London at risk of major measles outbreak

The models predict tens of thousands of cases
21 July 2023

Interview with 

Helen Bedford, UCL


The UK’s health authorities have said that London is at risk of a major measles outbreak, with modelling predicting tens of thousands of cases. Officials added that an urgent vaccination push is now needed in a bid to curb an epidemic. Measles kills over 100,000 people a year around the world, most of them children, but it’s also a severe disease for adults too, causing fever, pneumonia, and even swelling of the brain. Helen Bedford is a professor of children’s health at University College London. She is an expert on childhood vaccination and has spent the past 30 years conducting research into vaccine uptake.

Helen - In this country we have very high uptake of vaccination. But even so, it's not high enough to really control certain diseases. And measles is in particular a problem because it is very, very, very infectious. And to keep measles away completely, you have to have really high levels of vaccine uptake, which we simply don't have in this country.

Chris - And how high is really high?

Helen - Really high is 95% for both doses of the vaccine because we recommend that people have two doses of a vaccine that contains measles, which is known as MMR - measles, mumps, and rubella vaccine.

Chris - And what sorts of levels of vaccination, if we are not at 95%, are we at then?

Helen - In England, at two years of age, 89.5% of children have had one dose of MMR. So that sounds really high, but it really isn't high enough. And the real problem is that we have variation in uptake around the country. So if you go to London, and this is where the real problem is, the real risk of having an outbreak is at the moment, uptake is very much lower. Overall, across London it's about 82%. But then go to different parts of London, go to Hackney, which is in the east end. The uptake there is 65%, four in 10 children are not getting their MMR vaccine.

Chris - And obviously if you've got hotspots of low uptake, that's a Tinder box for an outbreak there, isn't it? If you've got lots of susceptible people all in one area.

Helen - Absolutely. That's the problem. What we're really worried about is when you get an outbreak, you tend to get more cases amongst under vaccinated communities. We know who those communities are, people who reject vaccination, people who move around. So in London there's a lot of population mobility, people who've recently come into the country. And then there'll be certain communities with particular cultural views, travelling communities, those sorts of communities at particular risk of measles outbreaks.

Chris - Has this become more acute more recently, or are we now just talking about it because we want to do something about it?

Helen - It has become more acute. Recently the UK Health Security Agency has done some modelling. They've basically worked out that at the level of vaccine uptake we have now, I'm talking about young children, but we've also got a lot of young adults who weren't vaccinated when they were babies 20 years ago. And all these groups have built up in the population and they've accounted for all this in their modelling exercise and concluded that unless we improve vaccine uptake, we could see an outbreak as big as between 40,000 and 160,000 cases.

Chris - What can we do about it, then? Obviously raise awareness, which is what we're doing here and urge parents to do this. But if you are in those young adult groups that you were discussing, is it too late for you or can those individuals, just like young babies, go and get an MMR?

Helen - Very, very luckily, there's no upper age limit for MMR vaccine. Anybody can get it. We need to get this message over very, very firmly that it's not too late. And it's really good to do it now at the beginning of the summer before people start travelling abroad, because we are seeing measles cases in Europe and in other countries too. It's very easy to go to the GP and it's best to have two doses of the vaccine. You need to have a month apart. Fortunately, we can stop this outbreak in its tracks if we can improve vaccine uptake and if we can encourage people that haven't been vaccinated to take the vaccine up.

Chris - A theoretical risk is one thing, but have we got evidence that measles really is on the move yet?

Helen - For the first six months of this year, we've seen 128 cases. It's already far more than we had in the whole of last year. Most of the cases are in young children under the age of 10 years. But the thing with these childhood diseases like measles, they're really, really nasty when you are a baby. But they can also be extremely nasty when you're an adult and you often have very high rates of people with measles going into hospital when they're adults. They can be really ill.

Chris - You mentioned that there are particular groups that are contributing to these higher numbers of unvaccinated individuals. Is that the focus then of various initiatives to try and address that? What are we doing about it?

Helen - Well, one of the things we need to do is remind parents. If you literally do something as simple as send parents a vaccination reminder, that's really important. Make it easier for parents to have their children vaccinated and perhaps use some of the initiatives that you used during the pandemic when we were offering vaccination in different places. So not just the GP surgery, but maybe offering them in community centres and family hubs where young families go. We've certainly seen this in the past, because we've had similar sort of situations to this in the past, where people have done things like literally painted a bus called the spotty bus and driven it around parking in supermarket car parks and offering vaccination to families who are in the vicinity.


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