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Children are at risk of measles because the NHS is “clearly failing” to ensure they get the MMR vaccine and its system needs an urgent overhaul, MPs and health experts have warned.
Calls for major reform of how MMR jabs are delivered are growing as it emerged that vaccination rates in some parts of England are now on a par with those in Afghanistan and Malawi.
More outbreaks of measles like the ongoing one in north London are inevitable, given that fewer than 60% of five-year-olds in some places have had both the recommended doses of MMR, public health specialists believe.
In Enfield, where the outbreak has seen 60 children recently contract measles, of whom 15 have been hospitalised, the MMR vaccination rate is only 64.3%. That is lower than the 69.3% seen in Malawi and just above Afghanistan’s 62% rate. The World Health Organization advises a 95% rate.
The outbreak in Enfield has reignited public and medical anxiety about unvaccinated children getting measles, which can damage the brain and lungs, and in some cases lead to meningitis, blindness or even death. Five “catch-up clinics” have been set up in local community centres to vaccinate children who got either one or no doses of MMR when it was offered to their parents.
NHS England has been accused of displaying “complacency” for its failure to halt a relentless decline over the last decade in the number of five-year-old childrenwho are fully vaccinated, from 88.2% to 83.7%.
Ministers are under pressure to let pharmacies start administering MMR jabs to infants, so that they can supplement the immunisation programmes GP surgeries and schools already run.
In England GP staff, mainly practice nurses, deliver the first and second doses of MMR to children when they are 12 and 18 months old. Schools also play a key role by hosting catch-up events at which unvaccinated and under-vaccinated pupils can get covered.
“The long-term decline in uptake of MMR and growing number of very worrying measles outbreaks, like the one in Enfield just now, show that that system is clearly failing,” said Ben Coleman, a Labour MP on the Commons health and social care select committee.
“That means that children are at risk of hospitalisation and even of dying from measles. Given that under-vaccination poses real risks to public health, it’s time for the NHS to accept that GPs and schools on their own appear not to be able to provide the 95% coverage the WHO rightly insists on. Pharmacies are somewhere families often visit and they’re being wasted as a resource. We can’t afford complacency.”
A child died of measles last summer in Alder Hey children’s hospital in Liverpool amid an increase in cases in the city.
The Royal College of Paediatrics and Child Health, which represents specialist children’s doctors, also said pharmacies should be handed a role in vaccination rollout. Prof Steve Turner, its president, said the change would help “make it faster and easier for parents and guardians to get their children vaccinated”.
“With appropriate training and support, enabling pharmacists to deliver MMR vaccines could be particularly helpful for families who have missed routine appointments or need to catch up on their children’s vaccinations,” he said.
The National Pharmacy Association also backed the call. “The decade-long reduction in uptake of MMR vaccinations among children is a sign that the current system is simply not working and needs urgent reviewing by the NHS, said Olivier Picard, the trade body’s chair. “We need to work across the whole health service to perform this vital public health role, not leave it to one small part of it.”
The vaccination expert Helen Bedford, a professor of child health at University College London, said pharmacies could help supplement existing NHS efforts to ensure better MMR uptake, especially as some schools – including some faith schools – do not take part in catch-up campaigns.
“That may be because of disruption to studies or that they don’t see it as a priority. Or it may be about [their] views about vaccination generally,” she said.
Coleman said MPs on the health committee sensed “complacency” among NHS bosses over falling MMR take-up when they gave evidence last week about trends in vaccination.
At the hearing Dr Mary Ramsay, the UK Health Security Agency’s director of public health programmes, admitted under questioning by Coleman that opposition among GPs to pharmacies being paid to perform a role currently undertaken by family doctors made that change difficult.
The MP asked: “GPs might be annoyed if pharmacies can do it?”. Ramsey replied: “That is an element.”
The Department of Health and Social Care (DHSC) did not indicate if pharmacies might start delivering MMR jabs. Superdrug has said it would start providing MMR jabs if asked.
Prof Andrew Pollard, the director of the Oxford Vaccine Group at Oxford University, said there was “a real risk of further spread both locally and in other parts of London”, since the virus could easily spread in communities where less than 95% of people were vaccinated, as is the case in many parts of London.
“When ‘enough’ people have been infected the outbreak will die down, only to return again later when more unvaccinated children are born and the number who are susceptible has re-accumulated; there will be another explosive outbreak,” he said.
A spokesperson for the DHSC said: “It is vital for anyone not yet vaccinated against MMR to do so as soon as possible. Not only does this ensure that you are protected, but also those around you.
“To improve uptake and provide earlier protection against measles, from January children can have their second dose of MMR sooner. We’ve also introduced chickenpox protection into the childhood programme with the MMRV vaccine.
“Low vaccination rates leave communities vulnerable, and we are taking urgent action with partners across London to boost MMR uptake and safeguard children’s health.”
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