February 7, 2024 - 7:00am
England is in the midst of a measles outbreak. Since 1 October last year, there have been 347 laboratory-confirmed cases, mostly in children under the age of 10. The outbreak has been widely attributed to falling uptake of the MMR vaccine, which is administered in two doses at the age of 12 months and then before children start school. But is this the whole story?
It’s true that coverage of the MMR vaccine has fallen. Only 84.5% of children in England received the second dose before their fifth birthday in 2022–23, compared to 88.6% in 2014–15. This means that completion of the full course has fallen by about four percentage points since 2014. According to the World Health Organization, 95% coverage is needed to achieve herd immunity.
Yet there is substantial geographic variation in vaccine coverage. In 2022–23, the percentage of children who received the second dose before their fifth birthday was 75.1% in Birmingham and 74.0% in London — well below the national average. (In Hackney, the local authority with the lowest uptake, the figure was just 56.3%.) It is therefore not surprising that the current outbreak is concentrated in Birmingham. Previous outbreaks in 2019, 2018 and 2016 were concentrated in the capital.
One thing many of the local authorities with low vaccine uptake have in common is big ethnic minority populations. Indeed, surveys consistently find higher levels of vaccine hesitancy in certain ethnic minority groups, particularly Black British. But is there an ethnic breakdown for uptake of the MMR vaccine specifically?
Yes, actually. A paper published last year in eClinicalMedicine analysed a large dataset of electronic health records and confirmed there are substantial differences in vaccine uptake by mother’s ethnicity. (By way of qualification, the authors note that their estimates “will not exactly reflect true coverage in the general population”.)
In 2020–21, the latest year for which data was available, coverage in the White British group was 93.4% — less than two percentage points short of the WHO’s recommendation. By contrast, coverage was 79.1% in the Black African group, 71.6% in the Black Other group and just 64.8% in the Black Caribbean group. So the difference in coverage between White British and Black Caribbean was almost 29 percentage points – seven times greater than the change in overall coverage since 2014.
In addition to these large differences in 2020–21, the paper found that ethnic disparities have widened since 2014. While several groups have seen little or no change in uptake, all three Black British groups have seen substantial declines — amounting to more than 20 percentage points in the case of Black Caribbeans. (The White Other group has also seen a sizeable decline.)
It is noteworthy that Birmingham, the epicentre of the current outbreak, has the largest Black Caribbean population out of all local authorities in England.
The exact reasons for vaccine hesitancy among Black British people are not well-understood — though mistrust of the healthcare system may be one. What the data does suggest is that falling uptake of the MMR vaccine is far from uniform across ethnic groups. Any campaign to boost vaccine uptake must surely take this into account.
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Subscribe‘Since 1 October last year, there have been 347 laboratory-confirmed cases, mostly in children under the age of 10.’
Are there figures for the demographics of which children are getting measles?
I wasn’t able to find any.
Hi Noah. Great article, thanks! After I read your article, I checked for relevant publications on PubMed and Google Scholar, but I couldn’t find anything relevant to Steven’s question. There seems to be a whole load of papers and reports on the distrurbing trend in the lack of uptake, but nothing about the healthcare outcomes of this trend.
Thanks again for a very informative article. Keep them coming!
Thanks – glad you enjoyed it.
When it comes to things like this, there is a concerted effort to NOT gather the data. That way, lack of clarity allows all kinds of statements to be made. It’s similar to the omission of citizenship/ethnic origin behind rape statistics.
This is also true of organ and blood donation.
When people start dying however then the blame will be firmly placed on systemic institutional racism.
What if their mistrust is a result of systemic institutional racism?
What if their mistrust is racist?
The NHS employes 383,706 BME (black and ethnic minority) people. At Birmingham’s UHB Trust 32.4% of emmployees are BMEers. Yet you want to entertain the notion that the shrinking proportion of whiteys are practicing “systemic institutional racism”.
A more likely explanation is that the unfortunate families have failed to get their kids vaccinated because they get their healthcare information from their “community leader”, God help them. But I have not seen any reputable investigation into the causes.
Ah of course. I should have applied prejudice before asking.
Not quite. The problem is that there are a lot of loudmouths out there who assume that any disparity is due to racism. To them, it’s obvious, innit? So when the Sewell Commission declined to leap on racism as the explanation for everything, it was savaged – unjustifiably so.
So when you ask a question which makes it look like you are one of the loudmouths, you get a chorus of disapproval. Personally, I’m sorry about that. Please try not to take it personally.
or because there are too many ethnic minorities working in the NHS
When something important is not well understood a bit or research into what is holding blacks back is in order and a plan formed to address the problem. Is the problem of black’s low take up unimportant? If not why has research not established precisely what the problem is and devised a solution. Asking black unvaccinated children’s parents might be a good start.
Out of curiosity, who are “Black other” given they are not Africans or from the Caribbean? Are they from the States perhaps?
(Btw, full marks to the author and/or editor for capitalising BOTH “White” and “Black”.)
What is the significance of capitalising “White” and “Black”? Or of not capitalising them? Is it important? Or trivial?
Definitely trivial, as long as you (don’t) capitalise both.
These differences in behaviour are cultural and not “ethnic” or “racial”. If you indulge a culture that distrusts professional medical advice, you must wear the consequences. That’s freedom for you.
The problem is that their choices also affect us! In other words, their decisions impact my freedom. For the record, I am fully vaccinated as are all my family members.
