Diseases that had been largely absent in the UK since the middle of the last century could make a comeback unless vaccination rates improved, public health experts warned. Measles, polio, and diphtheria were among conditions threatening to make a comeback, an expert panel told MPs, who are investigating prevention in health and social care.
Giving evidence to the Commons Health and Social Care Committee, Professor Dame Jenny Harries, chief executive of the UK Health Security Agency (UKHSA), said that whilst the UK had a strong record on utilising vaccines, "we are definitely not maxing out on them at the moment".
Dr Harries reminded MPs that these were "really serious" diseases, and that "we have seen, internationally, cases of acute flaccid paralysis which really we're completely unused to" and which "haven't seen since the 1950s and 60s".
Dr Mary Ramsay, director of public health programmes at the UKHSA, said that "the only reason we have good control of those diseases is because of vaccination". She said: "We always talk about measles as being the sort of canary because you need very high uptake to keep measles out, and measles will be the first one we get back at scale". Despite the threat, "we shouldn't panic too quickly – we've got time to get it back", she added.
Dr Ramsay said that "luckily" measles had not yet posed a serious challenge "because of the disruption of travel and lockdowns" during the COVID-19 pandemic. However, "we're expecting measles to come back", she emphasised, whilst seeing polio virus circulating in London was "disturbing", even though it had not resulted in any cases, she said.
Turning to preventative measures, Dr Ramsay said: "There are vaccines we're still not using as much as we should be. We haven't yet rolled out the full childhood 'flu programme to the whole school age, for example. We haven't yet adopted the varicella vaccine in this country – it's something we've been looking at for a while."
She said that "the focus on COVID, although very good for COVID, probably put us back a little while in terms of looking at some of those existing programmes".
Dr Ramsay suggested there was also scope for vaccine 'catch-up' for people who might have missed being vaccinated as children. "We're not as good at getting people back in and vaccinating them", and public health authorities needed to use opportunities to vaccinate young adults who did not receive the MMR vaccine 20 years ago as a result of a public health scare, she told the Committee.
Professor Sir Andrew Pollard, chair of the Joint Committee on Vaccination and Immunisation, noted that there had also been "some outbreaks of diphtheria", and that the challenge for public health authorities was to convey the threat of measles returning, "which we think is a very real one", as well as "the potential threat from polio transmission".
A challenge for the UKHSA was to "keep pedalling away" at promoting vaccination to prevent "complacency", according to Dr Ramsay. Messaging was "challenging in the absence of diseases – easier once you see the diseases come back", she said. Earlier this month, the UKHSA warned that the uptake of pertussis vaccination in pregnancy was at its lowest in 7 years, increasing the risk of whooping cough in infants.
Improving Trust in Vaccines
Prof Pollard said that achieving high vaccine coverage rates for these potentially preventable diseases required a concerted effort to target "the communities that don't access immunisation". He suggested establishing a "task force" to tackle vaccine access and "the problem of trust".
Prof Pollard said that the COVID-19 pandemic, which had seen higher rates of vaccine refusal and hesitancy in communities with traditionally low uptake of vaccines, was "a stark reminder that for peacetime, if you fix this problem, you'll be much better prepared in a future pandemic for accessing those communities where there's a problem of trust".
Prof Harries said the UKHSA had produced information on diseases and vaccines for vulnerable groups, including "a booklet to help services who are receiving migrants". Dr Ramsay described promoting vaccination among migrants to the UK, who had "just come off a boat", were cold, vulnerable, and likely to be dispersed around the country, as "challenging", but said work was underway, in cooperation with the Home Office, to try to ensure they got early access to antibiotics and vaccines.
She assessed the risk of diseases from migrants to the UK population as "very low", and mainly a problem within their own communities.