Measles

Maria Caulfield Excerpts

Monday 22nd January 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care to make a statement on the declaration of a national incident in response to the recent surge in measles cases.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank the hon. Lady for giving me the chance to update the House on this important matter, further to the written ministerial statement that we will publish later today.

The UK Health Security Agency announced last week that it has declared a national standard incident in response to an increase in confirmed cases of measles. In order for our measles, mumps and rubella vaccine to work, the World Health Organisation recommends at least 95% coverage to maintain population coverage. At the moment, our MMR reach is 89.3% for the first dose at 24 months, and 84.5% for the second dose at five years.

This is not a new issue. There has been a gradual decline in coverage over 10 years because of a number of factors, ranging from the Wakefield generation, when Dr Andrew Wakefield published his discredited paper on the risks of MMR, through to covid, when routine vaccinations were missed, and there has been a drop since then. There have also been concerns in particular communities, such as the Jewish and Muslim communities, about the type of vaccine used. We have not been waiting: the NHS has carried out a catch-up effort over the past 12 months, proactively contacting parents and carers of unvaccinated children aged five and younger, and we have seen a 10% increase in vaccination compared to the previous year.

However, that is not enough. NHS figures show that almost 3.5 million children under the age of 16 are unprotected and at risk of catching this serious and preventable disease. Measles is so infectious that one infected child in a classroom can infect up to nine other unvaccinated children, making it one of the most infectious diseases worldwide. While for most it will be a mild illness, one in five children with measles will need to be admitted to hospital for treatment, putting additional pressure on the NHS.

I want to stress that this is not just a childhood disease; for adults who have not been vaccinated it can be a serious and potentially life-changing event. My message to mums and dads with children who are currently unvaccinated is to come forward. We have a range of measures in place. One million letters are going out to the parents of unvaccinated children across London and the midlands.

We have extra clinics being set up by GPs, pop-up clinics in schools and vaccine buses targeting communities with low vaccination rates. We have held two MP briefing sessions, on 12 and 19 January: one for the west midlands and one for London. Today we have sent out information to MPs so that they can help us get the message out to their constituents to come forward. It is not too late. There is no age limit. Anybody who has not had their vaccination can come forward. The first vaccine will provide roughly 92% protection, and the second will provide 98%. The message is to come forward and get vaccinated.

[Preet Kaur Gill]

Thank you for granting this urgent question, Mr Speaker.

The declaration of a national incident due to the rise in measles cases by the UK Health Security Agency on Friday is concerning. Measles can be serious and it is extremely infectious, with a reproduction rate five times that of covid. However, it is also entirely preventable. The Minister is right to emphasise the importance of getting vaccinated. The MMR vaccine is safe, effective and the best way to protect ourselves and our loved ones against measles. There is no age cut-off for getting an MMR vaccine. There are alternatives available for those who do not touch pork products. Once a person has had it, the vaccine can provide protection within two weeks. I urge anyone watching this who has not been vaccinated to contact their GP.

Mr Speaker, we are in agreement that this issue is serious. I thank the Minister for outlining some of the steps that she is taking. However, we should never have got to this point. The UK was deemed by the World Health Organisation to have eradicated measles just five years ago. Since then, MMR vaccination rates have plummeted, leaving tens of thousands of children completely unprotected, which means that now one in five children is not protected with two doses by the age of five. Cases have also risen consistently over the years, and by 120% in the past year alone, so the warning signs could have been seen from space. What steps are being taken to get a grip on this crisis before it becomes a national outbreak? How will the Minister rectify her Department’s failure to maintain child vaccination rates for contagious diseases? Is this not another instance of Government complacency when it comes to protecting our children’s health?

For the record, Mr Speaker, my team attended a briefing with the Minister and her officials on this issue on 12 January, which she has mentioned. I requested some more information and communications materials that I could use in my capacity as a local MP, given the rise in cases in Birmingham. It took until this morning—some 10 days later—to be sent that information, but only after a national incident had been declared. Have the Government been asleep? Have no lessons been learned from the pandemic that, with highly transmissible diseases, the sooner we act, the better?

