Intended for healthcare professionals


MMR vaccine: Johnson urges new impetus to increase uptake as UK loses measles-free status

BMJ 2019; 366 doi: (Published 20 August 2019) Cite this as: BMJ 2019;366:l5219
  1. Jacqui Wise
  1. London

The prime minister, Boris Johnson, has said that urgent action is needed to boost the number of children receiving the measles, mumps, and rubella (MMR) vaccine after the UK lost its measles-free status with the World Health Organization.

In the first quarter of 2019 some 231 cases of measles were confirmed in the UK. Many of these were acquired abroad, with some onward spread in under-vaccinated communities. The UK achieved measles-free status in 2016 after three years of limited spread due to high vaccination rates. However, a small but steady decline in MMR vaccine coverage has been measured in recent years.

Global rise

Earlier this month WHO warned that, in the first six months of 2019, almost three times as many measles cases were reported globally as in the same period last year.12 Measles is now classed as endemic in a number of European countries including Belgium, France, Germany, and Italy.

While visiting a hospital in the south west of England, Johnson called for a renewed effort for both doses of MMR to meet 95% vaccination coverage rates. Currently, only 87.2% of children in England are getting the second dose of the MMR vaccine, and uptake in London has dropped to 77.8%. Public Health England says that one in seven 5 year olds in England starts school without a second dose of MMR, and the situation is even worse in London, where one in four in this age group lacks full protection.

Johnson said that he would call a summit of social media companies to discuss how they could help to promote accurate information about vaccination. Advice on the website will also be updated to specifically tackle misleading information about the dangers of vaccines.

In addition, NHS England is writing to GPs, urging them to promote catch-up vaccination programmes for MMR in 10-11 year olds, as well as in people aged 5-25 who have not had two doses. The role of local immunisation coordinators will also be strengthened.

Tackling negativity

The Department for Health and Social Care is due to deliver a comprehensive strategy in the autumn to improve vaccination uptake. This is likely to include asking the NHS to use technology to identify who may have missed vaccinations, to issue reminders, and to make booking appointments easier. The GP contract review will also look at improving GPs’ capacity to allow additional immunisation appointments and will ask NHS England to consider settings other than general practice for vaccinations.

Helen Stokes-Lampard, chair of the Royal College of General Practitioners, particularly welcomed the news that the government was involving social media companies in its strategy to boost vaccination uptake.

She said, “It is not just the responsibility of GPs and other healthcare professionals to combat anti-vaxxer propaganda: everyone has a part to play—health, public health, and education bodies. But we also need technology companies to take responsibility and tackle negativity and confusion around vaccination information.”

The Royal Society for Public Health said that the UK’s loss of its measles-free status was hugely worrying. The society’s chief executive, Shirley Cramer, said, “Uptake for the MMR vaccine has persistently been below the 95% target over the last few years, and if this doesn’t change we can absolutely expect to see a further rise in cases of this serious illness.”

WHO reported that 37 of 53 European countries were classed as measles-free in 2018.3 However, several countries are likely to lose their measles-free status alongside the UK at the end of this month, when the European Regional Verification Commission for Measles and Rubella Elimination publishes its report.

Provisional data, based on monthly reports to WHO as of August 2019, showed 489 measles cases in the UK. Other countries also previously classed as measles-free include Albania (475 provisional measles cases), Bulgaria (1032), the Czech Republic (569), Israel (981), and Lithuania (729).


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