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Feature

Measles outbreaks: Investing in patient relationships through GP continuity will be key to boosting MMR confidence

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q221 (Published 29 January 2024) Cite this as: BMJ 2024;384:q221
  1. Emma Wilkinson, freelance journalist
  1. Sheffield, UK
  1. emmalwilkinson{at}gmail.com

The “Wakefield generation” is just part of the reason for low MMR vaccine coverage. Local knowledge and connection with communities will be key to turning it around—and that needs resourcing, reports Emma Wilkinson

The World Health Organization has warned of an “alarming” and accelerating 30-fold increase in measles across Europe. On 19 January the UK Health Security Agency (UKHSA) declared a national incident in England amid spiralling cases and a drop in vaccine uptake.

Andrew Wakefield’s fraudulent and long discredited research linking the measles, mumps, and rubella (MMR) vaccine with autism has cast a long shadow. It remains part of the picture but the reasons behind falling vaccine rates are now more complex, GPs and public health doctors say.

Last year only 84.5% of 5 year olds in England had had both doses of the MMR vaccine, a figure that hides pockets of particularly low coverage. In Birmingham, the epicentre of the current measles outbreak, uptake was 75%. There are boroughs in London—where isolated outbreaks have also been reported—where only 60% of children are fully vaccinated. Because measles is so infectious, 95% coverage is needed for herd immunity.

Social media plays a role in spreading myths about vaccination. But also in the mix are a post-pandemic lack of trust in healthcare, cultural beliefs, poor access to healthcare, and complacency over the diseases vaccines protect against. It takes local knowledge and connection with communities to overcome these factors, but this is not always valued or resourced, GPs warn.

Cultural memory

UKHSA has raised concerns about coverage in the “Wakefield generation”—those who were not vaccinated in the early 2000s and are now young adults. Samuel Finnikin, a GP in Sutton Coldfield, says, “We have people who are now in their early 20s and are having their own children who grew up at the height …

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