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Oral - Measles

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Edwina Hart, Minister for Health and Social Services

I have a further statement to make on the outbreak of measles, which Members will be aware has occurred in Wales.


The National Public Health Service reported yesterday that, as at 5 p.m. on 1 June 2009, there were 253 confirmed cases of measles in Wales, with 32 people hospitalised. Members will know that measles can be a serious disease, against which effective vaccination is available. Medical advice has been clear for many years that the most effective form of protection is available through the combined, measles, mumps and rubella vaccine, called MMR.


The latest figures, published last week, show that from January to March 2009, uptake of the first dose of MMR for two-year-old children increased to 89.6 per cent in Wales from 88.4 per cent, and uptake of the second dose by five years of age increased to 83.4 per cent from 82.3 per cent. Uptake of the first and second doses also increased in children reaching their sixteenth birthday to 92.8 per cent from 92.6 per cent and 82.3 per cent from 80.6 per cent respectively.

While these figures are encouraging, coverage was at its lowest in mid and west Wales and Conwy, where most of the current cases have occurred. Although nine out of 10 parents of two-year-old children are content for MMR vaccination to be given, there are 80,000 school children in Wales who missed one or both vaccinations, and they remain at risk of catching measles, mumps or rubella.


There was a period, Presiding Officer, as you will be aware, when media attention focused on research that has since been discredited, but which nonetheless cast doubt on the efficacy of the vaccine. Most of the children who have missed one or both vaccinations would have been due to be vaccinated during that period. At that time, a minority of parents called for single measles, mumps and rubella vaccines on the grounds that it offered choice when they felt that there were concerns about the safety of the combined MMR vaccine. The expert advice that I received then was that there is no link between the MMR vaccine and long-term health conditions.


Furthermore, separating the components of the MMR vaccine would have involved unnecessary additional clinic visits and vaccinations. During the periods between vaccinations, these children would have been vulnerable to serious diseases. There was also the risk that the public’s health would not be protected because some children would not complete the course. This advice has not changed and since then there have been many studies worldwide supporting the safety of the MMR vaccination. The best way of protecting the health of our children and the wider community is through the combined measles, mumps and rubella vaccine. Conversely, there is no proven medical and scientific benefit in giving single vaccines—but there is the risk of harm.


About 40,000 children have received no MMR vaccine at all, and so are unprotected should they be exposed to measles, mumps or rubella. Extensive work was undertaken in 2005-06 to implement a Wales-wide catch-up campaign to vaccinate these children and to put in place a series of steps to ensure that any unprotected child reaching school age and entering or leaving secondary school would be identified and offered vaccination. Our intention is to ensure that every opportunity is taken to protect these children before they leave school.


The catch-up campaign and additional measures were a response to a large outbreak of mumps that began in 2003, rising to a peak of about 5,500 cases, with 3,757 laboratory-confirmed cases. Vaccinations are offered in secondary schools, colleges and universities for students, and at general practices for those not in education. A total of 60,820 were immunised with one or more doses of MMR. Mumps notifications fell to low levels, with cases in Wales lower than in any region in England, and there were just 14 confirmed cases in the whole of 2007.


The current measles outbreaks result from the number of children who remain vulnerable in spite of the catch-up campaign and additional measures. The National Public Health Service’s health protection teams are working closely with local health professionals to support efforts to reach the unvaccinated children in outbreak areas. To remind parents about the seriousness of measles, we have redistributed copies of the DVD ‘Immunisation—Why Our Children Must Be Protected’ to all outbreak areas, and plan to provide copies to all secondary schools in Wales during the next two weeks.


We have also produced a new leaflet to help parents understand the considerable risk from measles. This explains that nearly everyone who catches measles will become ill, and that about one in every fifteen are likely to go on develop serious complications. Distribution of the leaflets to all parts of Wales begins later this week. 


I encourage all those with children who have missed one or both vaccinations to contact their general practice as soon as possible. Practice nurses, doctors and health visitors will be able to help and reassure parents about vaccination. It is important to place the issue of MMR vaccine in the context of our success in ensuring that uptake of other childhood vaccinations in Wales meets or exceeds our 95 per cent target. That has been achieved through a process of dialogue, discussion and the provision of reliable information which commands general trust. Where parents have confidence in the information that they have for making decisions about vaccinating their children, the vast majority act on the advice that they receive.


The most recent outbreak demonstrates vividly what can happen when that trust breaks down. It underlines the importance of continuing and strengthening the efforts that have been made to date to repair that damage, and the consequences that can follow where there is still ground to be made up. The steps that I have set out this afternoon will, I am sure, help to bring the outbreak to an end as soon as possible. We need to restore the confidence of the minority of parents whose unvaccinated children enabled measles to become re-established as an endemic disease.


The cover of vaccination evaluated rapidly, or COVER, statistics show that in south-east Wales, the highest coverage of the first dose was in Blaenau Gwent, with 94.3 per cent, and the lowest was in Cardiff and Merthyr Tydfil, which were both at 88.6 per cent. In mid and west Wales, the highest coverage of the first dose was in Bridgend, at 90.8 per cent, and the lowest was Ceredigion, at 85 per cent. In north Wales, the highest first dose coverage was in Wrexham, at 95.6 per cent, and the lowest was in Denbighshire, at 88.1 per cent.


You will be aware that calls are being made, and reported in the media, to introduce compulsory vaccination to ensure that these vulnerable children are protected. Compulsory vaccination exists in some parts of the world. For example, in some of the United States of America there is a requirement for children to be vaccinated before entering school. However, this has not been necessary where high coverage has been achieved through other approaches, such as in Sweden, Norway, Denmark and the Netherlands.


In the UK, the principle of compulsory immunisation is already accepted in certain circumstances, such as hepatitis B vaccination for healthcare workers wishing to work in certain areas, or yellow fever vaccination for travel to some countries. However, immunisation alongside other health preventative and curative services is provided, for the most part, on the basis of informed consent and patient autonomy. All four countries have an agreed childhood vaccination programme, and compulsory vaccination is not consistent with the core principle that routine childhood vaccines should be administered on a voluntary basis.


In considering a compulsory vaccination policy for Wales, we would need to consider the legal issues and look at the potential benefit of delivering a higher coverage level against the controversy that is likely to ensue. The implementation and enforcement of such a policy for MMR immunisation may harm the confidence of parents on ethical, political, and religious grounds, perhaps. In addition, preventing unimmunised children from starting school would be seen as infringing their universal right to an education.


However, I think that we should explore further the options for making completed vaccinations or checking and recording vaccination status as an entry requirement for nurseries and schools. However, I would need to be assured that such a policy would not risk undermining the existing high levels of public trust in immunisation with the outcome that the current coverage levels could decline.

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