. So as part of the standards coverage on the measles outbreak in London, you visited Enfield to speak to some parents. Can you take us through some of the reactions that parents have had to the outbreak? So yeah, like you said, I was in Enfield and understandably, a lot of parents are nervous and anxious. There definitely were two camps. You have parents who are pro-vaccine and there were some parents who are also anti-vaccine. But I think it's a misconception to say that this anti-vaxxer group is particularly significant. I actually think the biggest barrier to immunisation from speaking with parents is more of a practicality thing.

2:09Dr Helen Bedford: London's really busy. People are busy. Scheduling vaccines might not be everyone's priority. I think another aspect of this is kind of hard to reach communities. We've heard that a lot, that there are some people who maybe aren't aware that they need to be vaccinating their children. and people who, whether that's through kind of a language barrier or cultural barriers, and these are people who we need to start engaging with and launching more outreach into understanding why people might not be getting vaccinated. And so I think whilst we can talk about anti-vaxxers being a part of the problem, actually a lack of knowledge and a lack of understanding is quite a big part, I think.

2:51Dr Helen Bedford: And did you get the sense that parents were worried about the outbreak? Yeah, for sure. I think parents definitely were worried. But if it's not happening at your school or in your school, I mean, you're speaking to a generation who have survived COVID. And so this kind of feels a bit like a repeat in many ways. And until it's happening on your doorstep, it doesn't quite feel real. And so I think that's also a big part. Neva, from the parents you were chatting to, had their kids been vaccinated? Yes, the majority of parents I spoke to, their children were vaccinated. And interestingly, they were surprised that it wasn't compulsory or that not everyone was.

3:33Dr Helen Bedford: One of the parents I spoke to was from Poland where vaccination is compulsory. And so she was surprised that it's not here in the UK. of course from speaking to anti-vaxxers and people who are against vaccination we also know that a lot of people believe it's their right to be able to choose and COVID in particular and the COVID-19 vaccine has made a lot of parents lose trust in government advice and also in vaccinations we saw there were some slightly kind of iffy side effects and so people definitely are more cautious about vaccination than they were. But the GPs I spoke to on the flip side have said it's completely safe.

4:15Dr Helen Bedford: The MMR vaccine has been around for a really long time. It's tried and tested. We know it works. Well, thank you so much, Niva, for your insights. It's been very interesting. Thank you so much for having me.

4:32Dr Helen Bedford: After my conversation with Niva, I had to have a chat with Helen Bedford and ask her how we got here and how we can contain this outbreak.

4:42Dr Helen Bedford: So Helen, as of last week, there were almost 90 confirmed cases of measles in London. At one point, measles were actually eliminated from the UK. Why are they back?

4:56Tamara Kormornick: Quite simply because vaccination levels in some parts of the country are too low to keep the disease away.

5:03Dr Helen Bedford: So let's just talk about the disease for a moment. What are the symptoms? How is it spread? And what are the health risks if you contract measles?

5:14Tamara Kormornick: Measles is caused by a virus and it's considered to be one of the most highly infectious diseases around. So it spreads really, really quickly. The early symptoms look very much like a cold. So children get runny noses, sore eyes. They often have a cough, but they can also have quite a high fever, which makes them feel very unwell. And then there is a classic rash, which starts usually on the face, the hairline or behind the ears, and travels down the body. So just an uncomplicated attack of measles can make children feel really unwell. But there are lots of complications as well, things like ear infections, pneumonia, less commonly inflammation of the brain.

6:01Tamara Kormornick: So it's a nasty infection.

6:05Dr Helen Bedford: And let's talk for a minute about the MMR vaccine that's measles, mumps, rubella. How effective is the vaccine and what are the risks of taking it?

6:17Tamara Kormornick: Well, the vaccine is highly effective. It's recommended that children have two doses, which is what is needed for best protection. So with the first dose of a vaccine containing measles, it probably gives about 94, 95 % protection. And then the second dose brings that protection up to about 97%. And we really need to have high levels of vaccine uptake to keep the disease away. It's called herd immunity, or I prefer community immunity. Since the 1st of January, it's quite important to mention that the vaccine that is being offered to young children also contains chickenpox vaccine. So it's now MMRV that's being offered to young children in this country.

7:06Dr Helen Bedford: So we're seeing vaccination rates for the first MMR dose in some London boroughs drop below 70%. Helen, what do you think the main drivers are behind the decline? Do you think it's a case of vaccine fatigue post-COVID? I think it's a combination of many things. We know the reasons that some children aren't vaccinated might be because parents have difficulty making appointments with a GP or taking time off work to take their children for the appointments.

7:42Tamara Kormornick: But there are also lots of parents have questions and concerns about vaccination and quite rightly, We know that the NHS and particularly health visitors in general practice are under a lot of pressure. There aren't enough of them, basically. And this means it can be difficult for parents sometimes to find answers to their questions. When you've got a question, it's not unnatural to go and look on the Internet or on social media where we know that there is an awful lot of misinformation around. And it's important to remember that not vaccinating is a decision just as much as vaccinating. And that leaves children unprotected and obviously at risk of infection.

8:28Dr Helen Bedford: We'll take a quick break. Coming up, I ask Helen about the biggest barriers to vaccination among marginalised communities, whether she thinks excluding unvaccinated children from school is a good idea, and if the latest figures should have us panicking.

