Vaccine hesitancy and the current state of preventable childhood infectious diseases in London.

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Introduction:

As many of you know, my hospital practice is at Chelsea and Westminster Hospital. As a paediatrician who set up Bright Futures Health to focus on preventative medicine, I am genuinely alarmed to see the rise in admissions to hospitals of paediatric patients with diseases that I didn’t think I would ever see again. In the last six months, I have seen sick babies, infants and young children who have been admitted to the hospital with pneumococcal and Haemophilus meningitis, babies too young to be vaccinated with life-threatening pertussis (whooping cough) and large numbers of infants with measles. Some have been sick enough to require transfer to the paediatric intensive care unit. Some children affected have parents who have not vaccinated their children for one reason or another. Others are children too young to be fully vaccinated and no longer benefit from herd immunity as vaccination rates have dropped and the viruses circulate in our community.

Watch Margot’s story.

Sky News covered the story of Margot, who was admitted to hospital with measles. She was too young to have received the first dose of MMR.

Parents describe babys scary measles symptoms — as cases across country soar

What does the current data tell us?

A league table of childhood vaccination rates by London borough cannot be accurately constructed. However, some specific data points and trends can be highlighted:

• In Waltham Forest, only 69.9% of children turning five years old in 2021 to 2022 had received two doses of the MMR vaccine, which is below the London average.

The London Borough of Richmond upon Thames had DTaP/IPV booster coverage at five years of age of 71.6% in 2019/20, which was significantly lower than the England and London averages of 85.4% and 74.4%, respectively.

• In Richmond, 88% of children were vaccinated with the MMR vaccine by age two years, which was 2.9% lower than the England average and 5.2% higher than the London average.
• The lowest current rate in England for the second dose of the MMR vaccine at the age of five was in the London borough of Hackney, where just 56% of children had received the double dose. Hackney was followed by Kensington and Chelsea (67%) and Camden and Enfield (68%).
• The uptake rate (outside of London) for one-year-olds is 92% and just below 90% for two-year-olds. London is falling behind the rest of the country.

Latest childhood vaccination uptake statistics published

These data points suggest substantial variation in vaccination rates across different London boroughs, with some boroughs having significantly lower rates than others. There are concerns about low vaccination rates in certain areas, and efforts are being made to improve uptake, including targeted campaigns and outreach to communities with low vaccine coverage.

Why is this happening?

Using MMR as an example, low MMR vaccination rates in London can be attributed to several factors based on the information provided in the sources:

1. Misinformation and Complacency: A GP highlighted that misinformation and complacency are significant factors behind the fall in MMR vaccination uptake in London. The fast-moving population, pockets of deprivation, and constant changes in GP practices can impact vaccination rates.
2. Accessibility and Convenience: Families struggling to access vaccination programs for various reasons, including mobility, changing GP practices, and lack of awareness, are a significant concern. Making vaccinations convenient and accessible is crucial to improving uptake.
3. Impact of the COVID-19 Pandemic: The COVID-19 pandemic has led to neglected vaccinations as people focused on COVID-19, resulting in a decline in vaccine uptake for diseases like measles. Children who missed their first MMR jabs between 2020 and 2022 are now older and need to catch up on their vaccinations.
4. Historical Factors: Before the pandemic, the UK faced a decline in MMR coverage, which cumulatively increased the threat of a measles crisis. The impact of a discredited study linking the MMR vaccine to autism in the late 1990s may have contributed to fluctuations in vaccination rates over the years.
5. Lack of Awareness: There is a lack of awareness about the risks of measles among parents, especially since many may not have firsthand experience with the disease. Increasing awareness about the importance of vaccination and the consequences of measles is crucial to improving uptake.
6. Health Inequalities: The COVID-19 pandemic highlighted existing health inequalities, which may have further impacted vaccination rates in London. Efforts to address these inequalities and ensure equitable access to vaccinations are essential.
7. Population Mobility: London’s fast-moving population, with people constantly changing GP practices, can make it challenging to ensure consistent vaccination coverage. Efforts to reach and vaccinate transient populations are crucial to improving overall vaccination rates.

These factors collectively contribute to London’s low MMR vaccination rates, highlighting the need for targeted interventions, increased awareness, improved accessibility, and community engagement to address and prevent measles outbreaks.

What can be done about it?

The NHS and local authorities are implementing various measures to safeguard children in London from the declining national and local MMR vaccination rates. These include vaccination initiatives, community involvement, and awareness campaigns. Unvaccinated children seeking emergency care at the Emergency Department are offered vaccination services within the hospital. Bright Futures Health provides vaccination services, albeit with charges to offset operational expenses. By executing these strategies, it is feasible to enhance MMR vaccination coverage in London and mitigate the threat of measles outbreaks.

As Bright Futures Health’s patrons and parents interested in preventative health, we encourage you to stay informed. To keep up with the latest information, please follow us on Instagram and share this preventative health message with your friends and family.

Thank you for taking the time to read this article.

Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult with your paediatrician or healthcare provider for personalised guidance and recommendations.