The 5-year-old looked nervously at his older siblings, scanning their faces for any sign of distress as needles quickly jabbed into their upper arms, the syringe plunger is pushed and the measles, mumps and rubella vaccine. Whether it was for his sake or not, they barely said a word.
Then it was his turn. The girl, Oma Nnagbo, stared at the happy nurse who moments later declared, “It’s done, so brave!”
Michael Nnagbo, 40, took his three children to this pop-up vaccine clinic in Wolverhampton in England’s West Midlands after receiving a notice from their school about a measles outbreak in the nearby Birmingham area.
“This is what we need to do, and it is important to do,” said Mr. Nnagbo. “I just want them to be safe. And it’s easy, you can just go in.”
Cases of measles, a highly contagious but easily preventable disease, have started to increase in clusters as the number of children getting the combined vaccine against measles, mumps and rubella has dropped worldwide. The trend worsened after the coronavirus pandemic due to lack of access and reluctance among some groups. The measles virus can cause serious illness and, in the most severe cases, death.
Across Europe, measles cases have increased more than 40 times by 2023 compared to last year – from less than 1,000 to more than 40,000 — according to the World Health Organization. And while most of that increase is concentrated in low-income countries like Kazakhstanmore developed countries, where higher vaccination rates have long accounted for measles cases, are also experiencing alarming outbreaks.
In Britain, 650 cases of measles were confirmed between October 1 and the end of February, according to the UK Health Security Agency, which declared a national incident In January. The rise in cases was initially driven by an outbreak in the West Midlands, but it has spread elsewhere across the country. Most cases in Britain are in children under the age of 10.
Vaccine coverage has declined at significant rates in some communities, particularly those facing the highest levels of deprivation. That’s less the result of a growing anti-vaccine movement, experts say, than a lack of resources, a lack of awareness, and some cultural reluctance.
The percentage of children vaccinated by country regular vaccination program has fallen over the past decade in all diseases, including whooping cough, measles, mumps and rubella, polio, meningitis and diphtheria.
England no longer has vaccine coverage levels recommended by the World Health Organization, which advises that more than 95 percent of people should have had two doses of measles vaccine containing an attenuated amount of the virus to prevent outbreaks.
England will have 84.5 percent measles vaccine coverage by the end of 2023, but in some areas it will be lower. London has a coverage rate of 73.1 per cent overall, lower than the West Midlands, where coverage was 83.6 per cent at the end of last year.
Jenny Harries, the chief executive of the health security agency, said in a statement that lower vaccine rates were linked to inequality.
“While most of the country is protected, there are still high numbers of children in some areas who continue to be unprotected from preventable diseases,” he said. “Unless uptake improves, we’re going to start seeing the diseases that these vaccines protect against reemerge and cause more serious disease.”
Carol Dezateux, a professor of pediatric epidemiology at Queen Mary University of London, said the current measles outbreak was “completely predictable,” as vaccinations had fallen to alarmingly low levels even before the pandemic. The causes are complex, he said, but lockdowns and concerns about exposure to the coronavirus have exacerbated the problem.
Immunization rates for children in England have continued to decline over the past decade, partly due to vaccine hesitancy but also due to a lack of resources and logistical issues in the most deprived areas. It’s not just the MMR vaccine, Dr. Dezateux, as there is evidence of widening inequalities between rich and poor children across Britain in all five key childhood vaccinations.
“There’s a failure to think about how we can move the dial on this,” said Dr. Dezateux, adding, “You may want to climb a high mountain, but if you have no hope of climbing to the first base camp, you’re not going to try it, you know?”
The coverage gap is difficult to close in some areas, Dr. Dezateux, because so much pressure has fallen on general practitioners in the country’s already highly stretched National Health Service.
However, the cost of prevention in the form of vaccines is about 4 percent of the cost of an outbreak, he said, which shows the need for a coherent and coordinated plan to work toward better capture. of the vaccine.
“We know that where resources are brought, people can do more. It’s not rocket science,” said Dr. Dezateux.
Dr. Milena Marszalek, a research fellow at Queen Mary who is a general practitioner in north-east London in an area with one of the worst vaccination rates in the country, said it was a logistical struggle to combat declining vaccine coverage. .
“There is a real problem with the lack of capacity, lack of appointments,” he said. “We don’t have the resources needed to bring children in for vaccination.”
Still, some things have worked, he said, citing pop-up clinics and outreach to local imams to deliver information about vaccine safety to the area’s large South Asian Muslim community.
Local Haredi Jewish families told him that flexible hours at clinics and walk-in appointments also removed a barrier.
However, it is often only after a significant outbreak that the issue of vaccination becomes more urgent. Nicole Miles, the lead nurse for Vaccination UK, a group commissioned by Britain’s National Health Service to deliver childhood vaccines and which ran the Wolverhampton clinic, said an accessible, sensitive and tailored approach was essential. .
“What people don’t realize is how much it hurts,” Ms. Miles about the measles virus. “There is this idea that, ‘Well it’s just measles,’ because we have not seen cases of measles for years like we are now. So people don’t realize how dangerous it is, because it’s never been here.”
Ms. Miles, 34, and two other nurses who work to distribute the vaccines discussed how rare vaccine hesitancy is in their patients.
“There are always groups of people who don’t want to be vaccinated,” Ms. Miles. “And essentially, there’s nothing we can do about that, right? But we need to vaccinate people who want to be vaccinated and somehow miss the line.”
At the Wolverhampton clinic, many of the families attending said they were not opposed but had not been vaccinated for one reason or another. Like Mr. Nnago, many have heard about the push for vaccination in schools.
The Okusanya family, originally from Nigeria, have been living in Wolverhampton for two years. Oluwafunmilayo Okusanya, 42, said none of her three children had received the MMR vaccine in their home country, so when she heard about the local measles outbreak, she knew it was important to bring them.
“When the opportunity came, I felt it would be a good thing for them to have it,” he said. “It made it very convenient. While some don’t see the need to come forward for this, we just have to protect the children.”
