In 1998, the UK was measles-free: the disease was no longer spreading among the local population, although some imported cases were regularly recorded. It has been a long road but the UK was an exemplar to others striving to eliminate this highly-infectious illness.
The MMR vaccine – which protects against measles, mumps and rubella – was introduced in the UK in 1986. Thanks to a strong awareness campaign, encouragement from health professionals and a robust disease surveillance system, the public embraced the vaccine.
By 1994, measles transmission had been ‘interrupted’ thanks to high levels of measles vaccine uptake.
Then, a bombshell. In 1998, The Lancet – a reputable scientific journal – published a paper based on a small study that would undo the good work that already spared thousands of children and their families the misery of measles – and saved lives.
The man behind the paper, Andrew Wakefield, then a gastroenterologist, held a press conference that would spark one of the most damaging vaccine scares in history.
The media went wild. For headline writers, this was a story of huge interest to readers. It concerned child safety; appeared to upend everything we thought we knew about a widely used vaccination; and pitted one maverick scientist against mainstream opinion.
Vaccination rates plummeted.
‘We had interrupted indigenous measles transmission as a consequence of the successful introduction of MMR in 1986,’ says Prof David Salisbury, former Director of Immunisation at the UK Department of Health and a member of the Vaccines Today Editorial Board. ‘The good work was undone by the contribution of Wakefield who thereby put the lives of children and young people at risk.’
The study would eventually be thoroughly scientifically debunked and Andrew Wakefield branded as ‘dishonest and irresponsible’ by his peers. The paper was ultimately withdrawn by the journal with an admission that its central thesis was ‘utterly false’.
However, restoring high immunisation rates was a slow process. It took 14 years for measles vaccination rates to recover to pre-crisis levels. Now, with uptake rates holding steady, the UK – along with Spain and Denmark – join a growing list of countries in the European region where measles has been stopped in its tracks.
Dr Mary Ramsay, head of immunisation at Public Health England, told the BBC: ‘This is a huge achievement and a testament to all the hard work by our health professionals in the NHS to ensure that all children and adults are fully protected with two doses of the MMR vaccine.’
However, the experience of the late 1990s will keep health authorities in the UK on their toes. ‘We need to ensure that this is sustained going forward by maintaining and improving coverage of the MMR vaccine in children and by catching up older children and young adults who missed out,’ Dr Ramsay said.
Elimination in Europe
Measles is no longer endemic in 79% of the WHO European Region. Forty two of the 53 countries have interrupted endemic transmission of measles, and 37 countries have interrupted endemic transmission of rubella.
‘I congratulate each country for fulfilling the commitment to protect its people from measles and rubella and collectively moving the European Region closer to its elimination goal,’ said Dr Zsuzsanna Jakab, WHO Regional Director for Europe. ‘However, we cannot become complacent now. Outbreaks continue to cause unnecessary suffering and loss of life, and routine immunization coverage is decreasing.’
Romania and Italy have recorded measles deaths and large outbreaks this year. Small numbers of cases have been reported in other European countries due to faltering MMR uptake rates.
‘It is unacceptable that 1 in every 15 children still does not receive the first vaccination dose against measles and rubella on time,’ Dr Jakab said. ‘We will eliminate these diseases from our Region, but need to be ready to walk the hardest last mile.”
Keeping our promise to the world
Earlier elimination target dates of 2012 and 2015 have been missed, making Europe a laggard in the global push to wipe out the disease. In fact, if you are in Paris, Berlin or Bucharest, the chances of your child catching measles are much higher than if your family lived in Bogota, Havana or Mexico City.
Yet optimism remains that Europe will meet its target in the years to come. ‘This Region has eradicated polio, eliminated malaria and drastically reduced the transmission of measles and rubella. With continued commitment and hard work, we will be the generation that also eliminates measles and rubella from the remaining endemic corners of this Region,’ says Dr Nedret Emiroglu, Director for Health Emergencies and Communicable Diseases of WHO/Europe. ‘This is not only our contribution but also our obligation to the generations that follow us.’
The lesson from the UK is that even in the face of an extreme crisis of confidence, vaccination rates can be restored. Perhaps dedicated health professionals, doctors and parents in Romania and elsewhere can take heart from this remarkable recovery.
