Inside the measles contamination zone
As New York declares a state of emergency and cases soar in the UK, Charlotte Lytton reports from a city battling a health crisis
Of all the health time bombs threatening to blow up in Britain, a vaccine-preventable disease that had previously been eradicated did not look a likely candidate. Yet with new figures showing half a million children in the UK are not immunised against measles, cases rising fourfold in the last year, and a rapid spread across Europe and the US, this is, according to Simon Stevens, NHS chief, a crisis in action.
Across the Atlantic, this week, nearly 700 new cases of measles saw the disease – highly infectious and often characterised by cold-like symptoms, a sensitivity to light and high fever that can, at its most severe, lead to pneumonia and brain infection – reach a 25-year high. A state of emergency was declared in New York City, while mandatory vaccination orders, $1,000 fines and bans from schools and public places for those who resist – have been introduced.
“It’s becoming a public health threat,” specialist Dr Rabia Agha tells me from inside the sanitised walls of the Maimonedes Medical Centre.
On a sunny Tuesday this week, the hospital in Borough Park, Brooklyn, betrayed no sign of being in the current measles hot zone. Home to the city’s largest number of Orthodox Jews, it is in this community – and nearby Williamsburg – that much of the outbreak has spread. Though nothing in their religious beliefs
advises against vaccination, and only a minority is thought not to have had theirs, there have been ramifications. According to consultant Yosef Rapaport, who is orthodox, this is partly because of their lifestyle – large numbers of children, intermingling in the same small circles at school and in worship – which provides the perfect breeding ground. During a busy Passover lunch service at Masbia, the soup kitchen run by his son, Alex, Rapaport tells me just a few dissenters in this close-knit group are “enough to cause enormous damage” – as are the “fence-sitters who don’t vaccinate until they are pushed into it”.
Failure to reach herd immunity – where 95 per cent of the population is immunised, enough to protect those who are not – coupled with the five or so per cent for whom the vaccine is not effective, can be a deadly blend.
Dr Agha treated one 13-month-old who had breathing difficulties after contracting measles; on recovering, the parents decided not to pursue any other immunisations. “You can’t just think that you’re not affecting anyone else by your decisions,” she says.
It is this attitude that is powering – albeit a little late – a heavier-handed approach: Rapaport shows me a warning letter from one orthodox primary school this week, threatening permanent expulsion for families who fail to get their children vaccinated.
Whether it will work remains to be seen. “We try to educate people and make them understand that this is preventable but some are hostile,” Dr Agha says. “They don’t want to hear it.”
One of the key reasons, she believes, is complacency: by declaring that it had eradicated measles in 2000, the US has become a victim of its own success – most parents of young children have no idea how bad it can be. The idea of vaccinating against it either fails to occur or raise a red flag.
Sarah Walton, from Leeds, was 11 months old when she contracted measles in 1979. A vaccine did exist, though not in its current MMR form but, concerned by potential allergies, her mother Jo decided against immunising her infant daughter.
A “wanted, happy, healthy baby”, Sarah reached the regular milestones
‘We try to help people understand that this is preventable. They don’t want to hear it’
– smiling and crawling – early and, after becoming ill, recovered “very rapidly”, Jo recalls. For 24 years, it had been all but forgotten until, part-way through her midwifery course at King’s College London, Sarah was signed off sick. A sharp downward spiral of her cognitive and physical functions went unexplained for eight months, at which point she was diagnosed with subacute sclerosing panencephalitis (SSPE), a chronic inflammation of the brain. Thought to affect around 1 in 600 measles sufferers and able to lie dormant for years, it erodes motor control, leads to dementia, and is ultimately fatal.
No one, Jo says, told her about SSPE. Now 40, her daughter requires 24-hour medical care, which Jo provides from 7:15am to midnight, when a carer takes over. Sarah was due to marry two months after her diagnosis but by that time her state was such that “it would never have been legal”.
The MMR vaccine was introduced in 1988 and is most effective when delivered via two doses, the first usually being delivered within a month of a child’s first birthday. Those who have it are 93 per cent immune to measles, mumps and rubella, which rises by four points with the booster. In England, 87 per cent of children have the second dose by the time of their fifth birthday, making it the third worst among high income countries, behind the US and France.
Having contracted measles as a child in 1957, Stephen Morse, a virologist and professor of epidemiology at the Mailman School of Public Health at Columbia University, is in the unique position of having seen its effects and eradication. “I did survive,” he recalls of the illness, which at a time without a vaccine plagued “everyone I knew”. He is puzzled that, having developed such an effective means of control, the threat it poses is not taken more seriously. Morse points to anti-vaxxer ideologies online; burgeoning communities who purport that the “adverse effects” of MMR outweigh its efficacy. Much of this rhetoric relies on a discredited paper by Andrew Wakefield, the disgraced scientist who linked the vaccine to autism in 1998. Just over a decade later, the General Medical Council found his research had been conducted “dishonestly and irresponsibly” – and he was struck off.
This means little to the committed anti-vaxxer. Now an active presence in Europe, where measles rates are three times higher than last year, campaign groups post rallying cries on social media, legitimised by governments’ apparent distrust of the vaccine. In France, Marine Le Pen has backed overturning mandatory immunisation; in Italy, leaders of the populist Five Star party were last year vocal in encouraging parental choice – rebranded by online supporters as the “free-vax” movement. Now fifth on the World Health Organisation’s list of worstaffected high income countries, Italy has been forced into an aggressive about-turn, introducing bans on unvaccinated children attending school in outbreak areas and fines of €500. This week, Matt Hancock, the Health Secretary, refused to rule out extending similar penalties to British parents who fail to comply with Government measles guidance.
In New York, apathy rather than anti-vaxxer zeal appears to be at the root of the current crisis. But, Jo Walton urges, passivity cannot be an option. Her own has led to a lifetime of self-flagellation for “cheating” her daughter of a life “once full of so much promise.” When Sarah got her diagnosis, she told loved ones: “Don’t feel sorry for me, educate yourself.”
This week, Jo took down the 40th birthday cards from Sarah’s room, having left them up to add colour to the walls that have surrounded Sarah for 15 years. “You don’t bring your child into the world for this,” Jo says. “We can vaccinate measles out of existence. Why aren’t we?”