Children Should Have Compulsory Measles Vaccinations Before Starting School, Experts Urge

"Current vaccination policies are not enough to control rising numbers of cases."

The UK should consider introducing compulsory measles vaccinations before children can start school, experts have said.

A team of Italian researchers warned that current vaccination policies are “not enough” to control rising numbers of cases.

Researchers from the Bruno Kessler Foundation and Bocconi University in Italy looked at vaccination trends in several countries, including the UK, Ireland, Australia, Italy and the US.

They concluded that in order to keep the percentage of the population susceptible to catching measles under 7.5% by 2050 – the level at which measles is regarded as eliminated – further action is needed. Either far more people need to be vaccinated or a school policy should be brought in, they said.

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The study, published in the journal BMC Medicine, found that an estimated 3.7% of the UK population across all ages remained susceptible to measles in 2018. This figure is expected to rise by more than 50% by 2050 if current vaccination policies remain the same.

“Our results suggest that most of the countries would strongly benefit from the introduction of compulsory vaccination at school entry in addition to current routine immunisation programmes,” the researchers said in their report.

Co-author Dr Stefano Merler added: “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% of the population.”

In the UK, anti-vaccination groups have been blamed for some parents not vaccinating their children with the combined measles, mumps and rubella vaccine (MMR).

Simon Stevens, chief executive of NHS England, has said “vaccine rejection is a serious and growing public health time bomb”, and Health Secretary Matt Hancock also said he “wouldn’t rule out anything” when asked whether unvaccinated children should be banned from schools.

Figures out last month from Unicef showed that over half a million children in the UK were unvaccinated against measles between 2010 and 2017.

In the UK in 2017, there were 259 measles cases in England, rising to 966 in 2018. In 2016 and 2017, uptake of the first dose of the MMR vaccine in five-year-olds in the UK exceeded 95%. But uptake of the second dose of MMR in five-year-old children is 88% – well below the 95% WHO target.

In response to the new study, British experts have cast doubt on whether introducing a policy of compulsory vaccination would work.

Dr David Elliman, consultant in community child health at Great Ormond Street Hospital, and from the Royal College of Paediatrics and Child Health, said such a policy lacks evidence for the UK.

“Only about 1% to 2% of UK parents refuse all immunisations,” he said. “A larger proportion may have concerns that are readily addressed by healthcare professionals, while a significant number still have problems accessing appropriate family-friendly services.”

Dr Elliman said introducing compulsory vaccination in this country might reduce the “very high level of trust” that people have in the NHS – and prove counterproductive. “It could even result in lower levels of vaccination,” he said.

Sonia Saxena, professor of primary care at Imperial College London, agreed that making vaccination mandatory might have unintended consequences.

“It risks disenfranchising parents and carers, as well as risking a rise in unvaccinated children being excluded from school, which could carry stigma for children whose parents do not comply,” she said.

“More effective approaches would include reminding parents and providers of upcoming and overdue immunisations, as well as educating and providing feedback to the doctors, nurses and healthcare staff providing vaccinations.”