Only 75% of children are receiving their first dose of MMR vaccines on time, according to a Queen Mary University study.
A 95% uptake of MMR vaccines is needed to prevent an outbreak of measles. Low levels of vaccine uptake in economically deprived areas have raised concerns about health equality in the UK after the pandemic.
Researchers have called for greater investment in vaccination services in London to ensure that all children have equal access to MMR vaccines and are fully protected from these highly infectious diseases. This requires increased support for primary care teams to ensure they can reach all children efficiently. More flexible and local access to services and information for parents and carers is also needed according to the researchers.
The study has been published today in the journal BMJ Open.
MMR vaccines should be routine care
MMR vaccines are part of England’s routine childhood immunisation schedule. Two pre-school doses can provide protection against measles, mumps, and rubella for life. Measles can cause serious complications in some children, including pneumonia or brain swelling, and it is highly infectious. One person infected with measles typically infects 12-18 other people in an unprotected population.
Guidelines from the World Health Organization (WHO) recommend that 95% of children receive both of their MMR vaccines to avoid a measles outbreak. The lowest rates of MMR immunisation in the UK are in London, this problem predates the pandemic but become worse subsequently.
The researchers examined de-identified data from the GP records of half a million children in northeast London. MMR vaccinations in two groups of children were compared: those whose first dose was due in the 19 months before the start of the first COVID-19 lockdown in March 2020, and those whose first dose was due in the 19 months after.
The researchers observed that the proportion of children receiving the first MMR vaccine between 12 and 18 months of age decreased by an average of 4% during the pandemic. The poorest neighbourhoods saw the biggest decline in on-time vaccinations. Close to 5% of children in the most deprived areas did not receive their vaccine on time, compared to 1% in the least deprived areas.
No areas of London are on target
Currently, no region in London meets the 95% target recommended by the WHO. There are now more neighbourhoods than before the pandemic where less than 60% of children receive their first MMR vaccine on time in northeast London. These areas are at the highest risk of a measles outbreak. They also tend to be clustered in the region’s most deprived neighbourhoods.
“There is an urgent need to ensure all families have equitable, timely access to routine immunisations, regardless of their circumstances. The risk of an unprotected child catching measles is much higher if they are surrounded by other unprotected children, so we are particularly concerned about these increasing ‘hotspots’ where timely vaccination is below 60%,” said Carol Dezateux, Professor of Clinical Epidemiology and Health Data Science at Queen Mary University of London.
“Queen Mary’s Clinical Effectiveness Group works closely with the NHS and local authorities in northeast London, so we understand the immense pressure on primary care teams at the moment. We have developed free software tools to support practices to manage and deliver the complex childhood immunisation programme as part of a region-wide quality improvement programme. Our data shows where more targeted services are needed and can support local initiatives to remove barriers to access and ensure all children in the region have an equal chance of protection. We are working with the NHS in northeast London to tackle this problem together,” concluded Dezateux.
