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Head To Head Head to Head

Should measles vaccination be compulsory?

BMJ 2019; 365 doi: (Published 05 June 2019) Cite this as: BMJ 2019;365:l2359

Rapid Response:

Advocates of compulsory vaccination also need to acknowledge risks

Eleanor Draeger acknowledges a competing interest, "ED’s son caught measles when he was too young to have had the vaccine himself" [1], but she also needs to acknowledge that MMR vaccination seems to have actually increased the risk to infants. According to an Oxford Vaccine Group web page as many as 95% of cases in Europe last year were in children too young to be vaccinated [2]:

"Numbers of measles cases are currently high in several European countries. There were over 82,500 measles cases in Europe in 2018 . This is more than three times as many as in 2017, and 15 times as many as in 2016. In 2016 and 2017 there were 49 deaths from measles in Europe, and 2018 saw another 72 deaths. Some countries have reported that over 60% of measles cases have been hospitalised. See the regular reports from the European Centre for Disease Prevention and Control. There have been particularly serious outbreaks in Serbia, Ukraine, Georgia, Greece, Romania, Italy, and France. Around 95% of cases have been in babies and children under 1 year of age who were not yet vaccinated."

95% is a remarkable figure but it should be noted that this is likely a consequence of vaccination not non-vaccination. In 1996 a paper by Markowitz et al reported [3]:

"Among women born in the United States (n = 614), geometric mean titers (GMTs) of measles antibodies decreased with increasing birth year. For those born before 1957, 1957 through 1963, and after 1963, GMTs were 4798, 2665, and 989, respectively."

So 23 years ago we were beginning to see lowering measles immunity in the infant population as a result apparently of vaccine induced lowered immunity in the adult population (particularly female), a problem which would likely accelerate as the era before which children were vaccinated against measles receded into the historic distance. In 1996 Markowitz hypothesised:

"An increasing proportion of children in the United States will respond to the measles vaccine at younger ages because of lower levels of passively acquired maternal measles antibodies."

However, this hope has not been fulfilled, so a group infants under the age of one are unavoidably exposed to a measles risk which was perhaps slighter when we had herd natural immunity. It is also a problem that the risk of SSPE may be higher in an infant [4]. This is not to say there are no benefits to measles vaccination but the balance sheet is much more complicated than lobbyists for compulsory vaccination would have us suppose.

In any such discussion we ought also to acknowledge that we are not necessarily simply talking about measles vaccination. No single measles vaccine has been made available in Europe for years - only MMR - and the mandated schedules of of Italy and France extend well beyond measles. Moreover, the public are left wondering how many more vaccines might be mandated once the Rubicon has been crossed.

These are really issues which politicians seeking to enforce vaccine mandates need to address, along with the traditional opprobrium and disdain meted out to anyone who has concerns - and it will not be enough simply to be nice to people for a change, it will be necessary to answer their questions.

I also object strongly to sanctions against ordinary people which may be insignificant to the rich and powerful.

[1] Draeger, Elliman and Bedford, 'Should measles vaccination be compulsory?', BMJ 2019; 365 doi: (Published 05 June 2019)

[2] Oxford Vaccine Group, Vaccine Knowledge Project: Measles:

[3] Markowitz LE, Albrecht P, Rhodes P, Demonteverde R, Swint E, Maes EF, Powell C, Patriarca PA., 'Changing levels of measles antibody titers in women and children in the United States: impact on response to vaccination. Kaiser Permanente Measles Vaccine Trial Team.', Pediatrics. 1996 Jan;97(1):53-8.,


Competing interests: No competing interests

06 June 2019
John Stone
UK Editor
London N22