Across parts of the country this week, nursery workers will don plastic aprons and gloves. With more than 500 confirmed cases of a life-threatening virus in England so far this year, and one child in Liverpool having died this month, many nurseries are introducing emergency infection control measures such as PPE and social distancing.
Stop me if you’re getting a rush of deja vu. It is striking how news of the current rise in measles cases, and the early response to it, could easily be describing the coronavirus pandemic. Except, unlike at the start of Covid, when our only defence was lockdowns, a safe and effective vaccine – the MMR jab – has long existed for measles. The problem is, many of those at risk – about one in six children aged five and under – have not had one or both doses. Watching nurseries bring back their Covid hygiene protocols while health professionals urge more people to get vaccinated, it feels as if we are blindly going over an old routine, desperately scrubbing surfaces with disinfectant and denial.
There is already a debate brewing again over whether the unvaccinated should be allowed to use some public services, with Melanie Pilcher of the Early Years Alliance recently stating that nurseries shouldn’t turn away children who are not vaccinated against measles because it is “a parental choice”. Squint a bit and you can practically see yourself in your front garden banging a pot and pan for the NHS.
There was a period, somewhere between stockpiling toilet rolls and Boris Johnson declaring everything was back to normal, when we had plans to learn lessons from Covid. Vaccine creators and scientists were going to be lauded. The social safety net would be valued; the NHS and key workers finally appreciated. There was some progress. For example, the Labour government brought in sick pay for 1.3 million low-paid workers. But in many ways, the good intentions were chucked away along with the banana bread, not least when it came to public health.
The infection control methods we learned during Covid – think regular inoculations, testing, air filters and masks in high-risk settings – have not been continued, and on some level, things are actually worse now. With school absences up, the last Conservative government actively encouraged students to go to class with mild (but potentially infectious) coughs and sore throats. Meanwhile, vaccine take-up has plummeted. Last winter, the number of NHS staff agreeing to the flu jab to protect patients crashed to its lowest level since 2010 (37.5%) – the fourth consecutive year these immunisation rates have fallen since the pandemic. At the same time, efforts to eradicate cervical cancer in England by 2040 are under threat as the number of pupils getting vaccinated against HPV has dropped by 17 percentage points since before the pandemic.
This is in part a clear sign of the “vaccine fatigue” that the pandemic accelerated. Coupled with the rise in misinformation online and distrust of “elites”, the push to get vaccinated after being legally mandated to stay at home for months left a lasting distaste for – and distrust of – public health diktats. For some, the Covid rules were not a lesson in how collective action saves lives, but in how the state can control them.
It is notable, though, that child immunisation rates were falling for several years before Covid hit, with the UK remarkably now failing to meet the World Health Organization’s target of 95% coverage for herd immunity for any routine childhood jabs.
The issue with vaccine uptake is not simply hesitancy but longstanding issues with access. Many low-income parents are unable to take time off work to get their child vaccinated, or can’t afford the transport to get there. There is also a lack of GP appointments in the first place. Meanwhile, aslyum seekers and other marginalised groups can be reluctant to engage with official health services. This makes it even more frustrating that funding has not been maintained for outreach efforts that were effective during the height of the pandemic, such as translators and community engagement.
“The reality is we failed to learn from Covid about the investment needed for NHS teams and local authorities to do outreach in a ways that work and to sustain it when needed,” Ben Kasstan-Dabush, an assistant professor and medical anthropologist at the London School of Hygiene & Tropical Medicine, told me. “Recent plans for integrated care boards to slash their operational costs by as much as 50% will only place further obstacles to vaccine coverage recovery.”
Seeing nurseries adopt infection control strategies in recent days therefore feels at once entirely sensible and a dodgy sticking plaster. Since the 1980s, we have known a quick injection is the real solution to the scourge of measles. We also know the way to achieve it: a public health campaign for immunisation; vaccinations in the community (as recommended in the government’s recent 10-year plan for NHS England); and a culture of collective responsibility to protect one another.
That last one is something we are not supposed to say out loud, lest we intrude on individual liberties. But it is nonetheless a vital piece of any conversation about vaccines. Herd immunity, after all, is at its heart an acknowledgment that “personal choice” about vaccination has consequences – sometimes deadly – for the rest of society. Children with suppressed immune systems, for example, can still fall seriously ill with measles even if they have had the MMR jab. They rely on everyone else doing the right thing and helping them keep safe. Again, stop me if you’ve heard this one before.
Perhaps the real lesson does not come from Covid but from the long fight against measles. Public health is not a single victory. One day there is joy in the invention, the next a backlash against it. The great irony of vaccines is that populations become complacent about a disease and the need for immunisation largely because a successful vaccine made it feel as though the threat was consigned to the past. As a nation, we still remember coronavirus patients gasping for air in the ICU. Let us hope it does not take more dead children for the public to be reminded of the danger of measles.
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