Though not a household name in the UK, model and actor Jenny McCarthy’s claims that vaccinations caused her son’s autism have had a huge and damaging influence in the US. Photo: Getty Images
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Anti-vaxxers have revived measles in the US, but what about the UK?

The resurgence of diseases like measles in the United States has come from the refusal of parents to vaccinate their children. The good news is that Britain isn’t seeing those same risks – but it could in the future.

The United States is currently facing a public health disaster, as diseases that were thought to have been effectively eradicated as serious threats to children – like measles, whooping cough and rubella – make a comeback. There are currently eight states facing localised outbreaks of measles where the source has all been traced back to Disneyland in California, with at least 102 cases identified in January aloneAt this rate, 2015 will easily break 2014’s record for most measles cases recorded in the US since 2000, when the Centers for Disease Control declared measles “eliminated”:


Note: The figure for 2015 is January only.

To get a grasp of just how much better things have become since the introduction of the first measles vaccine in the US in the 1960s, there used to regularly be between 400,000 and 800,000 cases of measles per year – adding those figures to the above graph would require a scale that reduces more recent years to a flat, imperceptible line above zero. What we’ve seen in the US, and in other developed nations with successful vaccinations programmes, is a shift from measles being a common childhood disease to one which occassionally manages a comeback in very small, specific communities where enough unvaccinated people (usually children) mingle together.

This might not sound like a disease that has been properly eliminated, but the definition as used by the CDC doesn’t mean the extinction of a contagion. Instead, it refers to measles’ usual ability to survive within a group of humans indefinitely by always having new hosts to move into – this is what’s meant by the term “endemic”. A town with endemic measles always has people carrying and passing on measles. But the CDC considered measles eliminated because, as of 2000, there was not one single place within the US where measles was transmitted successfully from person to person to person over a period of 12 months, continuously. Subsequent studies confirmed that measles had essentially become something that was accidentally imported from abroad – from 2004 (where there were only 37 confirmed cases, the lowest recorded so far) to 2011, at least 88 per cent of those with measles caught it while in another country and brought it back. Those outbreaks sourced from the US failed to achieve endemic status, thanks to widespread vaccination.

Understanding why this has changed isn’t difficult – it’s the expected result of several years of dedicated campaigning by anti-vaccination activists (so-called “anti-vaxxers”), who offer a potent ideological mix of libertarianism, pseudoscience and parental instinct. After all, what kind of parent intentionally gives their child something that would harm them? And how dare the government tell me that I must inject my child with something? Beyond being merely about public health, vaccination in the US has been successfully framed as a political choice, analogous to gun control, where the rights of parents and their children are framed as being violated by an intrusive government. The current scrambling to state clear support for vaccines by politicians hoping to be picked as the Republican candidate for president in 2016, and seeing the damage that anti-vaxxer rhetoric has caused, has been impossible to miss.

Here in the UK, attitudes around vaccinations are different, though it’s absolutely necessary to point out that the source of the modern anti-vaccination movement as manifested in the beliefs of influential campaigner celebrities like Jenny McCarthy (above) is the deplorable work of the British doctor Andrew Wakefield. His infamous 1998 study alleging the MMR (measles, mumps and rubella) vaccine could cause autism in young children has been debunked repeatedly, and he himself has been villified and expelled from the scientific community, but the fears his work has instilled in a generation of parents has had measurable, deterious effect on the health of children both here and around the world.

But of course explaining why this is can be difficult, because so often it’s about the clash between an abstract scientific concept and the relatable, real experiences and fears of individual parents who, understandably, take threats against their children seriously. Measles outbreaks offer a clear example of this – how herd immunity can seem very abstract and unreal, until it isn’t. This piece explains herd immunity in more detail than I’ll go into here, but the short version goes like this:

Imagine a town with a hundred people, where everyone in the town has ten friends each and everyone’s friendship groups overlap so that everyone in the town is at least a friend of a friend of a friend and so on of each other. If someone in a town catches a disease (let’s call it vaxxeria, because metaphors) which spreads easily to every friend they meet each day, then within a predictable amount of time everyone in the town will have caught vaxxeria from each other.

