Measles, MMR, vaccine hesitancy: How at risk is Scotland?

This was a good year - in the early 1960s it was not unusual for around 600,000 cases to be recorded.

Tragically, Olivia was among 39 patients who lost their lives to the infection that year. Her death came as a shock.

Dahl wrote: "As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it.

"Then one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything.

"'Are you feeling all right?' I asked her.

'I feel all sleepy," she said.

"In an hour, she was unconscious. In 12 hours she was dead.”

Prior to the introduction of the first measles vaccine in 1968, roughly 100 people a year in the UK were dying from the disease - most of them children.

By the time the combined measles, mumps and rubella (MMR) jag was rolled out in 1988 - just two years after Dahl's essay - that number had fallen to around ten annually.

During the whole of the 1990s, there were fewer than 20 deaths in total, and by 2017 the UK had officially "eliminated" the infection according to the World Health Organisation's definition - meaning that endemic transmission had been halted.

Children's author, Roald Dahl, lost his seven-year-old daughter Olivia to measles encephalitis (Image: free)

Seven years on, however, measles is making a comeback.

The west Midlands region of England - which encompasses Birmingham, Coventry and their surrounding areas - is currently in the grip of its worst measles outbreak since the 1990s.

As of January 15, the region had 198 laboratory-confirmed cases and an additional 104 suspected cases (where a doctor has logged a notification based on a patient's clinical symptoms).

Most of the cases were in unvaccinated, school-age children.

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MMR coverage in the Birmingham area, where 80% of cases have been detected, is known to have fallen to around 83%.

To achieve herd immunity and prevent the virus which causes measles from spreading, at least 95% of five-year-olds should have received two doses, including a booster, by the time they start school.

Over the past month, more than 50 youngsters have been admitted to Birmingham Children's Hospital due to measles, hinting that a much larger outbreak is underway in the community.

While the vast majority of children will experience fairly mild cold-like symptoms, a small number will develop potentially-fatal complications including pneumonia and brain swelling.

Historically, Scotland has fared better than the rest of the UK - particularly England - when it comes to measles cases and MMR coverage.

Vaccine hesitancy in the wake of the MMR-autism controversy appeared less prevalent north of the border.

This remains the case: in the final four weeks of 2023, there were 217 known measles cases in England and Wales compared to just one laboratory-confirmed case in Scotland during the whole of 2023.

In 2022, Scotland also logged just one known case of measles - the first since 2019. The actual number will, of course, be higher; most infections never result in testing.

That is not to say that public health officials here are not concerned.

Immunisation statistics published days before Christmas show that uptake of both MMR doses among five-year-olds in Scotland dipped below 90% in 2023, for the first time since current records began in 2014.

Just 89.6% of children starting school were fully vaccinated against measles as of September 2023, with the figure falling as low as 84.5% in Highland and 82.5% in Shetland.

In August last year, a memo sent to health boards by Scotland's chief medical officer warned that a "slow decline" in MMR uptake posed a growing public health risk.

It noted that "almost one in every 10 children aged four to 11 in Scotland are missing one or both doses of MMR vaccine".

Based on Public Health Scotland's (PHS) analyses of vaccination uptake and vaccine efficacy this would suggest that "more than 60,000 children of school age in Scotland are susceptible to measles": roughly 33,000 at primary school, and 30,000 at secondary school.

So why is uptake dwindling?

It has been more than 25 years since the infamous (and debunked) claims that the MMR vaccine causes autism, but doubts and conspiracy theories persist.

Dr Naveed Syed, a consultant in communicable disease control at the UK Health Security Agency, said pandemic-related "fake news" had "stirred up a lot of issues" around vaccine mistrust.

"It's a challenge to try and overturn some of those myths, which have become more embedded in some communities,” he added.

In Scotland, the issues may be more logistical.

Highland in particular is struggling with the Scottish Government-led transfer of vaccine delivery from GP surgeries to health boards.

An NHS report, leaked in September last year, describes "significant challenges" in the region including shortages of vaccinators, some of whom were driving hundreds of miles to reach remote communities.

It warned that some infant vaccination clinics are "simply not sustainable" due to the ratio of inoculations to travel time.

In one case, vaccinators had driven for 11 hours to provide jags to just four infants at a GP surgery where doctors wished to continue providing vaccinations in-house, but – under current arrangements – are blocked from doing so.

The report noted that 64 childhood vaccination clinics were cancelled between March 1 and May 10, with more than 1,500 Spring Covid booster appointments axed due to staffing shortages, scheduling mix-ups or problems with venues.

Once source who contacted the Herald this week said there remains "considerable disquiet" among the team tasked with implementing Highland's Vaccine Transformation Programme (VTP), but so far little political will to change course.

They added: "Unfortunately it will take something tragic to jolt the complacent health department into changing their approach."