By Fiona Fox
This blog contains the thoughts of the author rather than representing the work or policy of the Science Media Centre.
Some of us are enjoying the break in the wall-to-wall Brexit coverage and the welcome return of more science in the headlines. I came back from an Easter break to read 45 pages of glorious news coverage of the Nature study showing we can partly restore some functions of pigs’ brain cells hours after death. But the surprise come-back story of the past few weeks is MMR and measles. Hardly a day passes without another alarming new report or radical response from government. The WHO has declared that there were 110,000 new cases of measles diagnosed in the first 3 months of 2019, a 300% rise on the same point of the previous year. UNICEF last week released analysis showing that over 20 million children worldwide missed out on MMR in the past 8 years including more than half a million children in the UK. Meanwhile US authorities in New York have announced a plan to ban unvaccinated children from public spaces and the WHO declared ‘vaccine hesitancy’ one of the top 10 global health threats for 2019.
The rhetoric has also been dialled up in the UK. Simon Stevens, head of NHS England, has called a fall in vaccination levels “a growing public health time bomb” and Matt Hancock, Secretary of state for Health, last week refused to rule out mandating vaccination for all school children. Stevens and Hancock have pointed the finger of blame for the current crisis at the growth of anti-vaxx information on the internet. Stevens attacked “grossly irresponsible” anti-vaxxers and called on social media companies to have zero tolerance for dangerous content. Matt Hancock has proposed new laws to force social media companies to remove inaccurate information from the internet and is meeting the companies this week.
But are we sure that the problems in the UK are caused by anti-vaxxers spreading misinformation on social media?
Let me stress that this blog is not a call for complacency. The SMC believes that scientists need to challenge misinformation wherever we find it and I am all for vaccine experts taking to social media to call out dangerous myths.
I should also say that this blog is very much about the situation in the UK. I know there are serious problems with vaccination uptake in countries like Ukraine, Madagascar, India, Brazil and the Yemen. But the experts who look at this issue at a global level tell me that there tend to be different drivers in each country. In Ukraine, for example, the government halted vaccination in 2008 after a teenager died after getting the measles vaccine; and the news last weekend that Pakistan has called a halt to its polio vaccination programme after Islamist militants shot dead a health worker highlights the wide variations from country to country.
So let’s just look at some facts about vaccination levels and measles outbreaks in the UK.
MMR uptake in the UK is currently 90.5% of children by the time they’re 2 years old and 94.9% by the time they’re 5 (for two doses it is 87.4%). So one problem lies with parents failing to return to get the second dose for their child. Because “herd immunity” (the level of vaccination we need to protect the wider community from getting these diseases) lies at 95%, missing that crucial second jab is a problem and there is no question that we need to get vaccination levels up. The facts about measles are similarly worrying. Measles rates in England shot up from 259 in 2017 to 966 in 2018. And the problem is that because measles is so infectious, even small groups of children missing or delaying their vaccines leaves them and others vulnerable to serious or even fatal infections.
The concern about exposure to anti-vaccination messages is also very real. According to a survey by RSPH, as many as two in five parents said they are exposed to negative messages about vaccinations online ‘often or sometimes’: 41% on social media and 38% on online forums. This rose to one in two among parents with children under five years old (50% and 47% respectively).
So I am not denying there are some real problems here. But do we know for sure that misinformation on social media is driving parents not to vaccinate? This is certainly the strongest media narrative and the one favoured by Matt Hancock and others in Government. But where is the evidence? And are we sure that banning anti-vaxx websites will solve the problem?
I think there are reasons to be cautious before we assume a strong link.
First, many of the young adults getting measles now are catching the disease because they didn’t get MMR when they were children. That crisis was nothing to do with social media and everything to do with the Andrew Wakefield MMR/autism scare of the late 1990s which saw levels of vaccination falling to 80% in England and 78% in Wales in 2004. Interestingly, the confidence in MMR has been steadily restored in parallel with the growth of social media.
Second, the fact that first vaccination levels are currently up at over 90% suggests that the vast majority of those not taking their children back for the second jab are not avoiding it for reasons of ideology or belief.
