NHS ’clearly failing’ to ensure children get measles vaccine, experts warn | MMR
Children are at risk of measles because the NHS is “clearly failing” to ensure they receive the MMR vaccine and its system needs an urgent overhaul, MPs and health experts have warned.
Calls are growing for major reform to the way MMR vaccines are administered, as it has emerged that vaccination rates in some parts of England are now comparable to those in Afghanistan and Malawi.
Further measles outbreaks, such as the one currently gripping north London, are inevitable, public health experts say, given that in some areas fewer than 60% of five-year-olds have received the recommended two doses of MMR.
In Enfield, where 60 children recently contracted measles, 15 of whom were hospitalized, the MMR vaccination rate is just 64.3%. This rate is lower than the rate of 69.3% in Malawi and just above the rate of 62% in Afghanistan. The World Health Organization advises a rate of 95%.
The outbreak in Enfield has renewed public and medical concern about measles in unvaccinated children, which can damage the brain and lungs and in some cases lead to meningitis, blindness and even death. Five “catch-up clinics” have been set up in local community centers to vaccinate children who received one or no doses of MMR when it was offered to their parents.
NHS England has been accused of being “complacent” for its failure to stem a relentless decline over the past decade in the number of five-year-olds fully vaccinated, from 88.2% to 83.7%.
Ministers are under pressure to allow pharmacies to start giving MMR vaccines to infants so they can complement vaccination programs already being run by GP practices and schools.
In England, GP staff, mainly nurse practitioners, give the first and second dose of MMR to children aged 12 and 18 months. Schools also play a key role in hosting catch-up events where unvaccinated and under-vaccinated students can be covered.
Ben Coleman, Labor MP on the Commons health and social care select committee, said: “The long-term decline in MMR uptake and the growing number of very worrying measles outbreaks, such as the one in Enfield just now, show that this system is clearly failing.
“This means children risk being hospitalized and even dying from measles. Given that under-vaccination poses real risks to public health, it is time for the NHS to accept that GPs and schools alone do not appear to be able to provide the 95% coverage that the WHO rightly insists on. Pharmacies are a place that families visit often and they are wasted as a resource. We cannot afford the complacency.”
A child died of measles last summer at Alder Hey Children’s Hospital in Liverpool, amid a rise in cases in the city.
The Royal College of Paediatrics and Child Health, which represents children’s specialist doctors, said pharmacies should play a role in the vaccination rollout. Professor Steve Turner, its chairman, said the change would help “make it quicker and easier for parents and carers to get their children vaccinated”.
He said: “With appropriate training and support, enabling pharmacists to dispense MMR vaccines could be particularly helpful to families who have missed routine appointments or need to catch up on their children’s vaccinations. »
The National Pharmacy Association also supported this call. “The ten-year reduction in uptake of the MMR vaccine in children is a sign that the current system is simply not working and needs to be urgently reviewed by the NHS,” said Olivier Picard, president of the professional body. “We need to work across the whole health service to fulfill this vital public health role, not leave it to a small part of it. »
Helen Bedford, a vaccination expert and professor of child health at University College London, said pharmacies could help complement existing NHS efforts to ensure better uptake of MMR, especially as some schools – including some faith schools – do not take part in catch-up campaigns.
“This may be due to the interruption of studies or the fact that they do not consider it a priority. Or it may be a question of [their] opinions on vaccination in general,” she said.
Coleman said MPs on the health committee had sensed a “complacency” among NHS bosses over falling MMR uptake when they gave evidence last week about vaccination trends.
At the hearing, Dr Mary Ramsay, director of public health programs at the UK Health Security Agency, admitted when questioned by Coleman that opposition from GPs to pharmacies being paid to fulfill a role currently carried out by family doctors made this change difficult.
The MP asked: “Might GPs be annoyed if pharmacies could do this? Ramsey replied: “It’s an item. »
The Department of Health and Social Care (DHSC) has not said whether pharmacies could start dispensing MMR vaccines. Superdrug said it would start supplying MMR vaccines if asked.
Professor Andrew Pollard, director of the Oxford Vaccine Group at the University of Oxford, said of the Enfield outbreak that there was “a real risk of further spread both locally and to other parts of London”, since the virus could easily spread in communities where fewer than 95% of people were vaccinated, as is the case in many parts of London.
“When ‘enough’ people have been infected, the epidemic will subside, only to reappear later when more unvaccinated children are born and the number of susceptible people builds up again; there will be another explosive epidemic,” he said.
A DHSC spokesperson said: “It is vital that anyone not yet vaccinated against MMR does so as soon as possible. This ensures that not only are you protected, but also those around you.”
“To improve absorption and provide earlier protection against measles, starting in January, children can receive their second dose of MMR earlier. We have also introduced protection against chickenpox into the children’s program with the MMRV vaccine.
“Low vaccination rates are leaving communities vulnerable, and we are taking urgent action with our partners across London to boost MMR uptake and protect children’s health. »
