Experts from an Italian study have suggested that compulsory measles vaccines before children start attending school may be necessary to prevent increasing disease incidence rates worldwide.
Shutterstock | Kaspars Grinvalds
What is Measles?
Measles is a viral disease that is highly contagious and is transmitted through droplets from the nose, mouth, or throat of people infected with the disease. Symptoms of measles progress from fevers, white spots inside the mouth, and bloodshot eyes, to a rash on the face and neck that spreads across the body.
Although the infection can clear within 7 to 10 days, it can cause life-threatening complications including blindness, encephalitis (swelling of the brain) and pneumonia. Severe cases of measles are more likely to develop in malnourished, young children, or in people with suppressed immune systems like those living with HIV/AIDS or other diseases that compromise the immune system.
Why is Measles an Issue?
Despite the NHS stating that measles is now “uncommon in the UK because of the effectiveness of vaccination”, there has been a sharp increase in measles cases worldwide in recent years.
Preliminary measles surveillance data for 2019 published by the World Health Organization (WHO) revealed a “clear trend” in measles outbreaks, with outbreaks currently occurring in the Democratic Republic of Congo, Ethiopia, Georgia, Kazakhstan, Kyrgyzstan, Madagascar, Myanmar, Philippines, Sudan, Thailand, and Ukraine.
It also states that in 2017, an estimated 110,000 deaths were caused by measles, and mostly affected children under the age of 5. This is despite approximately 85 percent of the world’s children having one dose of the measles vaccine by the age of one.
Researchers in Italy have suggested that vaccines for measles should be made compulsory to combat the fall in vaccination rates in several countries, from the US, Ireland, Australia, but particularly in the UK.
Researchers from the Bruno Kessler Foundation and Bocconi University expressed concern about the fall in vaccination rates worldwide. Using computer modelling, they have predicted how many measles cases could occur between 2018 and 2050, detailed in a study published in BMC Medicine.
The projections made in the study suggest that by 2050, if vaccination policies remain the same, the proportion of the population susceptible to measles would range from 3.7 percent in the UK to 9.3 percent in Italy.
In recent years, we’ve witnessed a resurgence of measles cases even in countries where, according to World Health Organization guidelines, elimination should already have been achieved. This resurgence is due to suboptimal vaccination coverage levels.
“In Italy, where measles incidence rates were among the highest, the government has made measles vaccination compulsory for children before they enter primary school.
“We investigated the potential of this and other policies to reinforce immunization rates in seven high-income countries.”
Dr. Filippo Trentini, First Author of the Study
However, not everyone agrees that compulsory vaccination would be an effective tactic to combat a resurgence of the disease. Professor Adam Finn of the University of Bristol explains that this approach may not be effective for everybody.
Mandatory immunization is certainly one way to try and increase coverage but it’s far from clear how well it works or whether it would work at all in many places.
“If the reasons that the vaccine is not getting into the children relate to easy access, vaccine supply or clarity of information available to parents, then making it compulsory will do nothing to alleviate such obstacles.
“If there is widespread mistrust of authority or of the motivation behind any such requirements, it could actually make things worse.”
Professor Adam Finn, University of Bristol
Co-author of the study Dr. Stefano Merler is confident about the conclusions made by his study.
“Our results suggest that most of the countries we have studied would strongly benefit from the introduction of compulsory vaccination at school entry in addition to current immunization programmes.
“In particular, we found that this strategy would allow the UK, Ireland and the US to reach stable herd immunity levels in the next decades, which means that a sufficiently high proportion of individuals are immune to the disease to avoid future outbreaks.
“To be effective, mandatory vaccination at school entry would need to cover more than 40 percent of the population.”
Smitha Mundasad, a BBC health correspondent said that vaccines “may have become a victim of their own success. Because they’re working so well and doing what they’re supposed to do, maybe people aren’t seeing the serious complications of […] measles anymore.”
This may lead to people underestimating the seriousness of the disease and not believing vaccines are necessary.
The fall in vaccination is also due to a study that was based on just 12 children drawing links between the measles, mumps and rubella (MMR) vaccine and autism, leading many people to be wary of vaccinating their children, despite this research being extremely flawed and later disproven and removed by the Lancet where it was first published.
Social media is also helping to fuel anti vaccine debates through sharing low quality or inflammatory information.
Health Secretary Matt Hancock stated that he was open to considering “all options” to help England raise its vaccination levels, which included bringing in compulsory vaccinations, although he said he did not necessarily want to reach that point