Measles immunisation: Why have we failed?

Abstract

Measles is still a significant cause of illness in British children although a safe and effective vaccine has been available here since 1968. 1982 was a particularly bad year with a steep increase in the notification rate of measles that probably represents only a fraction of the real incidence. Thousands of children have been ill; many have had troublesome complications; and a few may even have died or suffered permanent damage, all quite unnecessarily. If we consider the extra demands placed on the medical and nursing services by such epidemics, not to mention the countless hours of anxiety for parents, it is surprising that this continuing problem has not attracted greater medical, public, or political attention. Is this dismal picture just an unfortunate side effect of the ill-judget and ill-informed publicity that accompanied the recent campaign for compensation for infants damaged by pertussis vaccine? For a number of reasons this is unlikely. Undoubtedly there has been some erosion of public confidence. Many doctors and nurses have become less enthusiastic in promoting immunisation and have chosen to practise defensively by finding all kinds of excuses to postpone or avoid it because of anxiety about the medical (and legal) consequences of a vaccine reaction. All this notwithstanding, our overall record (and that of some other western European countries) has never been as good as that of the USA where, if anything, patients (and parents) are much more litigious. It is more likely that our poor performance reflects differences in attitude that are most apparent in public and professional apathy and in national immunisation policies.