If you’re fully vaccinated, how do their choices affect your freedom? You’re all set, no?
It certainly passes unneccessary and avoidable health costs onto the general population and that prevents us from doing things we might otherwise do (classic opportunity cost).
Of course, people should be free to not take vaccines. But they should not expect the rest of us to pay for the inevitable costs.
Sorry to be the bearer of bad news, but it seems as if refusing the Covid mRNA vaccines was quite a good idea given the excess deaths we are seeing. I’ve taught this stuff and broadly agree but the pejorative “anti-vaxxer” epithet doesn’t help
If you won’t support their access to public health care, then you in all fairness ought not to ask them to pay for it (via taxes) either.
Vaccines are not 100% effective for 100% of people (nor do they pretend to be). Some vaccinated people will still be vulnerable and some simply can’t have vaccines for other reasons (e.g. allergic reaction).
Not if you’re a parent of an infant who is too young to get vaccinated.
The problem is that babies and toddlers will not have received their full MMR vaccination and therefore are vulnerable to measles outbreaks
The author appears to be under the illusion that the captured, Pharma-funded communist-stooge led WHO has any moral or medical credence or authority left. Remember that this good-for-nothing organised lie machine also knowingly recommended useless face masks, destructive lockdowns, fanned the flames of fear by deliberately conflating infection and case fatality statistics, and preposterously claimed that only if every man, woman, and child on earth were “vaccinated” would what it described as a “pandemic” come to an end.
And only the most delusional “blue heart” remains wilfully blind to the gross harms that the covid jabs did to people. We all know someone who has been injured.
So no wonder uptake for the measles jabs is falling. The public’s trust has gone, and it’s not coming back until or unless the all those cowards hiding behind that sham of an inquiry own up, admit that things have gone wrong at the system-level, that pharma funding has distorted public health decision making at the global and national levels, and that the UK must now withdraw from a power-grabbing WHO that has become infested with corporate and political interests. Until or unless they summon the courage to do that people will go on needlessly suffering and dying.
Those who avoid the vaccines will get sick, and children will die. The “R” is for “Rubella” – if a pregnant woman gets rubella, her child will be deaf.
Vaccines cure avoidable diseases. Morons do not get vaccinated.
You’re being hysterical.
Er, he’s being factual.
When white people are sceptical of vaccines it’s do your own research independent free-thinking when non-white people are sceptical it’s voodoo.
What research is there on MMR vaccines that leads people to be sceptical?
Your straw man does you no favours and says more about YOU than anybody else commenting on here. The very fact you divide the world into ‘white’ and ‘non-white’ speaks volumes. They used to do that in the 19th century you know, but for different reasons. Doing it again now is not progress.
Regardless of color, avoiding this vaccine is stupid.
This is my emphasis.
Can we infer that avoiding some other vaccines is logical?
Ignorance is a big factor and I would suggest all the rubbish spewed out by anti-Vader’s.
Mean anti-Vaxers! For some reason autocorrect has a thing about Darth Vader!
If you force people to take something not fully tested, lie about the risks, and do not deal with the apparent side-effects on some people, you must expect a little cynicism; not so much ignorance as perhaps justified caution
There is no absence of evidence for the MMR. It is stupid not to get it. Time to use clear language.
Those who avoid vaccines are stupid.
Those who call others “stupid” do not on the whole present a courteous and reasoned argument, and should be treated as bullies
Very interesting article. But misleading headline of the click bait tendency: the word should be not “Get” but perhaps “Take”?
Both are true. If they don’t take then they don’t get. If they don’t get it is because they don’t take. So is “get” misleading?
In the headline, yes. It implies that the vaccine is not being made available to Black Brits. The Guardian loves this sort of misleading headline
Click bait Unherd headlines have become endemic recently.
So very tiresome to hear the word “disparity”. A better word is “stupid”. People make stupid decisions. Black folks make stupider health care decisions than white people. Hiding the stupidity behind an excuse is not helpful.
And this is a problem why? How many people die of Measles? All these bogeyman diseases ceased being of high consequence before mass vaccination made an appearance.
We need to wait a few more years before Covid pandemic anomalies work out of the statistical picture.
Even so there is a problem to understand. I think the Covid experience has broadly knocked public confidence in institutional expects particularly those employed by the Government.
If you were a black person you witnessed dark skinned people dying from Covid at an elevated rate right from the start of the pandemic yet not a word expressing interest or advice from the Government.
Post pandemic as a black person you will likely know that western countries suffered far more from covid that your family’s country of origin in Africa and you might conclude western medicine is faulty.
A few more inquisitive members of your ethic community will by now be appraised of major doubts about the claims made for the covid vaccine.
And now we have the elevated deaths scandal and the sight of 600 MPs of largely white ethnic origin refusing to listen to a Parliamentary debate on the subject.
If you are a black person why listen to the incompetent white fools?
It must surely be because of straight white males.
It usually is.
Maybe it’s because “Data source: UK Health Security Agency – Two children in the UK have died of measles since 2006” and they just think “Why bother?” (ps none from mumps none from rubella).
From what I heard today (not mainstream media) many vaccines will use mRNA technology. From what I saw today White long strand clots having been removed by embalmers of dead people’s veins and arteries which appears with some correlation to be connected to both the SARS CoV 2 spike protein and the spike protein of the mRNA vaccines. This is extremely worrying and needs urgent attention by our Medical authorities. It is a totally new pathology not seen before and is not seen in any Medical textbooks.