Is it just MMR affected by a vaccination confidence crisis?

Measles is a highly contagious disease, and infection can result in hospitalisation, long-term disability and death. An effective vaccination, the MMR, has been provided since 1988, but to prevent measles outbreaks, 95% of the population must have two MMR vaccine doses. In the latest published data, approximately just 85% of five-year-olds in England had received both doses.

Between January and April this year, there were 724 confirmed cases of measles in England, triggering the UKHSA to declare a national incident following outbreaks in London and the West Midlands. Many more unvaccinated children are understood to be at risk of contracting the disease.

Previously, low MMR vaccine coverage was linked to discredited and unproven theories connecting vaccination to autism. Despite a rapid recovery in the early 2010s, coverage has recently declined. This begs the question: are we seeing a unique crisis in MMR vaccination confidence or is this part of a broader trend in childhood immunisations?

In the chart below, we compare MMR coverage with the Hib/MenC vaccine (given at one year to help prevent Hib and a form of meningitis) and the 6-in-1 vaccine, which is given at 16 weeks to help protect babies against serious illnesses like polio and whooping cough. MMR vaccine coverage correlates closely with Hib/MenC coverage. Areas with low MMR coverage such as the London boroughs of Hackney, Enfield and Kensington and Chelsea also have low coverage for the Hib/MenC vaccine.

However, MMR vaccine coverage does not correlate as strongly with the 6-in-1 vaccine, and areas generally have much worse MMR coverage than the 6-in-1 vaccine. This is particularly pronounced in areas like Surrey, Westminster and Richmond upon Thames.

The close correlation between MMR and Hib/MenC immunisations does not indicate a crisis in MMR confidence driven by unique factors. Many areas have low coverage for both vaccines. While parents are not specifically avoiding the MMR vaccine, that MMR coverage is following the trend of other first-year vaccines is still concerning given measles' significant infectiousness.

MMR vaccination coverage needs to align more closely with the 6-in-1 vaccination in all areas to prevent future outbreaks. Several factors could be leading to lower coverage at one year, such as work patterns after parents return to work, changes in home address impacting on GP registration, and difficulties travelling to appointments. Addressing these barriers could play a part in reversing the recent decline in MMR coverage.