If one person gets vaccinated against vaxxeria, then that in itself does little to save anyone but them – but if everyone in a certain circle of friends gets vaccinated, the disease has to kind of “work around” the block in the network. One person could catch it, but if all ten of their friends are vaccinated it hasn’t got anywhere to go, and when (or if) they survive their illness the outbreak will be contained. This is herd immunity, where someone who isn’t vaccinated won’t catch a disease simply because everyone they’re likely to come into contact with isn’t going to be a carrier. For those people who aren’t able to handle vaccines (for example, those with certain immune disorders) this herd immunity is vital to giving them the same freedom from diseases like whooping cough, measles and miningitis as everyone else. When herd immunity works, even if an outsider rolls into town carrying all sorts of diseases, enough people will be immune that the disease never spreads.

This is the rub. Vaccinations have successfully given those of us in developed nations the expectation of lives free from many diseases which were both extremely widespread and often lethal in the past – to the extent that this feels “normal”. (And, if you or a child does catch something like whooping cough, well, there are hospitals and modern medicines that can help, right?) The individual experience for many anti-vaxxers, then, is that autism is the more common and serious threat – as offensive as this is to those who actually have autistic traits and know that, say, inflammation of the brain (a possible complication caused by measles) is magnitudes worse by comparison. A parent can see their friends opt their kid out of vaccinations and see that nothing bad happens because herd immunity is maintained, making them also feel safe doing the same, and especially if they happen to have a doctor who doesn’t push the issue.

America is experiencing the dangers that come when that “small” percentage of the population opting out of vaccinations grows too large, in a concentrated area. It’s important to make that distinction, because vaccination rates nationwide have barely shifted for two decades – according to CDC figures, since 1995 the MMR vaccine has had between 90 to 93 per cent coverage of American kids aged 19 to 35 months every year. For measles, herd immunity kicks in when coverage is between 90 and 95 per cent. This sudden, not gradual, uptick in cases is exactly what we’d expect to see once anti-vaxxer views gain too much sway among very specific demographics in very specific geographical areas, and it’s no coincidence that a major outbreak has centred on Disneyland in California.

Among the wealthy and middle class of Los Angeles, anti-vaxxer views have become as fasionable as preferences for organic food and detox diets – Hollywood Reporter investigation last year found several private schools, daycares and other educational establishments where more young children hadn’t been vaccinated than had, at levels less comparable to those found in developing nations like South Sudan. Los Angeles now sees hundreds of cases of whooping cough among very young children every month, as well as its measles resurgence. However, don’t think that this is entirely a Hollywood fad – the states with the worst MMR vaccination rates are Ohio, West Virginia and Colorado, which each only managed 86 per cent coverage of children aged 19 to 35 months. As much of a problem as the wealthy choosing not to vaccinate children is the difficulty in making sure that poorer communities have access to those vaccinations in the first place.

But what about the UK? After the introduction of the MMR vaccine in 1988 to replace the single measles jab, the uptake rate for children younger than two quickly rose to close to near-90 per cent by the mid-1990s – but damage caused by Wakefield’s paper is obvious after that, especially if you track MMR’s rise and fall as a news story. It’s only very recently that the percentage of children receiving the MMR vaccine has recovered to its previous levels:

England and Wales have notably been worse than Scotland and Northern Ireland at ensuring comprehensive coverage, and, while Wales has managed to surpass pre-scandal levels, England has still struggled. That’s somewhat misleading, though, as more than 80 per cent of the UK lives within England’s borders, and it experiences significant regional variation in coverage – London is by far the worst part of the UK for it, for example, and was even before the scandal:

Note: due to NHS reorganisations under the Blair government, it’s not possible to go back further than 2001-02 and still compare like-for-like regions.

It took 15 years – until 2012/13 – for the UK’s MMR coverage to match and surpass where it was were before the scandal. And, like the US, there are still pockets of deprivation where the problem isn’t parents choosing not to have their children vaccinated, but simply that systems aren’t properly in place to ensure that they understand the options available to them, and the benefits of sticking to a good vaccination schedule. The World Health Organisation’s MMR target for nations is 95 per cent, in order to guarantee herd immunity – and it’s London and the surrounding areas that’s primarily responsible for the US not reaching that level.

