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THE INTERSECTIONMeasles: A Lesson For Vaccine Hesitancy
In her third column of of the semester, Keerthana Ramanathan (SOH '26), gives us insight into the prevalence of vaccine hesitancy through the lens of rising measles cases. What drives it and how can we address it?
In the United States, measles cases have increased 17-fold in the first quarter of 2024 alone, and epidemiologists are seeing similar patterns all over the world. Parts of England are experiencing their highest rates of measles since the 1990s, while the illness is prevalent in low- and middle-income countries across Africa, the Middle East and Asia. Although scientists created an effective vaccine for this highly infectious disease over 40 years ago, around one in five children have not received measles vaccines and therefore face the highest risk of complications.
Measles acts as a "canary in the coal mine" — it highlights gaps in vaccination due to its high transmissibility. But why have we been seeing such a significant resurgence of this disease that could be gone if we wanted it to be?
There is no doubt that global vaccination programs have taken a hit due to global conflict, displacement and the COVID-19 pandemic. However, another key culprit for the rising rate of preventable diseases is vaccine hesitancy. Though the pandemic highlighted vaccine hesitancy, the phenomenon existed long before then and is only getting worse. As the World Health Organization's (WHO) World Immunization Week, which is dedicated to appreciating the growth of vaccination programs and developments in technology and approaches, we must examine this key issue that impacts us close to home and worldwide.
Dr. Edward Jenner created the first vaccine, which prevented the deadly disease smallpox through the injection of the less deadly cowpox virus, over 200 years ago. Jenner thereby coined the term "vaccine" from the Latin word for cow, vacca. This vaccine allowed the world to eradicate smallpox in 1980. Since then, researchers have created dozens of vaccines to prevent diseases like hepatitis, influenza and polio.
However, the controversy started brewing much earlier. The 1905 Supreme Court case Jacobson v. Massachusetts saw observers first viewing vaccines through the lens of public skepticism, with the case questioning whether a state's enforcement of compulsory vaccination infringes upon personal liberty.
One of the major drivers of vaccine hesitancy, however, brings us back to measles. Discredited physician Andrew Wakefield falsely linked the MMR vaccine — proven to prevent measles, mumps and rubella — to autism in a 1998 paper published in The Lancet, a prestigious public health journal. Researchers have completely debunked all of Wakefield's claims, and The Lancet retracted the paper in 2010.
However, this scientific misinformation lives on in the eyes of the public. Misinformation has similarly driven hesitancy in the case of human papillomavirus (HPV) vaccination. As a result, HPV vaccination rates are much lower than other vaccination rates — even those of vaccines made available to the public within the same year, like the tetanus, diphtheria and acellular pertussis (Tdap) vaccines. Claims on social media have linked the HPV vaccine to side effects like fainting and dizziness — but scientists have since proven that doctors can attribute these links to the anxiety and stress surrounding vaccination, rather than the vaccine itself.
Another important example of vaccine hesitancy lies in the COVID-19 vaccination campaign. Though considered a paramount scientific accomplishment of the 21st century, the rapid development and use of the COVID-19 vaccine caused trust in many vaccines to plummet. This phenomenon, "spillover hesitancy," has resulted in mistrust of the influenza and measles vaccines, too. Vaccine hesitancy is casting its shadow around the world, resulting in drops in vaccine confidence in 52 out of 55 countries one UNICEF survey polled. To understand how to combat this global issue, we must look back to its source: misinformation.
False claims about vaccines, propagated through social media and their politicization, are a significant aspect of vaccine hesitancy. Misinformation not only drives fear but also obstructs solutions. To mitigate vaccine misinformation and mistrust, it is important to understand how heterogeneous the problem is — vaccine hesitancy disproportionately affects certain populations, particularly racial and ethnic minorities.
The prevalence of hesitancy, and subsequent lower vaccination rates, tend to exacerbate existing health disparities. To combat this, the WHO developed the Tailoring Immunization Programmes initiative, which uses a community's values and beliefs to inform solutions. It is also important to foster community engagement through tailored communication techniques, which utilize practices like presumptive provider communication, where the provider relays information with the assumption that the individual will get vaccinated, to increase levels of understanding and build trust. Vaccine advocates should also use social media to their advantage, making both tailored communication and broader vaccine campaigns more accessible and visible.
The fundamental principle of vaccines lies in herd immunity, the concept that vaccinating a certain percentage of the population prevents the spread of the disease overall. Every person, as part of a larger community, can act as a vaccine advocate, taking the initiative to learn more about vaccine efficacy and tackle misinformation and polarization. It's time to combat vaccine hesitancy. Our lives — and the lives of others — depend on it.
