Measles and myths: A dangerous duo on the rise

The U.K. reported no measles cases in 2016. In 2017 and 2021, the World Health Organization stated that the country had successfully attained "elimination status" for the disease, meaning no endemic case had been detected in the years prior.

However, there were 1,603 suspected cases in England and Wales in 2023, as recorded by the U.K. Health Security Agency. 2022 saw 735 cases, 360 in 2021, and 695 in 2020. Before the COVID-19 pandemic, 2,422 cases were suspected in 2019 and 2,608 in 2018.

Measles cases in the West Midlands are the highest since the 1990s, with around 300 cases and 50 children treated in hospital since December last year. Earlier this year, Birmingham Children's Hospital also reported more than 50 children needing treatment in just one month. According to a recent UKHSA prediction, a measles outbreak in London could result in up to 160,000 cases. Across the Atlantic, measles is also on the rise – in Florida, the surgeon general has defied federal guidelines, overseeing a dramatic increase in cases in the state. 

Logically Facts takes a closer look at what’s driving these increases and the myths surrounding measles. 

What is measles?

Measles is considered one of the most contagious existing diseases. If a person has it, up to 90 percent of the people around them who are not immune will become infected. If an infected person has been in a room, the air stays contagious for up to two hours after they have left. Measles is not just a rash, runny nose, and fever; it can lead to multi-organ system problems affecting the brain and lungs. It can also cause deafness.

Before measles vaccines, nearly every child contracted measles before age 15, and it was indirectly responsible for as many as half of all deaths caused by childhood infectious diseases. The disease became epidemic every two or three years, mainly in late winter and spring. Children stayed home for weeks with a fever and cough, and with each wave, thousands were hospitalized with pneumonia or brain swelling, which, in some cases, led to permanent brain damage, seizures, and death. Because measles depletes the immune system, children who recover remain more susceptible to ear infections, bronchitis, and pneumonia.

What about vaccines?

Fortunately, measles can be easily prevented with vaccines. Even a single dose is highly effective. Getting two doses of the measles, mumps, and rubella (MMR) vaccine at the age of two and five results in 99 percent protection and provides lifelong immunity. When planning to travel to an area where measles occurs more frequently or because of possible exposure during an outbreak, the second dose can be given one month after the first. Effective and safe, MMR is the gold standard of vaccines. 

Vaccines protect individuals and contribute to herd immunity, safeguarding the most vulnerable in communities – from small groups of people living in close proximity, to whole countries. 

About 95 percent of a community needs to be immunized to achieve herd immunity against measles. Even a small number of holdouts can precipitate a crisis. The R-rate of measles — the average number of people one infected person passes the virus onto — is between 12 and 18. By comparison, the R-rate of COVID-19 at the beginning of the pandemic stood at 2 to 3.

It sounds like an easy-to-solve problem, yet Dr. Jenny Harries, chief executive of the U.K. Health Security Agency points out that in parts of London, MMR uptake was down to 60 percent. Apparently, vaccine misinformation spreads just as quickly as the disease itself.

Scientific fraud with tragic consequences

In 1971, when the combined MMR vaccine was first introduced, it was a public health triumph. In 1998, however, infamous disgraced physician Andrew Wakefield published a paper in the medical journal The Lancet that purported to show a connection between the MMR vaccine and traits of autism. The results were rapidly refuted, the journal retracted the paper, and Wakefield lost his medical license and moved to the U.S. However, his claims burrowed deep among some social groups. 

Wakefield later founded the Autism Media Channel in Austin, Texas, which makes videos asserting a link between autism and the MMR vaccine. Its most famous film was Vaxxed, directed by Wakefield himself, and it was put forward for premiere at the 2016 Tribeca Film Festival by Robert De Niro, the father of an autistic child. After a furor and discussions with scientists, De Niro withdrew the film.

VAXXED film posters, claiming it to be “the film they don’t want you to see.” (Source: Screendaily, Screenshots)

Following this, numerous parents in the U.S. and Europe began avoiding the MMR vaccine due to unfounded fears of children developing autism. An outbreak of measles in Minnesota in the spring of 2017 was caused by doubts about the MMR vaccine in the local American-Somali community, which had seen a rise in autism rates. Wakefield had visited the community earlier, talking to them about the risk of autism after vaccination.

Nimo Hirsi, a community leader in Birmingham, said many Somali groups believe there is a link between vaccines and autism. Professor Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, said this sentiment was common among Somali groups worldwide. High levels of autism and low rates of vaccination have been reported among the Somali diaspora in Sweden, the U.S. state of Minnesota, and elsewhere. "There is no simple explanation," she said. "It might be a genetic predisposition. We don't know."

Extensive research has demonstrated that the measles, mumps, and rubella vaccine does not cause autism. Johns Hopkins infectious disease experts Aaron Milstone, M.D., M.H.S., and Lisa Maragakis, M.D., M.P.H., confirmed to Logically Facts that "the measles vaccine is extremely safe. Some children — about 10 percent — will develop a fever about six to 12 days after vaccination, and an even smaller percentage will have a rash that can last a few hours to a day or two. In sporadic cases, the fever can precipitate a seizure in children predisposed to fever-induced seizures. Scientific research has shown unequivocally that the measles vaccine does not cause autism or other permanent neurologic or developmental problems."

COVID-19 legacy

In 2022, England's measles, mumps, and rubella vaccination rates fell to their lowest in a decade. A growing distrust in vaccines, exacerbated by anti-vaccine movements during the COVID-19 lockdown, deterred many from vaccinating their children against polio, measles, and other dangerous diseases. The latest data reveals that most of the 209 laboratory-confirmed measles cases between 1 January 2023 and 30 November 2023 were in children under 10, reflecting the decline in vaccination rates.