We saw how much children suffered and lost out during the pandemic, so the re-emergence of serious childhood illnesses that we have vaccines for and that we know how to prevent is unacceptable. When 80 countries across the world are measles-free, it is a badge of shame that this Government have lost the UK that status on their watch.

[Maria Caulfield]

I remind the hon. Lady that health is a devolved matter across the United Kingdom. When she refers to the United Kingdom’s lower MMR vaccination rate, does she include Labour-run Wales? Wales has also not met the WHO threshold, and neither has Scotland, Northern Ireland or England. It is a real shame to play politics with this issue. This is an issue of the utmost importance.

As I have set out, this Government have been working over the past 12 months to get vaccination rates up in England, and we have seen a 10% increase. There are a range of reasons why we are seeing certain parts of the country and some communities not coming forward. The hon. Lady touched on the concerns of the Jewish and Muslim communities that a wide range of MMR vaccines are porcine vaccines. We do have non-porcine vaccines available. Priorix is not just available on request; following a meeting that we had with west midlands MPs, we proactively pushed Priorix out to communities. The help of local MPs to get that message out to communities would be extremely valuable. There is also a halal vaccine available. Again, we need to get that message out, so that people do not have to request it; it would be routinely offered to them.

We are also undoing much of the damage done to the Wakefield cohort of young adults, who were born between 1998 and 2004, when Dr Andrew Wakefield’s discredited paper on the risks of MMR led to a drop in the numbers coming forward for the vaccine. Those young adults are eligible for vaccines right now to try to prevent the spread of measles.

We also know that covid disrupted the routine vaccination programme. Again, that is a key reason why all four nations of the United Kingdom are not meeting the WHO recommended coverage. As I have set out, letters are going out to the parents of unvaccinated children, because we recognise that rates have been lower than we would wish. One million have gone out across London and the west midlands. Of all parts of the United Kingdom, it is the west midlands that we are most concerned about.

To give the House some context, last year there were more than 209 laboratory-confirmed measles cases in England, over three quarters of which were from the west midlands, predominantly Birmingham and Coventry, so there is a particular push in the west midlands. That is why nearly two weeks ago we gave a briefing to local MPs and local directors of public health, who are doing an outstanding job at the coalface, rolling out pop-up clinics in schools and going out on community buses to reach communities that may struggle to be reached through traditional routes. GPs are putting on extra clinics, but we have to get the message out. It is not through a lack of vaccines or a lack of messaging, but we still have vaccine hesitancy. We all have a role to play in getting communities to come forward.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

In April last year, the UK Health Security Agency told the Health and Social Care Committee that it was

“expecting measles to come back”,

while the Joint Committee on Vaccination and Immunisation told us that the threat was “very real”. Last summer, as the Minister knows, we published a vaccination report as part of our prevention inquiry. We were pleased that, in answer to a recommendation, NHS England published its vaccination strategy just before Christmas. Can the Minister say more about how she will inject more urgency into the roll-out, and will she commit, as we also asked, to a much more flexible delivery model for vaccinations, including through pharmacy?

[Maria Caulfield]

The Chair of the Health and Social Care Committee is right. That is why we have met with both the west midlands and the London teams to hear from those on the ground what resources they need in order to become more nimble in the vaccine roll-out. The communities that are not coming forward are the ones that are not engaging with the routine MMR vaccine programme, so we need to be more nimble, which is why we are hearing from those vaccinating on the ground about vaccine buses going into communities, pop-up clinics in schools, and GPs putting on extra vaccine clinics. From our data, we have a list of the children who are unvaccinated, and more than a million letters have gone out to their parents to urge them to come forward.

My hon. Friend is right about using pharmacy, with Pharmacy First as a model, to make it even easier for people to come forward, but the real barrier is people’s reluctance to get vaccinated for a variety of reasons, whether it is vaccine fatigue through covid or because they missed their routine appointments and find it difficult to come forward at an extra clinic. We are engaging with local authorities and the Department for Education to try to make it as easy as possible for children and adults to get vaccinated.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

There are clear inequalities in vaccination uptake, including MMR, which reflect various socioeconomic inequalities. What extra support is being given to those areas, and to places such as mine, and why, as the Chair of the Health and Social Care Committee suggests, was the risk assessment of the UK Health Security Agency seemingly ignored by the Government?

