We must put everything in place to catch up now to limit serious outbreaks across the UK, and I am not referring to COVID-19 this time but measles. Of course, we must still do everything we can to limit the spread of COVID-19 and make sure that children who are eligible get their vaccines but at the same time we must ensure that the recent drop in routine childhood immunisations uptake, due to some extent to the pandemic, does not lead to a major outbreak.
Measles is highly infectious and a high immunisation uptake is necessary to ensure herd immunity. Despite an estimated 86% of the world's children having received one dose of the measles vaccine by the age of one, there were 140 000 measles deaths globally in 2018. Most of these deaths were in children under the age of 5 years (World Health Organisation, 2019). The latest figures show that vaccine coverage in England is at 85.5%, well below the recommended 95% (see page 6) (UK Health Security Agency, 2022).
Nearly 10 years ago there were already major outbreaks in the UK. Undoubtedly some of you will remember the 2012/13 outbreaks in England and Wales, when school nurse teams in the affected areas scrambled to put together a catch-up programme within 48 hours (British Journal of School Nursing, 2013). Needless to say that as a result of huge cuts to funding and school nursing numbers over the years, as well as us finding ourselves in the midst of a pandemic, this kind of rapid public health response is very unlikely to be possible.
Those outbreaks were thought to be the result of a low coverage in 10–16-year-olds who missed out on vaccination in the late 1990s and early 2000s, when there was a widespread fear about the now disproven link between autism and the MMR vaccine.
It is possible that, like then, there will be a lag between poor uptake numbers and actual outbreaks but I wouldn't count on it and would recommend parents to get their children vaccinated as soon as possible. Indeed, the government's call for everyone to get back to normal and the dropping of measures such as masks and social distancing will also put an end to the mitigating effects of the pandemic on most childhood infections (Kadambari et al, 2021; Zhong et al, 2021). And, as COVID-19 cases soar in schools, it is likely that other infections will too.