'More Than 10,000 Children At Risk Of Brain-swelling Disease' If MMR Vaccine Uptake 'does Not Improve' An Expert Warns
THOUSANDS of British children are at risk of contracting a fatal brain-swelling virus, an expert has warned.
Dr Ava Easton of Encephalitis International said among the 3.4 million children in the UK who were unprotected or not fully vaccinated against measles, around 10,000 new cases of encephalitis could emerge.
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How measles can affect the body: from rash to brain swelling diseaseEngland is facing a measles emergency, with infection rates in some parts of the country higher than they have been since the 1990s.
"The surge in cases, which is due to decreasing levels of MMR vaccine uptake, is deeply alarming," Dr Ava said.
"Unless this trend is reversed, we will see many more children at risk of encephalitis – a complication of measles which cuts young lives short and can cause brain injuries.
"No parent would want to knowingly expose their child to that."
Read more on EncephalitisThere were 86 confirmed measles cases over the past week, according to the UK Health Security Agency (UKHSA).
It brings the total number of measles cases recorded so far this year to almost 900 - a sharp increase from 368 cases in all of 2023.
Encephalitis is a rare complication of measles that happens when the virus enters the brain.
The body tries to fight the infection, which leads to inflammation and swelling of the brain.
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Professor Benedict Michael The University of LiverpoolTypical encephalitis symptoms include confusion and seizures. These usually come on when the classic measles rash emerges.
"Up to three in every 1000 of those infected with measles would be vulnerable to encephalitis," Dr Ava told The Sun.
"That means over 10,000 children could develop the brain inflammation condition unless MMR uptake improves.
"This would be a totally avoidable tragedy."
Gail Peters, from Stoke-on-Trent, shared how her daughter Stephanie passed away at age 27, from a rare and slow-progressing form of encephalitis called subacute sclerosing panencephalitis (SSPE) that strikes sufferers years after they were first infected with measles.
Powerful new video urges all parents to protect their children from surge of deadly Victorian disease as millions 'at risk'Up to 15 per cent of children who develop encephalitis will die.
For those who survive, up to a quarter (25 per cent) will be left with permanent brain damage.
And one in 25,000 children with measles will develop SSPE, which almost always leads to death.
'Urgent action is needed'Professor Benedict Michael, from the University of Liverpool, added: "It is not acceptable that in the 21st century, we have children dying or living with long-term disability due to encephalitis caused by the measles infection, which is completely preventable with vaccination.
"This is particularly troubling as three million plus children are now unvaccinated against measles.
"Urgent action is needed to ensure children get vaccinated now".
While measles usually triggers cold-like symptoms, other complications include blindness, pneumonia and meningitis.
The bug has no specific treatment, but it can be prevented with the MMR (measles, mumps and rubella) jab.
Unvaccinated children who come into contact with measles are currently being advised to stay at home for 21 days.
This is because measles is very contagious, with a patient typically passing the viral infection on to 20 others.
It can spread to others through coughing and sneezing or touching contaminated surfaces.
To keep measles at bay, 95 per cent of children must be vaccinated.
However, vaccine coverage is the lowest it has been for more than a decade, with just 85 per cent of youngsters having both doses of the jab before they start school aged five.
Encephalitis symptoms to know
Encephalitis can occur in children either during or after a measles infection
It usually comes on during the rash phase of measles or several years later in the form of subacute sclerosing panencephalitis (SSPE).
Symptoms include:
It's important to act fast if your symptoms become more serious.
You should dial 999 immediately to request an ambulance if you or a loved one has symptoms (even if they don't also have measles).
For more information on Encephalitis, go to the Encephalitis International website.
Source: NHS
How can I look after a child with measles?While most measles sufferers recover, it can be very unpleasant to endure, especially for youngsters.
It can, however, usually be treated at home and will pass within a week to 10 days.
The NHS says it can help your child to:
Children should stay off nursery or school for at least four days after the rash appears.
How can I stop my child catching measles?The best way to protect your child from measles, for which there is no treatment or cure, is by getting them vaccinated against it.
This means two doses of the measles, mumps and rubella (MMR) vaccine.
It's typically given to babies and young tots through the NHS vaccination schedule.
The first dose can be administered when your child is one and the second when they're three years and four months.
If your child has missed these jabs, you can still ask your GP surgery to give them.
Expert answers MMR questions
TO help deal with parental concerns, Professor Helen Bedford, a specialist in child public health at University College London, tells you all you need to know about the MMR vaccine.
When is the vaccine given?