8:54Dr Helen Bedford: Welcome back. Let's head straight back to my chat with Helen.

9:00Dr Helen Bedford: Helen, you've done extensive work on inequalities in vaccine uptake throughout your career, including among marginalised communities. What do you think the biggest barrier is to a high uptake of vaccination?

9:18Tamara Kormornick: So in London there is a very very mobile population very diverse lots of different communities who may access NHS services in different ways or not know how to access the services, but it's that kind of mobility of the population. There's a big churn. So families move into London districts and then move off quite quickly, maybe into another district in London or outside London. And those things make it very difficult for people often to complete vaccination for their children, or they may be sort of lost to the system because they've moved off. But we also know that obviously parents' views about vaccination are very important too.

10:02Tamara Kormornick: And one of the things about vaccination is it is absolutely brilliant. It's literally saved millions and millions of lives. But the problem is because basically we have a successful vaccination programme in this country, people don't see the diseases anymore. and then people start thinking oh well you know measles isn't around I don't need to get my child vaccinated but as we're seeing when people do stop vaccinating their children the diseases come back because they're not gone completely they're out there somewhere.

10:37Dr Helen Bedford: It's almost like there's a kind of collective amnesia as to how bad these outbreaks can really get.

10:42Tamara Kormornick: Yeah well I think it's not surprising. I mean, I'm of an age when I had measles because I was young. The vaccine wasn't even around when I was young. I can remember how ill I felt at the age of about five with a measles attack. But my own children, the worst, the most severe illness they got was chickenpox. And for a lot of younger parents, there is just no experience of what it's like looking after a sick child because we can prevent so many diseases, which is fantastic. But people's kind of collective memory about how sick children can become has been reduced, which is good in some ways, but it does make people not see the importance of vaccination quite so much.

11:28Dr Helen Bedford: My dad actually had the whooping cough and you can still hear it in his cough. So, you know, the legacy of these diseases really, you know, it does live on.

11:39Tamara Kormornick: Oh, absolutely. Absolutely. I mean, some people do have, sadly, complications from these diseases that will be with them for the rest of their lives.

11:55Dr Helen Bedford: So, Helen, some schools are now saying they might exclude unvaccinated children for up to 21 days if they've been exposed. You've advised the National Institute for Health and Care Excellence on vaccine uptake. Do you think this is the right course of action? And what would your advice be to ministers today to control the outbreak?

12:21Tamara Kormornick: So it's just a question of putting a lot of effort into contacting parents, reminding them that vaccination is required and putting on vaccination clinics at times and places that are convenient to families and children. When children start school or nursery, this is a good opportunity to check their immunisation status. One of the kind of slight limitations of excluding children from school if they're exposed is that schools don't always have good records of children's vaccination status. So this, you know, this might actually be quite difficult to do in practice. And obviously, we don't really want children being off school for three weeks with all the ramifications around that.

13:08Tamara Kormornick: And meaning that parents, working parents have to take time off to look after them. So it's quite an extreme response when all we need is for children to be vaccinated.

13:21Dr Helen Bedford: And my colleague, Niva Yadav, did some reporting in Enfield on this. She spoke to some parents, and some of them were quite surprised that the vaccinations are not compulsory in this country. Do you think they should be?

13:39Tamara Kormornick: Personally, I don't. I think that we should be doing the things we know improve uptake, such as, you know, reminding parents, communicating with them, giving them opportunities to ask questions about vaccination, and then making sure that vaccination services are accessible. So lots of clinics available at times. We should be doing all those things first, I think, before we start bringing in any kind of compulsional mandation. And one of the problems with having mandation, requiring children to be vaccinated, which does happen in very, very many countries, actually, is that you may actually make more people reluctant to be vaccinated.

14:28Tamara Kormornick: If people are a little bit hesitant and don't know what to do, and then you're saying, OK, you've got to do this. You've got no choice. It might actually make people a little bit dig their heels in a bit harder. so it would have to be done very very carefully and I think only when we get to a point where we just need to increase vaccination by a few percentage to reach the target levels rather than where we are now.

14:54Dr Helen Bedford: And Helen finally the UK HSA assessment has found the risk of a measles epidemic in the UK was considered low. This is from Vegas last month. Do you think we are at risk of measles becoming a part of life here again in the UK? Is this endemic reversible or should we be sounding the alarm bells at this point?

15:22Tamara Kormornick: Well, I mean, the way to stop it is vaccination. It's as simple as that to improve our vaccination levels. And there are many parts of the country where vaccine uptake is very, very high. But it's just that when we're thinking about cities, particularly cities like London, and also there's a lot of cases in Birmingham, these are complex cities with diverse populations, very mobile populations. And we really have to think very, very hard about how we make sure that parents are aware of vaccination and have ready access to it.

16:02Dr Helen Bedford: Well, thank you so much, Helen, for your time and expertise and for coming on The Standard Podcast today.

16:08Tamara Kormornick: OK, pleasure. Nice to see you.

16:14Dr Helen Bedford: And that's The Standard. For all the latest news, head to standard.co.uk. If you're new here, hit follow and give us a rating. if you'd like to get in touch email us at podcasts at standard.co.uk we'll be back here tomorrow morning see you then