London’s figures are quite amazing, actually, when it comes to MMR coverage. The latest annual report from NHS England (for the 2013/14 financial year) shows that wealthy local authorities – like Kensington and Chelsea (80.4 per cent) and the City of Westminster (79.5 per cent) – are just as culpable for the capital’s poor coverage as deprive boroughs like Newham (85.1 per cent) and Enfield (78.3 per cent). London’s best borough, perhaps surprisingly, is Tower Hamlets, with 93.8 per cent coverage. There is no single way to fix this that will work across every demographic here, but, as should be clear by now, when immunisation rates within an area are on the edge of triggering herd immunity, it doesn’t take a lot to tip over either way. As much as anti-vaccination groups (and yes, the UK has some) are extremely small relative to the rest of the population, their influence can be substantial.

And, of course, the long-term consequences of the MMR scandal are still with us, many years later, because someone unvaccinated stays unvaccinated – we have a bulge in the population pyramid for those unlucky enough to have been kids at just the right time for parents to either withdraw them from having the first MMR dose before their second birthday, or (as was even more common) withdrawing them from having the booster shot follow-up that the NHS recommends before the age of five. Those places where herd immunity is compromised can experience a mass change of heart, but often only with hindsight – as happened in Swansea from November 2012 to July 2013, when 1,219 cases of measles were reported, and at least one person died. The local paper, the South Wales Evening Post, had campaigned against the MMR jab after the 1998 publication of Wakefields paper. Locals who had been misled about the risks at the time and chosen not to have their children vaccinated ended up rushing their now-teenage kids to hospitals and GPs for belated vaccinations.

With the recent news from America, it’s tempting to go all-out angry at anti-vaxxers for creating the impression that their views are not just rational, but morally correct, but there are good reasons not to take that approach. The first is that the original MMR scare was, more than anything, the fault of the media as much as Andrew Wakefield, and there hasn’t been any kind of reckoning for turning a lone scientific paper into a major health scandal that included speculation as to whether the prime minister had had his son vaccinated or not. Journalists deserve criticism for poor reporting of the health risks of vaccines as much as dodgy scientists do for publishing bad science.

Then there’s also this to think about: if somebody’s distrust of scientific and/or political authority is so great, for whatever reason – maybe they’ve been scared by sensationalist stories in the media, or maybe they sincerely believe the government has no moral right to dictate health choices to citizens – that they’re willing to significantly increase their child’s risk of catching a (possibly fatal) illness, then calling them names and telling them scientists and politicians disagree with them is probably futile. Arguing that “the science is settled” with someone whose stance is predicated on the belief that the standards of proof used by scientists are flawed is definitely futile. And it may even be one of the main contributing factors in turning vaccinations into the politically-polarised issue we’re seeing in America.

As Brendan Nyhan at the New York Times notes, there is evidence that this is something that happens during outbreaks of diseases that could otherwise be prevented by vaccinations and herd immunity. The perception that anti-vaxxers are anything other than a tiny, tiny fringe group ironically increases their influence, and makes it more acceptable for other people to agree with them. Compassion and improved local healthcare provision – it’s not a glamorous measles prevention strategy, but it’s likely the most effective.

Ian Steadman is a staff science and technology writer at the New Statesman. He is on Twitter as @iansteadman.

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Q&A: What are tax credits and how do they work?

All you need to know about the government's plan to cut tax credits.

What are tax credits?

Tax credits are payments made regularly by the state into bank accounts to support families with children, or those who are in low-paid jobs. There are two types of tax credit: the working tax credit and the child tax credit.

What are they for?

To redistribute income to those less able to get by, or to provide for their children, on what they earn.

Are they similar to tax relief?

No. They don’t have much to do with tax. They’re more of a welfare thing. You don’t need to be a taxpayer to receive tax credits. It’s just that, unlike other benefits, they are based on the tax year and paid via the tax office.

Who is eligible?

Anyone aged over 16 (for child tax credits) and over 25 (for working tax credits) who normally lives in the UK can apply for them, depending on their income, the hours they work, whether they have a disability, and whether they pay for childcare.

What are their circumstances?

The more you earn, the less you are likely to receive. Single claimants must work at least 16 hours a week. Let’s take a full-time worker: if you work at least 30 hours a week, you are generally eligible for working tax credits if you earn less than £13,253 a year (if you’re single and don’t have children), or less than £18,023 (jointly as part of a couple without children but working at least 30 hours a week).