Similarly, it’s probably wrong to assume that the low take-up in certain religious groups is down to misinformation. There have been measles outbreaks in the orthodox Jewish community over the past decade because of low levels of MMR uptake. But this is a community with very limited exposure to mainstream media or social media; and GPs who see these patients point out that they tend to have large families and experience difficulties in getting their children along to baby clinics.
Even though we know people are exposed to misinformation, there is reassuring evidence that parents are not relying on it when making decisions about vaccination. A survey of parental attitudes published by PHE last week showed that health professionals remain the most trusted source of advice on immunisation (93% of parents agreed), while social media and the internet ranked as the least trusted. Overall, only 9% of parents said they had seen, read or heard about something that would make them doubt having their child immunised – a historically low proportion and down from a third (33%) in 2002.
The survey also shows that reported parental confidence in the immunisation programme is very high and the percentage of parents refusing one or more of their child’s vaccines remains at just 4%. For those parents who didn’t vaccinate when due, most had postponed, rather than refused vaccination, with their child going on to have it later.
So if it’s not the influence of anti-vaxxers on social media, what is the problem? One of the enjoyable bits of the return of this issue to the media has been spending more time with some of the UK’s leading vaccine experts, scientists we got to know when the SMC was set up in 2002 in part because of the MMR furore. Those experts – including Professors David Elliman, Helen Bedford and Adam Finn, and Dr Mike Fitzpatrick – are all sceptical that the main problem is with the influence of anti-vaxxers on parents. In comments on all the recent stories these and other experts stress the need for more practical actions in the NHS and caution against banning misinformation or mandating vaccination for school children. Instead they suggest government and the NHS need to act to make it easier for parents to book return appointments, run better organised and cheaper immunisation services and make more health workers available to answer parents’ questions and concerns effectively. Research by the Royal Society of Public Health seems to support this suggesting that drops in vaccination levels may be due to timing, availability and location of appointments. And Dr Mary Ramsay from Public Health England has said they believe that sending out reminders and making GP appointments as convenient as possible will make ‘the biggest difference’ in reducing numbers of unvaccinated children.
Admittedly this is not the stuff of sexy headlines. But if we can fix the problem in the UK with some of these measures, might it be better than reaching for more draconian solutions that carry their own risks?
One of the other reasons I have been left scratching my head about the latest MMR discussion is because mainstream media coverage on vaccination has never been so good. When the SMC opened its doors in 2002, things were very different. The MMR story was often covered by non-science journalists and high-profile commentators openly sided with Wakefield. Today Programme editor Rod Liddle allegedly instructed his reporters to cover this story from the perspective that a link would be found between MMR and autism, and false balance was endemic with BBC journalists like Fergus Walsh and Niall Dickson castigated by bosses for refusing to include anti vaccination pundits in their reporting. All the media case studies back then were of children apparently damaged by the vaccine; JABS, the campaign group run by parents who believed MMR caused their child’s autism, was never off the airwaves.
That feels like an age ago. I can’t even remember the last time I read a terrible piece on vaccines in mainstream news and the UK’s wonderful crop of science and health reporters take great pains to report on vaccination in a measured and responsible way. Wakefield may be enjoying a resurgence in the US, but he is shunned by the UK press. And the case study used by the BBC’s Hugh Pym in a recent BBC news report was a child damaged – not by MMR – but by measles.
One argument put to me is that it doesn’t really matter that some in government are blaming anti-vaxxers and social media, because after all those factors are definitely a serious problem in countries like the US and Italy and it makes sense to act now to stop this stuff coming our way. I’m less sure. Celebrity anti-vaxxers and those who spread misinformation give the measles resurgence an enticingly evil face; but before going on the offensive we need to look at the evidence.
Those charged with championing medical evidence and truth should always be cautious before pinning society’s problems on unsubstantiated claims; and if the real problems lie in more mundane issues, that’s where we should focus our efforts. Otherwise we are guilty of making our very own bit of fake news.