[Maria Caulfield]

I can assure the hon. Lady that it was not ignored by the Government. Over the past 12 months, we have been pushing vaccinations to those who have not come forward, and to communities that struggle with vaccination uptake, which is why in the past 12 months there has been a 10% increase. As I say, that is not enough. There are still people who need to come forward for vaccination who have not done so. I emphasise to the House that this is an acute outbreak of measles. If someone has their first dose of the measles vaccine today, within two weeks they will have roughly 92% immunity. If they go on to have the second vaccine, they will have roughly 98% immunity, which will be lifelong.

[Sir Desmond Swayne (New Forest West) (Con)]

Might vaccination rates benefit from a much more generous compensation scheme for the very small number of severe adverse reactions?

[Maria Caulfield]

We have a vaccine damage payment scheme, which provides a one-off payment of £120,000. That is accessible for any vaccine that someone takes up, but I have to say that part of the problem is misleading information about the safety of vaccines. The measles vaccine is safe. At one point, we had eliminated measles in this country. Most children will be fine, with a mild illness, but we have had episodes of children getting encephalitis, which is a swelling of the brain that has lifelong consequences. We must move away from the narrative that vaccines are not safe. The measles vaccine is one of the safest vaccines people can have. I really do not think that that messaging is helpful.

[Daisy Cooper (St Albans) (LD)]

During the covid pandemic, my constituency of St Albans had one of the highest rates of vaccination. That was, in part, because of the work of our GPs and pharmacists, but we were also incredibly proactive at recruiting community champions, who could have those vital conversations to tackle hesitancy within particular pockets of our community. The Minister has mentioned pop-up clinics and vans, but she has not mentioned the role of community champions. Will she work with and support the directors of public health to recruit those community champions, who can have those vital conversations so that people can put their questions to people they know and trust?

[Maria Caulfield]

The hon. Lady is right that we used community champions during covid. We had some particularly effective campaigns for those communities that do not traditionally come forward for vaccinations, and that was done by using community leaders, faith leaders and trusted organisations within communities. We are doing that in the west midlands, in London and across the country.

Those people tell us that one of the key things that prevents Jewish and Muslim communities in particular from coming forward is their fear about the porcine vaccine. Just to reiterate, we have two types of MMR vaccine. Priorix does not contain gelatine and is safe and effective as an MMR vaccine. It is available on request, but we are also pushing out its availability so that people do not have to request it and it is offered up front. It is important that people know we have sufficient supply of the gelatine-free MMR product, and faith leaders, community groups and organisations are trying to get that message out to those two particular groups.

[Maggie Throup (Erewash) (Con)]

My hon. Friend has an important message today because, after clean water, vaccines are the most impactful public health measure we have and, without a doubt, they save lives. One of the lessons we learned through the pandemic was that the most effective way to reach hard-to-reach communities is through faith and community leaders and to take the vaccines to those communities, whether that is to mosques or temples. Will she do whatever she can to ensure that we employ the same measures this time and take the vaccines to the communities and not expect the communities to go to the vaccines? Will she also consider reaching out to those fantastic vaccinators we had during the covid pandemic, who are highly trained to deliver vaccines to all age groups, and getting them on board to get the MMR vaccinations carried out as quickly as possible?

[Maria Caulfield]

My hon. Friend is absolutely right. I pay tribute to the work she did during the covid pandemic to roll out the vaccine programme to those community groups. That had such an effective reach for something we were struggling with previously, and she worked hard on that. That is exactly what we are trying to replicate with this roll-out, and we are working with community groups and faith leaders, but also taking the vaccine out to communities. I was on the call with the London teams on Friday, and they have a vaccine bus that they are taking out to community centres and faith groups so that people do not have to book an appointment to get the vaccine. It is important to say that this is not just for children. If an adult has not had their vaccine, it is never too late to get the MMR vaccine to protect themselves against measles.