And for families?

A family with children and an income below about £32,200 can claim child tax credit. It used to be that the more children you have, the more you are eligible to receive – but George Osborne in his most recent Budget has limited child tax credit to two children.

How much money do you receive?

Again, this depends on your circumstances. The basic payment for a single claimant, or a joint claim by a couple, of working tax credits is £1,940 for the tax year. You can then receive extra, depending on your circumstances. For example, single parents can receive up to an additional £2,010, on top of the basic £1,940 payment; people who work more than 30 hours a week can receive up to an extra £810; and disabled workers up to £2,970. The average award of tax credit is £6,340 per year. Child tax credit claimants get £545 per year as a flat payment, plus £2,780 per child.

How many people claim tax credits?

About 4.5m people – the vast majority of these people (around 4m) have children.

How much does it cost the taxpayer?

The estimation is that they will cost the government £30bn in April 2015/16. That’s around 14 per cent of the £220bn welfare budget, which the Tories have pledged to cut by £12bn.

Who introduced this system?

New Labour. Gordon Brown, when he was Chancellor, developed tax credits in his first term. The system as we know it was established in April 2003.

Why did they do this?

To lift working people out of poverty, and to remove the disincentives to work believed to have been inculcated by welfare. The tax credit system made it more attractive for people depending on benefits to work, and gave those in low-paid jobs a helping hand.

Did it work?

Yes. Tax credits’ biggest achievement was lifting a record number of children out of poverty since the war. The proportion of children living below the poverty line fell from 35 per cent in 1998/9 to 19 per cent in 2012/13.

So what’s the problem?

Well, it’s a bit of a weird system in that it lets companies pay wages that are too low to live on without the state supplementing them. Many also criticise tax credits for allowing the minimum wage – also brought in by New Labour – to stagnate (ie. not keep up with the rate of inflation). David Cameron has called the system of taxing low earners and then handing them some money back via tax credits a “ridiculous merry-go-round”.

Then it’s a good thing to scrap them?

It would be fine if all those low earners and families struggling to get by would be given support in place of tax credits – a living wage, for example.

And that’s why the Tories are introducing a living wage...

That’s what they call it. But it’s not. The Chancellor announced in his most recent Budget a new minimum wage of £7.20 an hour for over-25s, rising to £9 by 2020. He called this the “national living wage” – it’s not, because the current living wage (which is calculated by the Living Wage Foundation, and currently non-compulsory) is already £9.15 in London and £7.85 in the rest of the country.

Will people be better off?

No. Quite the reverse. The IFS has said this slightly higher national minimum wage will not compensate working families who will be subjected to tax credit cuts; it is arithmetically impossible. The IFS director, Paul Johnson, commented: “Unequivocally, tax credit recipients in work will be made worse off by the measures in the Budget on average.” It has been calculated that 3.2m low-paid workers will have their pay packets cut by an average of £1,350 a year.

Could the government change its policy to avoid this?

The Prime Minister and his frontbenchers have been pretty stubborn about pushing on with the plan. In spite of criticism from all angles – the IFS, campaigners, Labour, The Sun – Cameron has ruled out a review of the policy in the Autumn Statement, which is on 25 November. But there is an alternative. The chair of parliament’s Work & Pensions Select Committee and Labour MP Frank Field has proposed what he calls a “cost neutral” tweak to the tax credit cuts.

How would this alternative work?

Currently, if your income is less than £6,420, you will receive the maximum amount of tax credits. That threshold is called the gross income threshold. Field wants to introduce a second gross income threshold of £13,100 (what you earn if you work 35 hours a week on minimum wage). Those earning a salary between those two thresholds would have their tax credits reduced at a slower rate on whatever they earn above £6,420 up to £13,100. The percentage of what you earn above the basic threshold that is deducted from your tax credits is called the taper rate, and it is currently at 41 per cent. In contrast to this plan, the Tories want to halve the income threshold to £3,850 a year and increase the taper rate to 48 per cent once you hit that threshold, which basically means you lose more tax credits, faster, the more you earn.

When will the tax credit cuts come in?

They will be imposed from April next year, barring a u-turn.

Anoosh Chakelian is deputy web editor at the New Statesman.