The MMR vaccine is part of the NHS Routine Childhood Immunisation Programme.
It's typically given via a single shot into the muscle of the thigh or the upper arm.
The first dose is offered to children at the age of one (babies younger than this may have some protection from antibodies passed on from their mother, which start to wear off at about 12 months.)
The second dose is then offered to children aged three years and four months before they start school.
To check to see if you or your child have had the recommended two doses of MMR, you can look at their/your Personal Child Health Record, also known as the red book.
If you can't find the red book, call your GP and ask them for your vaccine records.
You are never too old to catch up with your MMR vaccine.
If you see from your vaccination records that you did not receive two doses as a child, you can book a vaccination appointment.
Is the vaccine safe?
The MMR vaccine is safe and effective at preventing measles, mumps and rubella.
In the UK, we started using the jab in 1988, so we have decades of experience using it.
The jab is made from much-weakened live versions of the three viruses.
This triggers the immune system to produce antibodies that are protective in the face of future exposure.
It takes up to three weeks after having the vaccine to be fully protected.
Like any vaccine, the MMR jab can cause side-effects, which are usually mild and go away very quickly.
This includes rash, high temperature, loss of appetite and a general feeling of being unwell for about two or three days.
There is also a very small chance children can have a severe allergic reaction.
But compared to the complications of measles, there is no contest that vaccination is by far the safest and most effective route to take.
Why was it linked with autism?
In 1998, Andrew Wakefield and his colleagues published a now-discredited paper in medical journal The Lancet.
The paper suggested that the MMR vaccine might be associated with autism and a form of bowel disease.
It led to a sharp decline in vaccination rates.
Even at the time, the research was considered poor.
The Lancet retracted the story in 2010 after Wakefield's article was found "dishonest" by the General Medical Council.
He was later struck off and subsequently, in 2011, the British Medical Journal declared the story fraudulent.
Does it contain ingredients from pigs?
There are two types of MMR jabs: One with gelatin (animal/pig collagen), and one without it.
For some religious groups, the inclusion of pig products is not acceptable.
Those people should ask for the vaccine without gelatin
Experts Recommend Maintaining Quebec's Measles Vaccination Schedule For Children
A measles outbreak is currently hitting Quebec and babies under one year old are among the most vulnerable as they are not vaccinated. Quebec's immunization committee, however, has advised the health ministry not to increase the age of vaccination since this risks compromising herd immunity.
There is currently community transmission of measles in Quebec, one of the most contagious diseases in the world. Serious complications of this disease include encephalitis, pneumonia and in one in 3,000 cases, death.
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According to the most recent data from the provincial government, as of Wednesday, there have been 50 confirmed cases of measles since the start of 2024.
Vaccination is the best way to protect against measles since there is no cure, only treatments depending on the complication developed.
According to the Quebec vaccination schedule, children are vaccinated against measles at the ages of 12 and 18 months and they are 95 per cent protected from the disease throughout their life.
Since a first case of community transmission was confirmed in Quebec, public health has been concerned about a low vaccination rate in certain regions. It launched a targeted vaccination campaign to try to increase these rates.
The proportion of individuals who need to be protected against measles in order to eliminate community transmission is estimated at approximately 95 per cent.
In this context, many parents are worried about their unvaccinated babies under one year old. The Institut national de santé publique du Québec (INSPQ) confirms in a notice that the Info-Santé service has received calls from parents who wish to vaccinate their 10-month-old child early.
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The health ministry has been asked by the regions to provide guidance on this issue. It mandated the immunization committee to assess the risks and provide a recommendation.
The committee said the data suggest that "the long-term effectiveness of two doses of vaccine is lower when the first dose is given before 12 months of age."
It concludes that even with very high vaccination coverage, loss of vaccine effectiveness can compromise the ability to control measles transmission at the population level.
In addition, no study demonstrates whether two doses administered after the age of 12 months would compensate for the loss of effectiveness of the first early dose.
For these reasons, the committee advised the government not to bring forward the first dose of vaccine before the age of one.
It emphasized that France maintains the age of the first dose at one year "despite transmission considered endemic and a higher incidence of cases than in Quebec." The United Kingdom, which recently declared a state of emergency in connection with a resurgence of measles, is also not accelerating a first dose for infants.
The committee, however, notes an exception: the Netherlands, which authorized vaccination among six- to 14-month-olds in communities where vaccination coverage was less than 90 per cent during a measles outbreak in 2013-2014. Antibodies in children who received an early dose were significantly lower than those who received a first dose at 14 months.
Canadian Press health coverage receives funding through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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