[Clive Efford (Eltham) (Lab)]

Does the Minister accept that the reduction in the number of health professionals who support parents has contributed to the reduction in the number of parents presenting their children for the MMR vaccine, and that that is one of the lessons we should learn from this situation?

[Maria Caulfield]

I would not agree with the hon. Gentleman. We have plenty of vaccine—that is one of the messages we want to get out—and that is both the traditional MMR vaccine and the non-porcine vaccine. We also have plenty of vaccination spaces. We have spaces at GP clinics and pharmacies, and the school roll-out programme has spaces, but we still do not have people coming forward. We really need the help of all hon. Members in this place to get the message out that people should come forward for their MMR vaccine to protect against measles.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

Every time my six-year-old comes home coughing, I get a bit scared because, obviously, measles is highly contagious. It is important that we get the message out about the way it is passed on through coughs, sneezes and high fevers. The Minister has outlined a range of areas where the Government are trying to get that message out, but the fact is that they are fighting against a system where a number of the hesitancy messages are shared in closed groups—groups that are getting that message out to parents and carers who will not come forward. Will the Minister outline what the Government are doing to counter that and to give people an informed choice on the vaccine, so that they come forward with their children?

[Maria Caulfield]

The hon. Lady is quite right that there is vaccine hesitancy, and that is a key reason why uptake has dropped so significantly across all groups, but more in some groups than in others. That is why NHS England and the UK Health Security Agency have written to more than 1 million parents in the west midlands and London to highlight the benefits of having the MMR vaccine. As more cases of measles break out, we are seeing more people come forward to take up the vaccine, because they are balancing for themselves the risk of having the vaccine, which is very minimal, against the risk of having measles. Any help that hon. Members can give is welcome and we are very willing to hear any suggestions they have for helpful messages in their own particular communities.

[Alex Davies-Jones (Pontypridd) (Lab)]

The Minister is right to point out that one reason for the decline in people coming forward to take up the MMR vaccine is the rise of dis- and misinformation about the vaccine—not just online, but, sadly, perpetrated in this House. The Online Safety Act 2023 does very little to tackle online dis- and misinformation and to keep people safe. What is the purpose of the Government’s counter disinformation unit? Why is there no transparency on what that unit is supposedly doing, and when will the Government stand up to the social media platforms and stop them proliferating this dis- and misinformation and profiting from something that is causing real-world harm?

[Maria Caulfield]

The hon. Lady has a point that part of the vaccine hesitancy is due to misinformation about vaccines more generally. That is why we are trying to use the message of immunisation rather than vaccination, because it is a much more positive message. We are also providing positive messages and social media graphics for communities and Members of this House to roll out to counter some of that misinformation. It is really important that we get that message out. There is a problem with misinformation, and I want to reiterate that measles is a highly infectious disease that can be eliminated by vaccination alone.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her positive response to this urgent question. You and I are of similar vintage, Mr Speaker, and I recall getting my measles vaccination at Ballywalter Primary School in the early ’60s—so not yesterday, but a long time ago. There was a system where vaccination happened in schools, and I think that is where it should happen.

The Northern Ireland Audit Office reports that the number of pre-school vaccinations has been steadily declining and the rate of children getting the MMR vaccine at two years of age has fallen from 96% in 2012 to 90% in 2022—a significant drop in Northern Ireland, with a population of 1.95 million. There is clearly a crisis emerging not just in England, but across the whole of the United Kingdom, in particular in Northern Ireland. Does the Minister agree it would be helpful to have a joint approach across the whole United Kingdom of Great Britain and Northern Ireland, to ensure that children are vaccinated and, more importantly, protected against this awful disease? It is always better to do it together; that is my suggestion to the Minister.

[Mr Speaker]

I think that was the Adjournment debate on measles. [Laughter.]

[Maria Caulfield]

The hon. Gentleman is absolutely right and I want to work with all four corners of the United Kingdom, because none of us is meeting the World Health Organisation coverage for MMR. Northern Ireland has similar rates to England at 89%. A joined-up approach, so that we have better coverage for MMR across the UK and can get back on top of breakouts and eradicate measles once again, would be very welcome.