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6 March 2024

Child vaccination uptake is falling once again

The current wave of measles cases can be traced back to the cost-of-living crisis and cuts in NHS health visitor numbers.

By Phil Whitaker

The boy was four years old, with a high fever, cough and sore eyes. It was his skin that alerted me – densely distributed, starkly florid spots, quite different from the usual viral rashes. Laboratory tests confirmed the clinical suspicion: measles.

That was in 2008. I remember it because it was the only case I’ve seen in my 33-year career. It coincided with “peak Wakefield”. In 1998, the now discredited former doctor Andrew Wakefield published his infamous paper in the Lancet (since retracted) that claimed a link between MMR vaccination and autism. The subsequent public alarm saw uptake of the measles, mumps and rubella vaccine slump to around 80 per cent by 2004. The loss of population immunity led to spikes in measles cases – 1,280 were notified in England in 2008, 1,920 in 2012. It took years to dispel the Wakefield effect but by 2014, MMR coverage had regained the lost ground and case numbers had fallen again.

Wakefield has exerted a minor effect during England’s current brush with measles: around a quarter of the 650 cases confirmed to date have been in young adults who missed out on immunisation when children. But the causes of this latest outbreak lie elsewhere.

This isn’t just about MMR; the uptake of all childhood immunisations has been falling since 2014. You will hear this blamed on vaccine hesitancy, exacerbated by the misinformation about the Covid jab during the pandemic, but that doesn’t explain the data. The uptake of immunisations given in the first four months of life remains strong. It is the vaccinations scheduled for later in childhood – particularly the preschool boosters given at around three-and-a-half – where the big drop-off occurs.

According to the Office for National Statistics, the proportion of mothers who are in work has been rising steadily for years, with more than 75 per cent now in employment. And in recent years the numbers working full-time have surpassed those in part-time roles. Most working mothers – and it is still largely mothers who bring children for vaccination appointments – will be on maternity leave for their baby’s early months, so attendance is relatively simple. But fast-forward a few years and time off will likely be needed. Vaccination uptake is lowest in the most socio-economically deprived areas. In its 2023 Working Families Index report, the charity Working Families highlighted the growing numbers needing to work additional jobs or hours to make ends meet. And they note that those on lower incomes struggle with short notice of work schedules and more rigid work patterns. For some, getting a child to a vaccination appointment can seem impossible.

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The other striking feature in the data is the difference between the UK nations. According to the Nuffield Trust, Scotland has by far the highest rates of childhood immunisation, Wales and Northern Ireland are in second and third place, and England lies a dismal fourth. The key factor is health visitors – the specialised community nurses for families with preschool children. One of their myriad roles is to inform, reassure and encourage immunisation.

According to the Institute of Health Visiting, health visitor numbers in England have been slashed by 40 per cent since 2015, and the average caseload is 409 children. Contrast this with Scotland, which over the same time frame has invested heavily in its service. Most Scottish health visitors have caseloads below 250 and provide continuity of care to most of their families, enabling trusting relationships to be built. In England, fewer than half of health visitors say they can provide continuity.

Good health-visiting provision enhances breastfeeding rates, improves dental hygiene and reduces children’s visits to A&E – and those are just some of the more readily measurable outcomes. The architects of austerity may have long left office (David Cameron’s comeback excepted) but the England measles outbreak illustrates that the long-term consequences of their policies will continue to be felt for at least a generation.

[See also: Pharmacy First, which bypasses GPs, may lead to even greater antibiotic use]

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This article appears in the 06 Mar 2024 issue of the New Statesman, Bust Britain