Intended for healthcare professionals


Measles: low uptake blamed on “incredulity and hostility” towards doctors

BMJ 2019; 365 doi: (Published 26 April 2019) Cite this as: BMJ 2019;365:l1932

Linked opinion

Rebuilding trust in immunisation is key to tackling vaccine hesitancy

  1. Elisabeth Mahase
  1. The BMJ

Around 169 million of the world’ children did not receive their first dose of measles vaccine between 2010 and 2017, an average of 21.1 million a year, shows the latest report from Unicef.1

Of the world’s high income countries, the US topped the list for the number of children who were not vaccinated in that time, with 2 593 000 missing out. France came second with 608 000, then the UK with 527 000.

In low and middle income countries the situation was much worse, the report said. In 2017 nearly four million children under the age of 12 months missed out on the vaccine in Nigeria—the highest number worldwide—then 2.9 million in India, 1.2 million each in Pakistan and Indonesia, and 1.1 million in Ethiopia.

Global health researchers said that though the major historical barrier to vaccination take-up was poor supply in lower income countries, a key factor now was “incredulity and hostility” in rich countries towards doctors and governments who promote the importance of vaccination—exacerbated by a suspicion of experts propagated by populist political parties.

Earlier this month WHO reported that numbers of measles cases in January to April 2019 had risen by 300% from the same period in 2018, with Africa experiencing a 700% increase, Europe a 300% increase, and the Americas a 60% increase.2

In 2017 England and Wales had 277 confirmed cases of measles, a drop from the 547 in 2016 but higher than in 2015 (91) and 2014 (121).3

Meanwhile, the latest figures from the US Centers for Disease Control and Prevention (CDC) show that as at 24 April a total of 695 measles cases had been reported by 22 states in 2019, the highest number since measles was officially eliminated from the country in 2000.4 The CDC said that the numbers reflected three large outbreaks, two in the New York metropolitan area, leading to New York City’s mayor declaring a public health emergency,5 and one in Washington state.

In Central and South America, the Pan American Health Organisation has launched the 17th annual immunisation week, an initiative begun in 2003 in response to measles outbreaks in the region.6 Across 20 countries, including Jamaica, Uruguay, Suriname, Colombia, Guatemala, and Haiti, the scheme should see more than 2.25 million people vaccinated against measles this week.

The chair of the BMA’s board of science, Parveen Kumar, who this week won the Outstanding Contribution to Health award at The BMJ Awards 2019,7 said, “There is a voluntary system for childhood vaccination in the UK. Parents and carers need support to make informed choices, but if misinformation—be this via targeted campaigns or through inaccurate reporting—is a deterrent this must be stopped.

“We need vastly improved awareness campaigns, publicising the benefits of vaccination and working towards removing apathy and indecision.”

Jonathan Kennedy, lecturer in global public health lecturer at Queen Mary University of London, said, “Historically, the major barrier to raising vaccination rates was poor supply in low and middle income countries, but now it is relates to falling demand—vaccine refusal in other words—among parents in high income countries.

“Increased vaccine refusal is clearly linked with the rise in support for populist parties. In both cases, the driving force is increasing anger and suspicion towards elites and experts. In the political sphere, this is focused on traditionally dominant centre left and centre right parties and politicians. With public health, it manifests as incredulity and hostility towards the government bodies and medical doctors who insist on the importance and safety of vaccines like MMR.”


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