Even before COVID-19, vaccine hesitancy was one of the biggest threats to human health. The pandemic became an opportunity for vaccine skeptics. Misinformation infected social media, playing on parental fears, and was routinely spread by physicians. A recent U.S. study showed that distrust of the COVID-19 vaccine has caused some people to avoid measles vaccination. In the U.S., only 79 percent of people now think that children's vaccines are essential, a more than 10 percent decrease since 2020. According to UNICEF, adults under 35 are much more likely to be hesitant about children's vaccines. 

COVID-19 vaccines have been lifesavers. Among those who were fully vaccinated and boosted against COVID-19, only 8.9 out of 10,000 persons died or were hospitalized due to the disease. A study in the Lancet found that COVID-19 vaccinations prevented 14.4 million deaths in 185 countries.

The risk of unknowing

Another problem is that conspiracy-driven vaccine doubts affect some groups more than others. Those from lower-income and some racial and ethnic minority communities tend to be more vulnerable to conspiracy theories. Understanding this phenomenon is crucial, given the long history of mistrust towards medical authorities and experiences of discrimination and disadvantage. This partly explains lower vaccination rates among children in lower-income neighborhoods and some ethnic minority communities. Dr. Peter Hotez has argued for "vaccine diplomacy" in the fight against measles. 

Dr. Stephanie Dawe, a GP at Handsworth Wood, said to The Times, "The problem we have is that many people in West Birmingham cannot read even in their language. There is a real communication issue, a real feeling of distrust. They look at someone like me — pale and freckly — and know I don't have the same life experience."

Dawe and Joy Krishnamoorthy of Flourish, a Birmingham health group, devised the idea to record myth-debunking videos in various languages and distribute them via WhatsApp. "We think it needs to come from a trusted health professional but be shared by women in their social media groups," said Dawe.

The UKHSA conducted a survey in partnership with the U.K.'s Department of Health and Social Care, which noted that 48 percent of parents were unaware that measles can lead to complications such as pneumonia and brain inflammation. Fifty-six percent were unaware that two doses of the MMR vaccine give 99 percent protection.

Propaganda proliferates

Anti-MMR propaganda has mainly proliferated on social media and forums, thriving within groups of people who tend to reinforce each other's beliefs. While Meta has applied measures to prevent the promotion of anti-vaccine information, numerous agitators remain active on the platform. On Amazon, books skeptical of vaccines confidently dominate search results. 

However, such misinformation has thrived in more traditional mediums too. A pamphlet published by an organization known as PEACH (Parents Educating and Advocating for Children's Health) widely circulated for about two years in Orthodox Jewish communities in upstate New York and New Jersey. The copies included unproven anti-vaccination theories combined with passages from Jewish religious texts. They appeared in kosher grocery stores and by apartment doors. The authors and financing behind PEACH have remained primarily anonymous. 

New York City health officials later identified the handbook as propaganda. Rebecca Feldman, a local Orthodox Jewish nurse, called PEACH's actions a "pretty good propaganda effort,” considering that the number of measles cases in these neighborhoods has grown significantly.

Page of a PEACH pamphlet dedicated to the so-called Autism Epidemic caused by the MMR vaccine. (Source: Peach Magazine's Handbook, Screenshot)

Among the reasons measles outbreaks are mounting is that the COVID-19 pandemic caused millions of children to miss out on planned vaccinations. Since the onset of the COVID-19 pandemic in March 2020, there has been a notable decline in parents immunizing their children with childhood vaccines, including MMR. 

In one academic paper, Seilesh Kadambari of the Oxford Vaccine Group and British Infection Association representative comments, "The decline in MMR vaccine is multifactorial and needs further exploration. During the COVID-19 pandemic, it is possible that parents felt anxiety about attending healthcare facilities because it could potentially expose themselves and their children to SARS-CoV-2. Reduced access due to staff shortages in primary care and also parents' feelings of personal responsibility in not wanting to overburden the NHS may have also contributed to this decline in MMR uptake."

Some parents also struggle to get their children vaccinated, even when they understand the necessity. Kirsten Watters, Camden's council director of health and wellbeing, agrees that limited access to vaccination centers is a significant obstacle. She adds, "When talking to parents, we know that most intend to vaccinate their children, and they have high levels of confidence and trust. It's just that they're finding it difficult to organize those appointments." 

What can be done?

The resurgence of measles in the U.K. is a stark reminder of the complex interplay between public health, misinformation, and societal response. The decline in measles vaccination rates, fueled by misinformation and the legacy of COVID-19, has led to a distressing increase in cases, particularly in vulnerable communities.

Measles is not a benign childhood disease but a severe threat. The effectiveness and safety of the MMR vaccine are well-established, yet vaccine hesitancy remains a significant hurdle. This hesitancy is driven by misinformation, mistrust in medical authorities, access issues, and the lingering effects of the COVID-19 pandemic.

Addressing this crisis requires a multifaceted approach. First, it is crucial to counter misinformation with accurate, transparent, and culturally sensitive information. Initiatives like myth-debunking videos in various languages are a step in the right direction. These efforts must be amplified and supported by trusted community leaders and healthcare professionals to rebuild vaccine trust. 

Second, improving access to vaccination is essential. This means making vaccines available, ensuring that appointments are easy to schedule, and that vaccination centers are accessible to everyone, especially in underserved communities.

The battle against measles is not only about a virus. It is also about communication and education. The collective efforts in science, public health, and community engagement can turn the tide against measles and strengthen resilience against future health crises.